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Ask the Doctor


Dwane G. Broussard, MD is a board certified family physician in Houston. He completed his residency training at Baylor College of Medicine and is a partner at Village Family Practice, LLC. His clinical interests include treating patients with hypertension, hypercholesterolemia, and diabetes.

Skin Cancer
Colon Cancer
Depression
Shingles
Summer Precautions
Vitamin Recommendations
Heart Attacks in Women
Stroke
Flu Shots
Knee Problems

SKIN CANCER

Can you assist? I have a funny little "mole" that sometimes gets a bit itchy; is this something I should be worried about? How do I know if a mole, a spot on my skin is something I should worry about? If I do have a skin cancer, what are some possible treatment options? Do these options change if I am very old or in frail health?

Most moles on our skin are not cancerous. It is normal to have between 10-40 moles by the time we are adults. They appear on our skin in the first 30 years of life. The moles that cause concern are the ones that begin to look different than other existing moles. If you notice a change in the color, height, size, or shape, then you should have your doctor take a look at it. The mole that you reported has started to "itch." This symptom also warrants an evaluation by your physician.

Doctors tell patient to examine their moles and remember the ABCDE's that warrant concern. Warning signs are when moles show Asymmetry (one half of the mole is not shaped like the other half), irregular Borders, different Colors /shades throughout, Diameter larger than the eraser of a pencil, or Evolving (growing, shrinking, changing colors, itching, or bleeding). If any of these changes appear, or if you develop a new mole later in life, then your doctor may decide to biopsy this area.

This biopsy will be sent to a specialist, called a Pathologist, who will inspect the mole under a microscope for the presence of cancer cells, the presence of an infection, and/or the presence of inflammation.
Types of skin cancers include melanoma, basal cell carcinoma, and squamous cell carcinoma. Malignant melanoma if not diagnosed early is serious and difficult to treat. Basal cell and squamous cell carcinomas are more common and easier to cure.

Treatment usually involves removal of the skin cancer. Sometimes patients will need additional therapies, if the doctor is afraid that all of the cancer has not been removed, if the cancer has spread, or if the risk of recurrence or spread is great. Not every patient will need a skin graft, and the patient's age and physical condition will be taken into account when treatment recommendations are given.
In order to help prevent skin cancer, patients should remember to avoid excessive sun exposure and to wear sunscreen when outdoors.


COLON CANCER

I'd like to know more about colon cancer. Having a colonoscopy has to be one of the most difficult tests I've ever had to prepare for; is it really necessary to have a colonoscopy after the age of 70? I have some friends who have never had a colonoscopy; what are some of the risk factors and signs of colon cancer? Would a person know they are having problems? Is there an effective treatment for colon cancer if it is diagnosed early;  what about a late diagnosis? Are there ways I can reduce my risk of colon cancer?

One of the best ways to prevent colon cancer is get regular colonoscopies starting at age 50. Even if you do not have a family history of colon cancer, a colonoscopy is still a recommended procedure. During a colonoscopy, a physician inserts a flexible scope into the rectum and inspects the colon (large intestine). The patient needs to drink a medication the night before the procedure to make certain that the colon is clear of stool. If the physician finds a polyp during this procedure, the polyp(s) will be removed. Although most polyps are benign(non-cancerous), some polyps will become colon cancer. Since there is no way to know which polyps will become malignant, all must be removed. The good news is that removing these polyps reduces the risk that colon cancer will develop. Doctors routinely recommend this test because of the clear benefit of having the test done.

I have never had a patient tell me that he/she "enjoyed" their colonoscopy. However, most patients tell me that the procedure was not as bad as they had feared. The risks of complications of this test are low, and most patients tolerate it well. As previously mentioned, screening should begin at age 50 for most people. Some patients considered to be at high risk will need to start screening earlier. These high risk patients include those with a strong family history of colon cancer and those with inflammatory bowel disease (Crohn's disease or ulcerative colitis).

In the early stages, patients with colon cancer don't know that they are ill. As the disease progresses, patients may develop rectal bleeding, abdominal pain, weight loss, and/or fatigue. Patients should not wait for these symptoms to develop since diagnosing colon cancer in an early stage makes a cure much more likely.

The American Cancer Society and the American College of Gastroenterology do not specify an upper age limit for a colonoscopy. The decision for patients over the age of 75 to have a colonoscopy, is made on an individual basis. If the patient has been getting colonoscopies since age 50 that were all normal, and the patient does not have any risk factors for colon cancer, and the patient does not have any of the above listed symptoms, then it is less likely that a colonoscopy will be recommended. As always, it is wise to discuss this procedure with your physician.

To help reduce your risk of developing colon cancer, doctors recommend dietary and lifestyle changes, such as consuming less alcohol, boosting fiber intake, exercising, and maintaining a healthy body weight. Also, limiting the amount of red meat and processed meat in your diet may reduce the risk of developing colon cancer. Finally, some experts suggest that taking a coated aspirin daily will help.

DEPRESSION

I've heard about people having "clinical depression" or sometimes "feeling blue". Can you tell me more about depression and how it might be treated? What are the signs, and what are some of the medications that might be used? When do I know that I need to see a medical doctor or a therapist? Are there medications that seniors might be prescribed that can have a side effect of depression?


It is not uncommon for each of us on occasion to "feel blue." Such sadness can be a normal response to life's stresses. Typically, these feelings will subside after a short period of time. However, when these feelings of sadness last for a prolonged period of time, usually weeks to months, then you may be depressed.

In order to make the diagnosis of depression, doctors will ask if you have feelings of hopelessness or helplessness. Doctors will also find out if you have feelings of worthlessness or continued guilt. Symptoms of depression include anxiety, fatigue, loss of energy, poor concentration, decreased interest in things that used to interest you, weight gain, weight loss, insomnia, or excessive sleeping. Doctors will also ask about feelings of hurting yourself or hurting others. If you are experiencing enough of these symptoms for an extended period of time, then you maybe "clinically depressed."

Before this diagnosis is made, your doctor will first make certain that the symptoms you are experiencing are not related to another medical condition, such as hypothyroidism (low thyroid). Your doctor will also make certain that these symptoms are not a side effect of a medication that you are taking. Once these causes have been ruled out, then the diagnosis of depression is made.

The treatments for depression vary based on the severity of the symptoms and the extent to which theses symptoms affect your life. In some cases, doctors recommend psychotherapy. This "talk therapy" may improve the mood of some patients and improve their coping abilities. Some patients require medications to treat depression, including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and norepinephrine reuptake inhibitors (SNRIs), and Tricyclic Antidepressants (TCAs). In many cases, patients will have to take more than one type of antidepressant medication to improve their symptoms. Finally, some patients require a combination of psychotherapy and antidepressant medications.

When feelings of sadness affect your life, then you should discuss these feelings with your physician. Millions of Americans suffer from depression, but often these patients feel all alone. The diagnosis of depression is not always easy to make, but establishing good communication with your physician is the first step.


SHINGLES

Most adults had chicken pox when they were young. The virus that causes chicken pox is Varicella Zoster. This virus can become dormant, "goes to sleep", in nerve roots in your body. Under periods of stress, or when our immune system is diminished, or when we get older, the virus can become active. When this happens, the virus infects the nerve root and the nerves leaving that area. At this point, the infection is not referred to as chicken pox, but as shingles. Initially, patients may feel like they are getting the flu, but they have no fever. Later, patients will start to feel pain. Finally, most patients will develop a rash on one side of the body in a band along the nerve root and the affected nerves. This rash will not be over the entire body, like chicken pox. This rash typically appears like a cluster of blisters, and may last up to 4 weeks.

It is very important to see your physician as soon as possible if you suspect that you may have shingles. There are antiviral medications that your physician can prescribe to improve the course of this disease. Also, pain medications may be beneficial to some patients. Unfortunately, the nerve roots and affected nerves can remain irritated after the viral infection has resolved. In these cases, patients may have pain that can last for months. This condition is referred to as postherpetic neuralgia. Fortunately, there are medications to help with this type of pain.

Because of the potential complications related to shingles, it is important that everyone age 60 and over discuss getting the shingles vaccine with their physician. The name of the vaccine is Zostavax, and it is only given once. Patients with low immune systems or those who recently took high doses of steroids, should not receive the vaccine. There are very few side effects to the vaccine, so it is strongly recommended for most patients. The vaccine is not used to treat shingles, but even if you have had shingles in the past, the vaccine is still recommended. Please remember that Zostavax should not be given at the same time as the pneumonia vaccine.

Doctors recommend receiving the shingles vaccine as soon as possible after your 60th birthday.


SUMMER PRECAUTIONS

As we are moving into the hot summer season, I still like to work in my yard and garden but I worry about dehydration. My neighbor passed out in her yard last year and had to be taken to the hospital.
What are the symptoms that I should look for to know that I may be getting dehydrated?

All of us living in the Texas Gulf Coast region should be concerned about dehydration during the summer months. Dehydration occurs when the loss of body fluids, mostly water, exceeds the amount of fluid taken in through drinking. Our bodies all lose water throughout the day in our sweat, urine, and stool. We also lose water vapor as we breathe. When the outside temperatures rise, we will lose more fluid just performing our normal daily activities. Hydration, replacing the water we lose, is very important because it keeps our bodies in balance .
Symptoms of dehydration may be minor. We may notice having a dry mouth, swollen tongue, or increased thirst. The symptoms may become more severe, as weakness, dizziness, palpitations, vomiting and/or confusion may develop. If dehydration is not corrected, we may become confused and even faint. Dehydration places a tremendous amount of stress on our bodies, especially in the elderly.

What needs to be done for an older person if they get overheated or dehydrated?
During the summer, it is much better for those who like to spend time outside in their yards or gardens to do so early in the morning or late in the day. Wear light-colored and loose-fitting clothing. You should also consider carrying a personal fan or mister to cool yourself. Hydration is vital during this time, so make certain that you take frequent water breaks. If you start to notice any signs of dehydration, then quickly get to a cooler place and continue drinking fluids. Patients should remove any excess clothing. Placing a wet towel around you is a good idea, but avoid exposing your skin to excessive cold, such as ice packs. This can cause the blood vessels in the skin to constrict and will actually decrease your body's ability to lose heat. If the symptoms of dehydration continue or begin to worsen, then notify your physician immediately.

Are there any medical conditions that make possible dehydration more of a danger: diabetes, heart disease, etc?
Those patients with heart disease, hypertension, and diabetes are extremely sensitive to dehydration. These medical conditions may decrease the body's ability to handle the stress of dehydration. Also, some medications used for these conditions make it easier for dehydration to occur. Patients with these conditions who like to spend time outside should discuss this with their physicians at their next office visit.

Are there any tips for an older person about staying hydrated in the summertime?
Remember to plan ahead before all outdoor activities. Preventing dehydration from occurring will keep you safe.


VITAMIN RECOMMENDATIONS

As a senior what kind of vitamins should I be taking to stay healthy? Are there some vitamins that could be dangerous to my health when I'm on certain medications? I have friends who are also taking different kinds of herbal supplements, fish oil, glucosamine, and others. I'm in good health and just want to keep it that way. Submitted by W.M.J.

Before beginning to take any supplement, it is essential to communicate with your primary care physician so the two of you can partner together to develop the best treatment and prevention plan for your individual needs. Unlike medications that require a prescription, dietary supplements do not require approval by the Food and Drug Administration. There is a potential for some of these products to interact with prescribed medications. Supplements have the potential to lower the amount of medication in your body through decreased absorption or by speeding up elimination of the drug from the body. Other supplements may increase the amount of medication due to slowing down your body's normal mechanisms for eliminating prescription drugs. Therefore it is necessary to always communicate with your physician concerning any vitamins or supplements you are consuming.

Depending on individual diet habits, patients may not receive an adequate amount of essential nutrients from diet alone, and these additional nutrients can be provided in a daily multivitamin. There are many specific vitamins or minerals that one might consider and some of the most common supplements needed among elderly patients include vitamin D, calcium, omega-3, and perhaps vitamin C.

Vitamin D is a nutrient involved in many processes throughout the body, and is a primary factor necessary for bone strength. Calcium is also essential for bone health and this nutrient plays a role in muscle contraction and nerve conduction and signaling. Since increasing age brings an increased risk of osteopenia or osteoporosis, supplementation with Vitamin D and calcium is often recommended in older patients to reduce the risk of bone loss and fractures. Another important supplement is omega-3 fatty acid. Studies have shown that omega-3 fatty acid supplements lower blood triglyceride levels and can reduce the risk of heart disease and stroke. Vitamin C is essential for wound healing and in protecting the body from infections and oxidative damage. Many patients receive enough vitamin C in their diets; however one might consider taking supplemental vitamin C during cold and flu season. Many patients also find that glucosamine/chondroitin helps with joint pain. This over-the counter product has anti-inflammatory effects that may offer relief with arthritis pain, but all patients should get their doctor's permission before taking this product.

Good resources for patients:
Office of Dietary Supplements from the National Institutes of Health
FDA US Food and Drug Administration


HEART ATTACKS IN WOMEN

My doctor tells me more women die from heart attacks than from cancer; is this true?
•What are some of the signs that I might be having a heart attack?
•Are the symptoms different for women than for men?
•Is heart disease related to my weight?
•If I have diabetes, am I at greater risk of a heart attack?
•What can I do to reduce my risk of a heart attack? I use a cane and can't do strenuous exercise.

When one of the arteries which supply the heart muscle with blood becomes blocked it can no longer deliver oxygen to that area of the heart and, in time, the heart muscle dies. This is called a heart attack (or in medical lingo " myocardial infarction"). Depending on the location, area of injury, and amount of time without oxygen, heart attacks can cause life threatening arrhythmias or heart failure.

Heart attacks happen as the result of coronary artery disease (i.e. disease of the arteries that supply the heart with blood). Coronary artery disease is the single leading cause of death for American women. The same processes that cause coronary artery disease can also cause narrowing and blockage of other arteries in the body. Blockage of the arteries that supply the brain, for example, will cause a stroke. Nearly twice as many American women die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer combined, including breast cancer.

Women may experience heart attacks differently than men. One study showed that less than half of women who had a heart attack initially complained of chest pain and were, in fact, more likely to complain of shortness of breath, weakness, and fatigue. Women are also less likely to have chest pain in the hours before a heart attack and are more likely to report fatigue, sleep disturbances, and difficulty breathing. Women who do have chest pain are likely to describe the pain differently than men ("sharp" or "burning" instead of "crushing") and more likely to have additional symptoms including neck, jaw and back pain and nausea. In short, women should be aware that they may have a heart attack without the "typical" symptoms.

Women are somewhat less likely to have heart attacks than men and are, on average, 10 years older than men when and if they do have a heart attack. It is important to note, however, that women are more likely than men to have a stroke.

Cardiovascular disease, including heart attack and stroke, is more prevalent as we get older and occurs more in some families than in others. Smoking, high cholesterol, high blood pressure, physical inactivity, being overweight or obese, and diabetes are all factors that increase the risk of cardiovascular disease. These factors are considered to be "modifiable" because individuals can change these factors in order to decrease their risk for cardiovascular disease.

If you are concerned about your risk of heart attack, stroke, or other cardiovascular disease, your doctor can help you optimize your health with advice on diet and exercise that is right for you. Aerobic activity, such as walking, is very important in maintaining good heart health.If you are unable to walk or you use a cane, then consider stretching exercises and leg lifts while sitting. These simple activities will improve your overall physical stamina. Your doctor may also prescribe medications that will help you to lower your blood pressure, improve your cholesterol, and properly manage diabetes. Your doctor can even help you quit smoking. Please consult with your physician to identify treatment strategies that are best for you.


STROKE

How would I know if I am at risk of having a stroke?

A stroke is a sudden loss of brain function that occurs as a result of interrupted blood flow to a part of the brain. This is the brain's version of a heart attack. When brain cells are deprived of oxygen and nutrients provided by blood, the brain cells begin dying rapidly. Stroke is the third leading cause of death and the leading cause of disability in the US.

What are some of the symptoms; are they different for a woman than a man?
Signs of a stroke include numbness or weakness of the face, arm, or leg, especially limited to one side of the body. Other signs of a stroke include difficulty walking or loss of balance and coordination; confusion or difficulty talking or understanding speech; loss of vision; and severe headache. Men and women are subject to the same symptoms, and unfortunately the effects may be permanent.

Does having high blood pressure make me at greater risk of a stroke?
The risk factors for a stroke can be divided into two main groups; controllable and uncontrollable. Uncontrollable factors include age over 55, male gender, personal history of prior stroke or heart attack, family history of stroke, and certain heart conditions. Controllable factors include high blood pressure, irregular heartbeats, plaque build-up in the carotid arteries, smoking, high cholesterol, diabetes mellitus, and obesity.

What can I do to reduce my risk of having a stroke?
It is important to see your doctor to identify and treat high blood pressure, irregular heartbeats, high cholesterol, and diabetes early so that the risks of stroke are lessened. Also, healthier eating, regular exercise, weight loss, and smoking cessation can all reduce the risk of stroke. Unfortunately, even with these healthy modifications, a stroke can still occur. It is imperative to be aware of the common symptoms of a stroke and notify your physician immediately if you or a loved one experience any of the warning signs mentioned above.


FLU SHOTS

I am 85 years old. Do I still need a flu shot? Will this shot protect me from all types of flu? Will this shot protect me from H1N1? Is the flu shot covered by Medicare?

Yes, the CDC (Center for Disease Control and Prevention) recommends vaccination against the flu for all individuals over the age of 50. For individuals over 65 years old living outside of a nursing care facility, the flu shot is 30-70% effective in preventing hospitalization due to pneumonia or influenza. The flu shot provides significant benefits and should be administered yearly. The common flu shot contains three types of inactivated (killed) viruses. The type and strain of flu viruses that is used with the shot will vary year to year depending on the recommendations of the CDC. The CDC compiles annual scientific estimates along with recent results of surveillance studies to determine which strains of flu you are most likely to come in contact with for that particular year.

The novel H1N1 virus - commonly known as the "swine flu" - is a popular concern among those receiving vaccination for the flu this year. Many would like to know how to protect themselves from this new strain of flu. While the new H1N1 flu shot will become publicly available in the very near future, the current 2009 seasonal flu shot will not protect against the "swine flu". Once the H1N1 vaccine becomes available, it will be delivered to the public on a priority basis. Contact your doctor for more information as to when it will be available to you.

Absolutely, flu shots are covered under Medicare Part B and will incur no cost to the patient. There is no coinsurance or deductible required to receive a flu shot. Because more vaccinations means less people getting the flu and less transmission of the virus itself, Medicare has made it as easy as possible for individuals to receive their flu shot. If you are enrolled in Medicare or a Medicare Advantage program, contact your doctor today and ask about how you can be protected from the flu.


KNEE PROBLEMS

I'm having trouble with one of my knees; I'm 84 and I don't want to have knee replacement surgery. What can I do to make my knee stronger? Are there any treatments that I might look into that don't involve surgery?

There are several other options available for knee problems to help gain more functionality, some you may have already tried. It is important to lessen the load on the troublesome knee as well as strengthen the surrounding tissue and structures. Use of a cane or walker as well as strengthening the surrounding tissues may help a great deal. Use of a cane or walker as well as weight reduction can help take enough weight off of the affected side to lessen the pain and improve mobility. Corticosteroid shots are helpful in some patients. Non-impact exercise such as swimming or cycling can help strengthen the ligaments and muscles in your leg to provide better support for your knee. Physical therapy can help to achieve the same end. It is important to consult with your physician to determine which treatment plan is right for you.