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. 

I have arthritis but my neighbor said she was diagnosed with rheumatoid arthritis and she is on some very expensive medicine. Can you tell me what the difference is and how would I know if I had rheumatoid arthritis? I didn't know there was more than one kind of arthritis.  Why is her medicine so expensive?

There are many different types of arthritis. Osteoarthritis is the most common type and is due to "wear and tear on a joint." Rheumatoid arthritis is another type of arthritis, but is less common than osteoarthritis. Rheumatoid arthritis is also a long-term disease that causes joint pain like osteoarthritis but is not due to "wear and tear." Rheumatoid arthritis is an autoimmune disease and leads to chronic inflammation of the joints and other areas of the body. Osteoarthritis is a breakdown of the cartilage and overgrowth of bone, while rheumatoid arthritis is an inflammation of the joint's connective tissues, which leads to breakdown of the cartilage. 

There are several differences between these two types of arthritis that can help determine which type you have. Osteoarthritis tends to be worse after exercise and is often found in specific joints, while other joints are spared. Other signs that it is osteoarthritis may include a short (half hour or less) period of morning stiffness or signs of bone over-growth, such as bone spurs or bony enlargements. Rheumatoid arthritis, by comparison, usually affects joints symmetrically. This means that both wrists or both ankles are affected, not just one. Rheumatoid arthritis is more common in the small bones of the hands and feet, and the morning stiffness can last for an hour or longer.  In order to make the diagnosis of rheumatoid arthritis, your physician will likely order a blood test, called a Rheumatoid Factor. There are no blood tests for osteoarthritis. The diagnosis of osteoarthritis is made by physical exam and x-ray findings.

The medications used to treat osteoarthritis often focus on relieving pain. Your physician may initially recommend over-the-counter medications, such as Tylenol, Aspirin, Ibuprofen, and Naproxen. These medications are relatively inexpensive and may control many of the symptoms of osteoarthritis. Rheumatoid arthritis patients may also use these medications to help with their pain symptoms, but treatment is also focused on slowing the rate of joint breakdown. Examples of these medications are Methotrexate, Leflunomide, and Hydroxychloroquine. Many of these "disease modifying" medications are very expensive, require frequent blood tests, and are taken for extended periods of time. Your physician will discuss the risks and benefits of these arthritis medications before treatment begins. 

Aspirin is an anti-inflammatory medication that is used for many different conditions and health situations. Other than its use in reducing fevers and pain, aspirin is used to protect the cardiovascular system. Studies have shown repeatedly that aspirin can help to reduce cardiovascular events such as heart attacks and strokes, and it is also beneficial in patients with peripheral artery disease. The heart-protecting features of aspirin are very well studied and proven in research. 

Aspirin has also been shown in many studies to reduce the risk of developing colon polyps and colorectal cancer. More research still needs to be done to determine what specific dosage of aspirin and what length of time aspirin needs to be used for this benefit. 

It is always important to remember to discuss aspirin therapy with your physician, before starting it on your own. As with all medications, there are potential side effects associated with aspirin. Patients with a history of stomach ulcers and patients that are already on some prescription blood thinners are good examples of patients that should not take aspirin. 

If your physician feels that aspirin therapy is appropriate, you will likely be instructed to take one "baby aspirin" per day because of its cardio-protective features, as the benefits of being on this daily small dose of aspirin outweigh the risks of aspirin. This will typically be an 81 mg enteric coated aspirin. The coated aspirin are less likely to cause gastrointestinal bleeding. Many experts recommend that a daily baby aspirin should be given to women the between the ages of 55-79, and to men between the ages of 45-79 to prevent heart attacks and strokes. It is important to discuss with your physician what risk factors you have to determine whether it is right for you.

Sometimes I think that my doctor figures since I'm in my 70's, everything I complain about is associated with age. I have been experiencing a lower back pain that significantly affects my ability to get out of the house to volunteer or even sleep; I bought a new mattress but that hasn't helped. I asked my doctor for an MRI or some kind of test that can show if there is something wrong with my back that can be fixed. He says, oh that's not necessary and wants to just give me pain pills. I am in pain throughout the day; I am getting depressed with the pain and can't do my normal activities anymore. A friend of mine had back pain and after an MRI, she had to have surgery to remove a growth that was pushing on a disc. What can I do or how can I insist that additional procedures be done to identify the source of my pain? 

I am sorry to hear that your back pain is bothering you and affecting your normal daily routine. I would recommend that you contact your doctor and explain how your continued back pain is affecting you and starting to get you depressed. Ask for an appointment to discuss your concerns, and I encourage you to write them down prior to the visit. Your doctor will likely exam your back, check your reflexes, assess your muscle strength, and check the nerves going down your legs. Because you are older than 50 years old and have continued low back pain, your doctor will likely order an x-ray and blood tests (such as a Sedimentation Rate and a Complete Blood Count). These tests are usually enough to rule out a more severe systemic process and if they are normal, then you should be reassured that with rest, time, and pain relief, you will improve. Physical therapy may also offer you some improvement in your symptoms. If these tests and the physical exam are normal, then there is no indication that you need an MRI. This test is indicated only if surgery is being considered or if a worse disease is suspected. Your friend had a rare cause of low back pain, and her physical examination would not have been normal with a growth pushing on a disc. This is likely why her doctor ordered the MRI. I strongly encourage you to discuss your concerns with your physician as soon as possible, and I wish you a speedy recovery.

Lots of my friends have had problems with bronchitis over the past couple of months. What is the best thing I can do to relieve the cough Are there any good home remedies? When should I know when to see my doctor? Is there a chance that bronchitis can turn into pneumonia?

Bronchitis is an inflammation of the bronchi, the large tubes that carry air into and out of your lungs. Cough is one of the main symptoms of bronchitis, and sometimes coughing can bring up mucus. Bronchitis can be divided into two types – acute (lasting no more than several weeks) and chronic. Acute bronchitis is usually caused by an infection with a virus, often the same virus that causes colds. Less commonly, acute bronchitis is caused by bacteria. Patients can have a fever, shortness of breath, and wheezing with acute bronchitis. In contrast, chronic bronchitis is caused by smoking and, less commonly, other irritants such as chemical fumes and dust that cause the lining of the airways to become inflamed.

Acute bronchitis usually resolves on its own. The best treatment for it is to rest and drink plenty of fluids. Over-the-counter pain medications such as Advil and Tylenol can help with pain. Using a humidifier at home might help relieve your cough. Also, be sure to wash your hands often to decrease the spread of viruses. Because most cases of bronchitis are caused by viruses, antibiotics will not help. For chronic bronchitis, the best treatment is to quit smoking. Your doctor might prescribe inhalers to help with shortness of breath. Acute bronchitis can sometimes lead to pneumonia. You should call your doctor if your symptoms do not resolve after two weeks, if you are short of breath, if you have a high fever that doesn't go down, or if you feel weaker than usual. These are all signs of possible pneumonia, a more serious infection that might require treatment with prescription medications such as antibiotics.

I have carpal tunnel in both my wrists. My fingers go numb when I'm holding a cup or even the steering wheel of the car. Are there treatments available for carpal tunnel other than repeated cortisone shots or surgery? My friend had surgery on her wrist and her fingers are permanently numb. Is there value in exploring acupuncture to see if that will help? Also, someone told me that there is a type of massage therapy called "active release" therapy that helps with carpal tunnel. Can you suggest some options for me other than surgery?

Carpal Tunnel Syndrome (CTS) can be a truly debilitating disease. CTS is numbness, tingling, and weakness in the hand caused by pressure on the median nerve running through the wrist. Usually the thumb and first three fingers are affected. Some illness such as diabetes and hypothyroidism can increase the risk of a patient developing CTS.

While complications like your friend's unfortunate situation exist, this is an extremely rare occurrence. Most people undergo carpal tunnel surgery with successful results. There are other options besides surgery, such as steroid injections, which can help improve the symptoms. Wearing wrist splints as much as possible is another conservative treatment for CTS, and sometimes this allows the nerve to recover without surgery. By keeping the wrist in a neutral position, pressure is relieved from the median nerve. Some people are not able to wear the wrist splints during the day because it limits their activities. These people only wear the splints at night.

Medical data is limited on the success of acupuncture treatment for CTS. Some patients find that acupuncture, yoga, and other stretches are helpful. Additionally, there are occupational therapists certified in "hand therapy" that can do more of the "active release" therapy that you have described. It is best to discuss your condition with your doctor and figure out a treatment plan that makes you comfortable.

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 to 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. 

I have a friend who is receiving care in a skilled nursing facility; he had a recent outpatient surgery to close a tracheostomy hole. The day after the surgery, he didn't know where he was and was talking about things that didn't make sense. Prior to surgery, he was coherent and able to communicate with family. I'm told he is experiencing "delirium". Can you help me understand what "delirium" is and how this differs from dementia? What is the course of treatment for delirium and is this a temporary status? What can the family do to help?

The American Psychiatry Association defines delirium as a "disturbance of consciousness, attention, cognition, and perception." While the two conditions sound similar, the difference between dementia and delirium is the length of time the condition lasts. Dementia is a more progressive and permanent change in mental status. Delirium usually has a clear cause (surgery, infection, underlying illness, environmental changes, or medications), and usually reverses. When a patient has delirium, it is important to quickly figure out what new medical event has occurred or is occurring. In this case, your friend's delirium is likely due to his recent surgery. The symptoms can be treated with antipsychotic medications like haloperidol. Many patients will experience agitation during delirium, but it is best to avoid sedative medications like benzodiazepines (e.g., Xanax or Klonopin) unless the delirium is due to withdrawal from substances like alcohol or sedatives. Families and loved ones can best help by making surroundings look familiar with pictures, keepsakes, and other recognizable objects. This will help delirious patients to re-establish a baseline in their mental state. It is also important not to become frustrated with patients with delirium, as patients often will have waxing and waning functional levels. One moment your friend may know exactly what is going on, and the next he may hallucinate.

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.

I hear of so many of my friends having diabetes. Can you help me understand early signs of diabetes? Are some people at greater risk of developing diabetes?  Are there things I can do to prevent diabetes? If someone is diagnosed with diabetes, are there special precautions they should take with things like diet, foot care or wound care?

Early signs of diabetes include increased urination, thirst, and extreme hunger. Other signs include burning and tingling in your feet, increased infections, and poor wound healing. While some people are more prone to developing diabetes due to genetics, the best way to prevent diabetes is to eat healthy, exercise regularly, and maintain an appropriate weight. Simple blood tests can indicate if you are at increased risk of diabetes. In addition to a fasting blood glucose, your physician can check a hemoglobin A1C. This test will give an indication of what your blood sugar has averaged over the previous three months and will give an indication if you either have diabetes or if you are at risk for diabetes. 

If you are diagnosed with diabetes, then your physician will likely refer you to diabetic education to learn more about this disease, how to monitor your blood sugar at home and to follow an appropriate diabetic diet. Special precautions should be taken to avoid foot injuries and to monitor your feet for open wounds, especially if they are slow to heal. Your physician will frequently check your feet for signs of infection and for nerve damage. It is recommended that most diabetics visit an ophthomologist annually for a diabetic eye exam. By following an appropriate diet, getting exercise, taking your medications, and getting frequent checkups, diabetes can be managed well and the risk of these complications can be minimized.

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.

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?
  • 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. 

Over the last couple of months, I have been experiencing heel pain. When I get up in the morning or after I've been sitting for a while, I stand up and experience a sharp pain on the very bottom of my heel. I can hardly put my weight on it for the first couple of minutes; then it seems to be fine. 

Can you tell me what might be causing this kind of pain? What kind of doctor do I need to see for it if the pain continues? Is there anything I can do or pills I can take to help with the pain? Someone told me to do stretching exercises. Any suggestions would be appreciated.

What you are describing sounds like Plantar Fasciitis. This condition happens to be the most common cause of heel pain in adults. The plantar fascia extends along the bottom of the foot from the heel forward. It provides shock absorption and arch support in the foot. Common risk factors for plantar fasciitis include obesity, high arches or flat feet, as well as an inflexible Achilles tendon. The cause of the pain is degenerative and chronic inflammatory changes in the plantar fascia. You should be evaluated by your physician, because other causes of heel pain should be ruled out. Once the diagnosis of plantar fasciitis is made, conservative treatment is usually recommended. It is important to remember that this condition usually resolves on its own, however, it may last for months. To help with the symptoms, physicians usually recommend reduction in the duration and intensity of physical activity, Non-steroidal anti-inflammatory agents (such as Ibuprofen) or Tylenol, shoe cushions (such as heel pads), and plantar fascia stretching exercises. Some patients get relief by rolling their feet over a cold can of soda for 15 minutes 2 to 3 times daily. If the examination is otherwise normal and the symptoms haven't resolved in 3 months or so, then you may be referred to a Podiatrist for an evaluation and additional treatment recommendations. Surgery is rarely recommended for this condition.

Hospital-acquired infections also known as nosocomial infections are a major concern in health care and are taken very seriously. The chance of contracting one of these infections is increased with the amount of time spent in the hospital. The most common nosocomial infections include those of the urinary tract, surgical wounds, line infections such as IVs, and pulmonary infections such as pneumonia. The bacteria that are responsible for these infections "live" in the hospital and are often resistant to most common antibiotics. Developing such an infection will lengthen your hospital stay, cause more complications, and unfortunately can be fatal.

The best way to prevent these infections is by frequent hand washing. You will notice that the hospital staff and doctors frequently clean their hands prior to contact with patients. Also, patients should encourage their visitors to wash their hands as soon as they enter the room. There are usually signs posted throughout the hospital informing patients and visitors about these measures to help prevent hospital-acquired infections. Attention is also paid to the dates that your catheters, IVs, and wound dressings are scheduled to be changed. Your health care team should make sure that this is done in a timely and sterile fashion. Antibiotic-resistant infections are on the rise, and all efforts should be taken to prevent them from being spread.

As I'm getting older, I find that I occasionally have problems with my bladder and repeat infections. I drink lots of water. Also, my friend shared with me that she and her husband both have problems with incontinence. Can bladder infections cause incontinence? Are there medications or supplements that can help with incontinence?

Urinary incontinence is a common but distressing problem in people older than 50 years, especially women. There are several different types of incontinence with many different causes. Urine leakage can occur when you cough, laugh, or exercise because the muscles supporting the bladder are weakened. Alternatively, patients can feel like they cannot get to the bathroom in time because their bladders are overactive or overfilled. Diabetes, prostate enlargement (in men), and other conditions can cause these symptoms. Urinary tract infections (UTIs) can indeed cause some urinary incontinence; an infection can irritate the bladder and cause an urgent need to run to the restroom. Other symptoms of a UTI include burning with urination, more frequent urination, and cloudiness or odor in the urine. 

If you have symptoms of urinary incontinence, be sure to speak with your doctor about different treatment options. Because there are different types and causes of incontinence, he or she needs to fully examine and evaluate you before deciding on a treatment plan. If you're leaking urine because of pelvic muscle weakness, your doctor might recommend Kegel exercises to strengthen these muscles. These exercises are commonly practiced by women, especially those who have had children, but can also be done by men. However, it might take 3 to 6 months to see an improvement, and only works in cases of pelvic muscle weakness. Scheduling trips to the bathroom instead of waiting until you have an urge to go can also help prevent leakage or "bladder emergencies." You might also try cutting back on foods that can irritate your bladder, such as alcohol, caffeine, acidic foods like tomato or grapefruit, and spicy foods. 

If these more conservative measures do not help, there are various prescription medications and even surgeries that can help with incontinence. Depending on the type of incontinence, medications can help regulate overactive bladders or help with urination in cases of enlarged prostates. Surgery to provide additional support to the bladder is sometimes used in cases of muscle weakness. These treatments have benefits but also carry risks, so be sure to have a thorough discussion with your doctor about these options.

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.

Many years ago, smoking was very common and many of my friends smoked. One of my friends has been diagnosed with lung cancer; she never smoked but lived with a smoker for 54 years. Can you help me understand some of the risk factors associated with lung cancer? What are some of the early signs or symptoms of lung cancer? Are there effective treatments for lung cancer? What are the risks of second‐hand" smoke? Could my friend have developed lung cancer even if her husband hadn't smoked?

Lung cancer is the most common cause of cancer-related death for both men and women in the U.S. and approximately 85% of lung cancer cases occur in smokers. The risk factors for lung cancer really depend on the subtype of the cancer. Overall, the strongest risk factor for lung cancer is smoking and several studies have shown smoking to increase the risk of lung cancer 10-20 times. The increased risk due to smoking has also been shown to be proportional to the amount of smoking exposure. In other words, someone who has smoked one pack per day for twenty years is at a higher risk than someone who smoked for one month. Exposure to second-hand smoking has been shown to be as strong of a risk factor as the act of smoking. Other risk factors for lung cancer include exposure to asbestos, silica, chemicals and a family history of lung cancer. Lung cancer can occur in individuals with no smoke exposure with lung adenocarcinoma being the most common in type in non-smokers. Lung cancer may be asymptomatic in about 10% of cases that were incidentally found on imaging. Early symptoms of lung cancer depend on the type and location of the lesion. If located more centrally near the airways, patients may experience cough with blood (called hemoptysis), difficulty breathing, wheezing, and pneumonia. Other symptoms of tumors in this area can include hoarseness and difficulty swallowing. If the malignancy has metastasized, symptoms may occur due to those organs being affected. The most common locations for spread include the brain, bones, and liver.

It seems like every doctor I go to wants to do their own testing. Can you help me understand the differences in some tests and when one might be used over another? What can be determined by using a CAT scan? How is an MRI different and why would a doctor want to do an MRI rather than a CAT scan? These are just a bunch of letters to me but if I understood more about the "why's" of these tests, I would be a better patient and consumer. 

CT scans and MRIs are both imaging modalities used to aid in the diagnosis of many medical conditions. CT scans or CAT (computerized axial tomography) uses X-rays to create a 3-D image based on the density differences. They are helpful in showing evidence of inflammation or damage to the internal organs and large intracranial bleeds. Additionally, there are quickly performed and are therefore frequently used in the emergency setting. Because it uses X-rays, individuals are exposed to radiation during the scan. MRIs use powerful magnets to create a 3-D image by using the effect the magnets have on the water of the body. Although MRIs take more time, they provide a much more detailed image of soft tissues and are therefore very helpful in the diagnosis of neurological conditions, aneurysms, strokes, and conditions of the spine. Because MRIs use magnets, patients with certain metal-containing implants foreign-bodies, graphs, and pacers should not have an MRI. MRIs also require the patient be very still during the imaging process, so patients with claustrophobia or who cannot stay still for a period of time may not be able to have the MRI performed. Depending on the medical condition your physician is looking for, either of these tests may be ordered. It is important to talk with your doctor about previous imaging studies you have done and reasons why you may not be able to safely undergo an imaging study.

  • How often should I have a bone density scan?
  • What does the test reveal and is it just as relevant for women as for men?
  • What can I do to improve bone density?
Osteoporosis is a disease of the bone. It happens when bones become brittle and fragile. As a result, bones become weak and may break from minor falls, or in severe cases, even from minimal activity. There is a simple x-ray procedure, called a DEXA bone density scan, that shows which patients have osteoporosis. How often a patient gets a bone density scan depends on one's risk factors for osteoporosis. These risk factors include a history of bone fracture as an adult, current smoker, history of oral steroid use for over 3 months, body weight under 125 lbs., immediate family member with a fragility bone fracture, and excessive alcohol intake, among others. 

The U.S. Preventive Services Task Force recommends that all women get routine screening for osteoporosis starting at age 65. All patients with risk factors previously discussed, will likely start being screened at a younger age. Depending on the results and the risk factors, this test will likely be repeated every one to two years. Low bone mass found on bone density scans that is not low enough to be considered osteoporosis is referred to as osteopenia. If you are found to have osteopenia, your doctor will make recommendations to help prevent your bones from getting thinner and moving into the osteoporosis range.
There are both prescription and non-prescription treatments to help increase bone density. 

Non-pharmacologic methods include exercise (at least 30 minutes for 3 days out of the week), supplemental vitamin D (800 U/day), supplemental calcium (500-1000 mg/day), and cessation of smoking. The pharmacologic treatments most often prescribed include prescriptions of bisphosphonates, calcitonin, and raloxifene. 

Fractures can be devastating in patients over the age of 65. The healing process takes longer and the ability to fully recover is not always possible. Ask your doctor if a bone density scan is appropriate for you.

My back and side are aching and I feel awful.  I'm running to the bathroom more often than usual but I don't have any burning when voiding. A friend suggested I might have a bladder infection so I decided to set an appointment with my doctor. Are the symptoms of bladder infections different as we age? What are some things I can do to prevent a reoccurrence?  

Bladder infections fall into the category of urinary tract infections (UTI's) and are frequently referred to as such. Older patients with bladder infections may not experience the classic symptoms associated with these infections, and this may make diagnosing these infections more challenging. In younger patients, bladder infections typically cause pain with urination, burning with urination, urinary urgency, or urinary frequency. In older patients, these typical symptoms may be absent. When older patients develop bladder infections, they may experience a loss of appetite, nausea, or vomiting. Additionally, older patients may develop mental status changes, such as confusion or difficulty thinking clearly, when they have bladder infections. Other symptoms that may occur during these infections are low back pain, feeling the need to urinate more frequently, and feeling like your bladder doesn't empty completely when you urinate. If a fever develops, it may indicate that the infection has spread to the kidneys, which is a more serious infection. If any of these symptoms occur, you should consult with your physician to have a urinalysis performed. This is a simple study that most physicians perform routinely in their offices.

There are several strategies to decrease your risk of developing a bladder infection. First, drink plenty of water. Most experts recommend staying well hydrated by drinking 6 - 8 glasses of water per day. This helps to flush bacteria out of the bladder and urinary system. For female patients, it is often recommended to urinate after taking baths. Long baths give bacteria an opportunity to find their way into the bladder and cause infections. Also for the same reason, it is recommended that women should urinate after sexual activity. After menopause, women often experience thinning and drying of the vaginal lining. This thinning and drying may make it easier for bacteria to get into the bladder and cause infection. For women with this condition who are experiencing frequent bladder infections, vaginal moisturizing cream with or without estrogen may help to restore the vaginal lining and lessen the likelihood of developing bladder infections. Adding cranberries to your diet has been shown to help prevent bladder infections. Drinking cranberry juice daily or taking a daily cranberry extract supplement are both ways to reduce the likelihood of developing bladder infections. Because patients with certain types of kidney stones and patients on specific medications should avoid cranberries, it is important that patients discuss this with their physicians before adding cranberry products to their diet.

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. 

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.

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. 

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. 

The thyroid is a butterfly-shaped gland in the front of your neck. The thyroid acts as the thermostat of the body. It produces hormones that control the way your body uses energy. If the thyroid gland is not functioning properly, it may produce too much or too little thyroid hormone. Having either too much or too little thyroid hormone can make you not feel well.  If a patient's thyroid is not producing enough thyroid hormone, then the patient is diagnosed with hypothyroidism. Having a low level of thyroid hormone affects your whole body. The symptoms of hypothyroidism include fatigue, weight gain, constipation, and hair loss. If left untreated, hypothyroidism can cause an increase in your cholesterol and increase your risk of heart disease and stroke. People of any age can get hypothyroidism, and both men and women will experience the same symptoms. However, older adults are more likely than younger adults to get this disease. Women over the age 60 are at the highest risk of getting hypothyroidism. Also, those patients with a family history of hypothyroidism are at higher risk of developing it themselves. Fortunately, hypothyroidism is easily detected with a blood test and is successfully treated with medication.

If the thyroid gland produces an excess of thyroid hormone, the condition is referred to as hyperthyroidism. Symptoms of hyperthyroidism include unintentional weight loss, fast heartbeat, sweating, tremors, and feeling nervous.

Again this condition is easily diagnosed with a blood test and is easily treated. Radioactive iodine and antithyroid medicine are the treatments doctors use most often. The best treatment for each patient will depend on a number of things, including age and other medical problems. Most patients respond very well to treatment.  It is important to diagnose this condition early, because if hyperthyroidism is left undiagnosed and untreated, it can lead to serious heart problems, bone problems, and a life-threatening condition called "thyroid storm." 

Patients with hypothyroidism or hyperthyroidism don't usually need to have their thyroid gland removed. Those patients that need to have a thyroidectomy, usually have a concerning growth, or nodule, in their thyroid gland that requires surgery. Lab tests, ultrasounds, and thyroid scans are used to determine which patients will need this surgery. After a thyroidectomy, a patient will need to take thyroid medication for the rest of their lives.

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 and the FDA US Food and Drug Administration. 

We have been hearing a lot about the “Zika virus” on the news and in the papers. Is this something I should be concerned about as an older adult? I live in Houston and we always have problems with mosquitoes.

Zika virus disease (Zika) is caused by the Zika virus, which is spread to people mostly through bites from a specific type of mosquito, the Aedes species. The most common symptoms associated with a Zika virus infection are similar to other common viral infections, including fever, rash, joint pain, and red eyes (conjunctivitis). Many people might not realize that they have been infected with the Zika virus because these symptoms are usually mild and last less than a week. In addition to mosquito bites, this virus can also be spread through sexual contact with a person infected with the Zika virus. Once a person has been infected with Zika, he or she will more than likely develop antibodies to fight this infection and should be immune from catching it again. Unfortunately, no vaccine exists to prevent Zika virus disease.

Although most people infected with Zika virus will have a mild infection, the worse complications of this viral infection occur in some pregnant women and their developing fetus. The virus can cause serious birth defects, namely microcephaly and other severe fetal brain defects. For this reason, the World Health Organization declared Zika virus a Public Health Emergency of International Concern. At last report, there have been a few cases in Texas, but these patients have traveled to other countries where this virus is common. There HAVE NOT been any reported cases of mosquitoes spreading Zika virus in our area. However, many public health experts warn that our area may have Zika virus mosquito transmission in the future. Women who are pregnant or plan to become pregnant should take every precaution if traveling to areas of the world where there are reported cases of Zika virus disease. Also, men who travel to these areas should take every precaution not to transmit the virus through sexual contact. 

As an older adult, there is no immediate threat of contracting Zika in this area; however, you should do what you can to avoid mosquito bites in general. These include wearing long sleeve clothing and using mosquito repellant when outside. Also, take the necessary steps to prevent mosquitoes from getting into your home.