Meet "Dr. J"
Jim "Dr. J" Ellis from Provena Covenant visits Wednesdays at 7:40 AM to answer your questions. CLICK HERE to email him your question. And now you can get Dr. J on your iPod!! Click here to download podcasts from Provena Covenant Medical Center.
Wednesday, November 19, 2008 -- Hypothyroidism
This question is concerning my 18 year old daughter. She was diagnosed with hypothyroidism at 6 weeks old. She is 5'3" and weighs only 100. My concern is that she is not really able to gain weight. She religioiusly takes her synthroid. She is a freshman in college and has not gained any of the freshman 15! Her arms are very thin as are her legs, she doesn't look like a normal 18 year old. She has danced for the past 10 years but only a few classes at a time, and I know dancers are sometimes thin. Her endocronologist has been a little concerned about her weight but never given any suggestions. Her TSH and T4's are always within the normal ranges. Should I be concerned??
From Dr. J: Probable congenital hypothyroidism. Simple to test for and easy to treat.
WHAT IS YOUR THYROID?
Your thyroid is the gland directly below the Adam's Apple. It takes iodine and makes T3 and T4. Your thyroid regulates many things, including:
BMR (Basal Metabolic Rate . . . what your body needs to run on when idle.)
Glucose regulation
New growth
Regulating lipids
Regulating adipose tissue
Some regulation of heart
Nerve transmission
Growth and structuring of bones
WHAT IS THE DIFFERENCE BETWEEN HYPO- AND HYPER-?
Signs of HYPERthyroidism (increased thyroid activity):
Fast heart rate
Irritable
Difficulty sleeping
Weight loss
Sweating
Anxiety
Graves Disease
Signs of HYPOthyroidism (decreased thyroid activity):
Weight gain
Decreased growth
Irregular periods
Dry skin
Dry hair
Hair loss
Poor memory
Depression
SUGGESTIONS FOR OUR LISTENER:
Continue to follow up with endocronologist, take medications. Could be that her thin frame is her normal stature.
Wednesday, November 5, 2008 -- Braxton Hicks & reflux
Good morning Dr. J,
Hope you are having a great week. I am currently 24 weeks pregnant and have a couple of questions. I have had a terrible time with reflux. I am on nexium, bed has 4 inch lifts under upper legs, cut out all soda, fried foods, acid......nothing is helping. I feel like there is something caught in my throat at all times. My other question is in regards to BH (Braxton Hicks) contractions. I was put on bedrest at 26 week with last pregnancy due to gettting BH's at least 4 an hour. In hospital for 1 week-was put on Mag. Sulfate, which did not help. Was on terbutaline the remainder of pregnancy. Contracted every 4-10 minutes from week 30 to delivery. Carried my son to term. The contractions have started again. Should I be worried? Do I need to take all of those steps again? Can these contractions cause pre-term labor? Any advice would be appreciated. Thanks!
From Dr. J:
ACID REFLUX INFO:
"GERD", "Reflux", "Heartburn" . . . all terms for the same problem. Stomach acid leaves the stomach and splashes on lower esophagus.
VERY common in pregnancy. More than 50% of pregnant women get it.
Should resolve/return to normal after the pregnancy is over.
WHY IT HAPPENS IN PREGNANT WOMEN:
Progestrone loosens the "valve" on the lower esophagus, so it's easier for acid to get out.
Growing baby displaces abdomen and other organs, therefore increasing pressure on the stomach.
WHAT TO TAKE/WHAT TO DO:
Nexium, antacids, Tagamet, Pepcid, Zantac . . . most should be safe during pregnancy. As always though, CONSULT YOUR DOCTOR!!!
For relief, try elevating the head of bed 6-8"
Get a bed wedge
Lying on the left side
Sleeping in a recliner
Frequent small meals
Wait 2-3 hours after eating before lying down.
Chewing gum may also provide some relief
NO SMOKING!!! (Duh.)
BRAXTON-HICKS INFO:
Braxton-Hicks is also known as "false labor."
Usually occurs in the second and third trimesters and increases in strength closer to term.
Differences between BH and true labor . . . True labor is:
longer in length
closer in frequency
higher intensity
tend to be felt all over
walking makes them stronger
Some more info on BH: False Labor or True Labor During Pregnancy: What's a tired mom-to-be to do? Buy a Snoozer Pillow
Perhaps the biggest question on most women's minds during pregnancy is whether they will be able to identify true vs. false labor. The answer is tricky. Even experienced mothers sometimes have difficulty distinguishing between real labor and false labor. Chances are however once you are in true labor you will know it. It is however common for many women to experience false labor or pre-labor that feels like the real thing. Here are some tips for distinguishing between real and false labor.
Braxton-Hicks Contractions - False Labor
Braxton-Hicks contractions are your body's way of preparing for labor and delivery. Most women experience Braxton-Hicks as menstrual like cramping or brief tightening in the lower abdomen. This feeling tends to be sporadic, meaning it comes and goes at various times. Braxton-Hicks while common sometimes do result in discomfort or pain. This is part of the reason so many women have a difficult time distinguishing between false and true labor.
False labor contractions may occur regularly at 5 minute intervals, but generally only last about 30 seconds or so. It isn't uncommon for women who have had children before to misinterpret Braxton-Hicks as the real thing and show up at the hospital, only to be sent home a short while later. Here are some signs you may be in false labor:
Contractions are irregular.
Contractions don't get closer together after a certain period of time.
Contractions are usually weak and don't get stronger over time.
Contractions are usually felt in the front only instead of in the back.
Contractions may slow down or stop completely if you lay down, drink fluids or take a hot shower.
True Labor
True labor is characterized by contractions that come regularly, gradually strengthen over time and do not go away if you change position. Here are some signs of true labor you may be aware of:
Contractions usually last between four and six minutes apart and may last up to 60 seconds or more.
Contractions generally get stronger over time.
Vaginal pressure or back pain accompanies contractions.
Contractions continue to get stronger regardless of your position or whether you consume fluids.
Contractions are accompanied by a bloody show or the mucous plug.
Your water may also break during true labor. If in doubt, it never hurts to call your physician. Most doctors will recommend that if contractions occur regularly and last more than thirty seconds, you should try first drinking lots of fluids and lying down. If this doesn't stop the contractions you may be in labor. You might avoid timing your contractions until they feel quite strong and are regular.
Early labor, particularly for first time mothers, can last hours and hours, and you may find it tedious to time early contractions during labor.
Whenever in doubt it never hurts to get checked out. Don't worry about feeling silly or embarrassed. Even the most experienced moms check into the hospital with false labor contractions. What's more important is you make it to your doctor in time before it is too late. The very worst thing that can happen is you are sent home to labor on your own for a few more hours (or days if in false labor). Think of it this way, you'll have plenty of fun stories to tell your family and children after you do go into labor and deliver your baby!
Website you may find useful:
Dear Dr. J,
Recently my elderly father fell and broke the femur near the hip socket. When admitting him to the hospital, they discovered pneumonia, and tested for MRSA. The test came back positive. On the 3rd day in the hospital the personnel began wearing gowns, and gloves, but never told us visiting that we should not touch the patient. Then, we were informed to wear masks and gloves. If we were exposed to this bacteria, how much at risk are we? Should we be tested also? The latest word that I got was that it is very dangerous...especially for the elderly and the very young. Are the rest of us risk-free? After about a month now, my father still has the pneumonia and the MRSA. What are his hopes for recovery? He has been on antibiotics all this time. He lives in another state, so I don't get to see him as often as I would like, but I don't feel real comfortable visiting if I will be bringing back a dangerous bacteria to spread with other loved ones. What should I do?
From Dr. J:
MRSA stands for Methicillin Resistant Staph Aureus.
It used to be only "hospital-acquired"... it's now very prevalent in communities.
Estimated number of hospital cases have doubled since 2001.
The state of Illinois is inacted the MRSA Screening and Reporting Act in August 2007.
--Identify all ICU and other at-risk patients.
--Isolation of MRSA-colonized and infected patients.
--Strict enforcement of hand hygiene requirements.
INFECTED: pnuemonia, skin infections, abscesses, cystitis, wound infections
COLONIZED: have the bacteria, usually indise the nose, but no active infection. "Carrier state."
Due to law screening at-risk patients, hospitals are required to isolate MRSA positive patients:
--NO roommates
--De-colonization procedure: Bactriban to nose, shower with Hibiclens/Phisohex
--Oral antibiotics
Some experts recommend household members decolonize also.
The #1 way to stop the spread of MRSA?
WASH YOUR HANDS!!!
If concerned, talk to your doctor. Here are some links you may find useful:
Wednesday, October 22, 2008 -- Breast Cancer Myths
We continued our focus on Breast Cancer Awareness Month today when we discussed common breast cancer myths:
All breast lumps are cancerous. FALSE! 80% of lumps are caused by benign (non-cancerous) changes in the breast.
Antiperspirants or antiperspirants/deodorant combinations are a leading cause of breast cancer.
FALSE!
Underwire bras cause breast cancer.
FALSE!
An injury to the breast causes cancer.
FALSE!
Oral contraceptive pills (birth control pills) cause breast cancer. FALSE! (Dr. J says: TALK TO YOUR DOCTOR!!)
Breast cancer always presents itself in the form of a lump. FALSE! Not all women diagnosed with breast cancer will have a noticeable lump. Therefore, women should check for the following warning signs while performing monthly breast self-exams:
--Any new lump or hard knot found in the breast or armpit.
--Any lump or thickening that does not shrink or lessen after your next period.
--Any change in the size, shape or symmetry of your breast.
--A thickening or swelling of the breast.
--Any dimpling, puckering or indention in the breast.
--Dimpling, skin irritation or other change in the breast skin or nipple.
--Redness or scaliness of the nipple or breast skin.
--Nipple discharge (fluid coming from your nipples other than breast milk), particularly if the discharge is bloody, clear and sticky, dark or occurs without squeezing your nipple.
--Nipple tenderness or pain.
--Nipple retraction: turning or drawing inward or pointing in a new direction.
--Any breast change that may be cause for concern.
If a woman is diagnosed with breast cancer, she will lose her breast. FALSE!
Men do not get breast cancer. FALSE! Each year it is estimated that approximately 1700 men will be diagnosed with breast cancer and 450 will die.
Having a family history of breast cancer means you will get it.
FALSE! If you have a mother, daughter, sister or grandmother who had breast cancer, you should have a mammogram 5 years before the age of their diagnosis, or starting at age 35.
Wednesday, October 15, 2008 -- Vitamin D
Dear Dr. J,
Could you talk about the role vitamin D, the sunshine vitamin, plays in preventing breast cancer and other diseases. Please refer to grassrootshealth.org, an educational website developed by a breast cancer survivor who feels no woman should go through the torture of curing breast cancer. Thanks!
From Dr. J:
What does Vitamin D do? It regulates calcium and phosphate (strong bones)
There are 2 sources of Vitamin D: SUNLIGHT ("activates it" in the skin) and FOOD.
Main souce for most people is sunlight.
Once in blood stream Vitamin helps regulate calcium and phosphate and maintains bone growth and hardness.
Deficiencies in childhood leads to ricketts. That lead to Vitamin D fortifications in food in the 1930s.
Deficiencies in adults leads to osteoporosis and osteomalacia.
Vitamin D is linked to enhance immune response. May be a benefit in MS, Alzheimer's, RA, SLE . . .
CANCER There is an interesting POTENTIAL link between Vitamin D and cancer. It may have some anti-tumor cell activity.
May reduce colon, breast, ovarian and pancreatic cancer risk.
4 million cancer patients in a 2006 study. Sunny and less sunny countries. Vitamin D deficiency associated with a higher cancer risk.
BREAST CANCER 2 findings: Increased breast cancer cases at higher latitudes. Possible association with decreased sun exposure and decreased Vitamin D synthesis and Vitamin D deficiency.
Patients with Vitamin D deficiency at time of diagnosis of breast cancer had igher rates of metastasis and higher risk of death from cancer.
RECOMMENDATIONS Get some NON-BURNING sun exposure daily.
Vitamin D supplements, especially in winter months.
Talk to you physician about Vitamin D supplementation.
"Slip-Slap-Slop" campaign in Australia to cover up when exposed to sunlight saw an increase in Vitamin D deficiency.
VITAMIN D FOOD SOURCES Cod liver oil
Salmon
Mackerel
Fortified milk
Beef and liver
Wednesday, October 8, 2008 -- Testing for the breast cancer gene
Dear Dr. J,
My gynocologist recommended my mother get tested for BRCA1 and 2 since she and her sister both had breast cancer. If I got tested, it could affect my insurance AND life insurance. Doc said we could consider options if Mom does have the gene. Parents found out insurance probably won't cover tests, but they'll pay if it's really worth it...wondered if you could give me some quick insight. IS the test worth it? If she's positive, what are my odds? How accurate is testing?
From Dr. J:
Breast Cancer 1 & 2 (BRCA 1 & 2) -- tumor suppressor genes that produce proteins that prevent cells from growing too rapidly or ourt of control. Repairs DNA . . .
~BUT~
BRCA 1 & 2 can have mutations that produce ineffective proteins which can't prevent cells from rapid uncontrollable growth. I.E. Cancer.
Higher risk women and men with mutated BRCA 1 & 2, 36-85% risk.
Who is high risk? Age 50 and older, family history (mother, sister, daughter) . . .
What does a positive test mean? A higher risk of developing cancer. If a family member has cancer and a positive test for the BRCA gene . . . the higher the risk.
A negative test means haven't inherited a mutated gene. The risk is the same as the general population risk, but not zero.
What to do after a positive test?
Careful monitoring and testing . . . mammograms and exams.
Prophylactic surgery-mastectomy.
Salpingo-oophorectomy (tubes and ovaries) . . . NOT 100%
Risk Avoidance
Exercise regularly
Limit alcohol consumption
HIPPA Prohibits group health plans from using genetic information as a basis for denying coverage if a person does not currently have the disease.
Follow-up email from a listener:
I am the only cancer genetic counselor here in town at Carle Clinic. I just listened to Dr. J talk about the BRCA1 and BRCA2 gene testing. I would really like an opportunity to provide your listeners, especially the woman who emailed the question, with more information about the implications of this testing. I deal with this issue every day and typically test 5-6 patients a week for the “breast cancer genes”. This is a very timely topic during Breast Cancer Awareness Month and I applaud Dr. J for taking it on. However, I want to make sure everyone has access to some information before deciding whether or not to be tested.
BRCA1 and BRCA2 are not the only genetic causes of breast cancer. There are several other genes that when mutated can increase your risk of breast cancer as high as the BRCA genes.
Dr. J also mentioned a risk of ovarian cancer for women who test positive. To clarify, a hysterectomy removes the uterus, not the ovaries, a woman needs an oophorectomy to remove her ovaries. Now, some people, including some doctors, use hysterectomy to describe removing both the uterus AND ovaries, but this needs to be clear.
Dr. J stated that men with the gene may have an increased risk of prostate cancer. This is true but a bigger issue is that men also will have an increased risk of breast cancer – men with BRCA1 or BRCA2 have a 100-fold increased risk for breast cancer than men in the general population.
The final issue I will discuss is that of the concern about insurance, both health insurance and life insurance. Dr. J mentioned HIPPA – while this may provide some protection, there was not a good national law to protect these patients until earlier this year when President Bush finally signed a bill called GINA (genetic information non-discrimination act). This protects genetic test results from being used to discriminate against people for health insurance and or jobs.
Again, I think this is a great issue and talking about it on your show is a wonderful way to get information out to the public. Genetic counseling is recommended for all individuals considering this test. I am the only licensed genetic counselor in the area that deals with cancer genetics and BRCA testing. Other centers may offer “genetic counseling or testing” but this is not being done by a licensed, certified counselor.
Jennifer Burton, MS, CGC
Licensed Genetic Counselor
Carle Clinic
602 W. University Ave.
Urbana, IL 61801
PH: 217-383-5084
Fax: 217-383-6333
Email: Jennifer.Burton@carle.com
Wednesday, October 1, 2008 -- Pin worms
Dear Dr. J,
My 4th grade son recently contracted pin worms. We have been trying to figure out how he got them. He washes his hands regularly and is clean at home. But he is an active boy. One thing that bothers me is that his school recently changed their protocol for lunch recess. They used to go to the restroom, wash their hands, eat lunch and then have recess. Starting this year the school changed the order of this. They first go to recess and then come in for lunch. They do not go to the restroom to wash their hands before they eat. The students get a dollop of hand sanitizer to rub into their hands before getting their lunch. Is this enough to get rid of dirt, germs, etc., that the kids might pick up from outside? My son has played sports and has played in dirt a lot since he was in kindergarten and has never had this before.
Thanks for your input,
A concerned mommy
From Dr. J:
Pin worms are VERY COMMON. They are small staple-sized white worms. Their eggs are commonly found in lots of places and can get on hands and under fingernails.
Commonly found in linens, towels, junderwear, PJ's, toilets, food, utensils, counter, sandboxes . . .
The eggs are ingested and hatch in the small intestine. They move into the large intestine and attach to the wall of the bowel. Then they move to the area around the rectum and lay new eggs.
Causes intense itching, especially at night. Because of the itching, that transfers eggs to hands/fingernails.
It can be contagious and go through multiple family members.
ANIMALS DO NOT CARRY PIN WORMS.
Eggs can live for 2 weeks on some surfaces.
Diagnose by doing the "Scotch tape test" (yes . . . it's what you think: stick the tape on the butt and look for the worms). Sometimes you may be able to see them in the toilet.
PREVENTION:
--WASH YOUR HANDS AFTER PLAYING OUTSIDE, BEFORE EATING, AFTER USING THE BATHROOM!!
--Hand sanitizer is good IF it is 60-95% ethanol.
TREATMENT
--There is a pill. May have to treat all family members. May have to treat twice since pill kills worms but not eggs.
--Clean all clothes.
Wednesday, September 24, 2008 -- Psychiatric help
I have a friend who is in dire need of psychiatric help. He is not eating and his house if filthy. He has type 1 diabetes and was just in the Provena ED a few days ago for severely elevated blood sugar. His family can do nothing with him most of the time as he will not answer his phone or door. He lost his job of 30 years because of this illness.
We do not know what to do or where to turn. The police were called the same day he was at Provena because he disappeared on his motorcycle. We have called the Pavillion and they state they can do nothing unless he admits himself. He will not admit he has a problem. He stopped paying his bills and is about to be evicted from his condo. Please advise us as to what to do.
From Dr. J:
This problem is more common than people realize.
Psychiatric care is extremely overwhelmed in the U.S. Patients with acute psychiatric issues who can\'t care for themselves can\'t get care. Providers are overwhelmed.
Patients with acute psychiatric problems have impaired judgement, can\'t ask for help and many don\'t realize they need help. They stop caring for themselves, their basic needs, and stop taking their medications. They also have safety issues.
Many have no insurance or Medicaid (disabled) which can limit some medical services.
Possibilities for our emailer (and those dealing with similar problems):
The person in the email has diabetes as well as psychiatric problems. Could be bipolar, schizophrenic, paranoid schizophrenic, depressed . . .
There could also be drug (meth) and alcohol use/abuse.
The family needs to try and intervene: help with blood sugar, help with psych. meds.
CALL MENTAL HEALTH CENTER AND ASK FOR ADVICE! Champaign County Mental Health is 217-359-4141 or 217-398-8080 x213.
If there are imminent safety/health issues or suicidality/homocidality, INVOLVE POLICE. They will help determine degree of risk to patient.
If risk is severe, police can transport patient against their will to local ED or psych. hospital.
ED and crisis team will do an extensive medical evaluation first.
If medically clear, crisis team will interview and assess patient with help of psychiatrist.
If crisis team thinks patient needs hospital admission, they can admit voluntarily (if the patient agrees) or INVOLUNTARILY if the physician/crisis team and psychiatrist agree.
Address psychiatric diagnosis/meds and treatment.
Wednesday, September 10, 2008 -- Diverticulitis
Today, Kevin told the story of what landed him in the hospital and Dr. J expanded on exactly what DIVERTICULITIS and DIVERTICULOSIS are:
Wednesday, August 27, 2008 -- Fever
My 6 year old daughter has been complaining about headaches on and off since Friday evening (8/15/08) and was running a fever with a little nausea on Sunday. I took her to the doctor, but could not find anything wrong. Is this something I should be concerned about or could it be something as simple as allergies?
From Dr. J:
--Fever in kids is a very common reason for doctor and/or visits to the ER.
--Most common cause is viral illness.
--Other common causes: ear infections, strep throat, pneumonia.
--Much LESS common causes are MORE serious, like meningitis.
--Parents have different levels of comfort with fever.
--There is NO absolute fever level that is dangerous.
--A temperature greater than 104 degrees, more likely to have bacteria in blood.
--Most important symptom is the appearance of the child.
--Happy, smiling, interactive, running around . . . child RARELY has anything bad.
--Many children will look tired and sleep a lot with fevers.
--Children who are listless, never smile, don't interact with parents or caregivers are more of a concern.
TREATMENT
--Fever treatment at home: Tylenol every 4 hours and Motrin every 6 hours.
--Tylenol: 20 mg / kg (weight of the child) or 10 mg / lb.
--Motrin: 10 mg / kg or 5 mg / lb.
--Lots of fluids
--REST!
--Fever in and of itself is not a problem if child doesn't look really sick.
--If the child appears to be in pain, trouble breathing, etc. -- probably needs a clinic or ER visit.
--Allergies don't generally cause fevers.
--Allergies usually cause:
*Clear runny nose
*Itchy eyes
*Sneezing
*Post nasal drip
*Cough (because of post nasal drip)
*Watery eyes
Wednesday, July 16, 2008 -- Organ donation
Back in 1992, I received chemotherapy and radiation treatments for Hodgkin's Disease. I was wondering if I would still be able to be an organ donor. I was told once a few years ago when trying to give blood that I was not able to because of the chemotherapy and the possible effects on the blood (by the way, what would be the possible effects?). I would like to sign up to donate my organs, but I am not sure if they can be used. Thank you.
From Dr. J:
--Hodgkin's Lymphoma is cancer of the white cells and lymph system. Starts in the lymph nodes and is treated with chemotherapy and radiation. Has an 85% cure rate!!
--Lymphoma is the most common blood cancer.
ORGAN AND TISSUE DONATION
--Organs you can donate: kidneys, heart, lungs, liver, pancreas and intestines.
--Tissues you can donate: cornea, middle ear, skin, heart valves, bone, veins, cartilage, tendons and ligaments.
--You can also donate blood and platelets and your body.
--Everyone is eligible. EVERYONE!
--A donation team will determine health and risk of donor at time of donation.
--With a blood cancer like lymphoma, you cannot donate blood. If you've had chemotherapy/radiation, you can't be a blood donor.
--HOWEVER, if the time arises when our listener can donate again, final determination will be made. Even if can't donate organs to another person, CAN donate for research, CAN donate corneas. Can donate BODY to science for research/education at medical schools.
Wednesday, July 9, 2008 -- Skin conditions
I have noticed as I've gotten older, I am 37, I have seen clear/white spots on my face. They are not zits and I don't really know what they are or how to get rid of them. Any suggestions?
From Dr. J:
It is hard to diagnose a skin condition without actually seeing it. 3 possible diagnoses, though:
#1.) Tirea Versicolor (many different colors)
--It it NORMAL for us all to have yeast on our skin.
--For some reason, higher levels of yeast will shut off the pigment producing cells in the skin, producing red/white spots.
--More common on trunk and arms/legs. Face usually spared.
--Treatment is usually effective. (Topical creams, shampoos . . . sometimes oral medications.)
--Yeast is easy to kill, but pigmentation may take weeks, months to recover.
#2.) Pityriasis Alba
--More common in kids.
--Usually on the face.
--Usually set limited and heals without scarring.
--May be red spots, scaley at first, hten become pale (losing pigment).
--Minimal treatment needed . . . sun protection.
#3.) Vitiligo
--Chronic skin condition.
--Loss of pigment.
--Irregular patches.
--Trunk, neck, skin folds.
--Young adults.
--Cause: multifactorial and not fully understood.
--White patches on skin, face, limbs, and torso.
--Can be accociated with autoimmune and inflammatory disease, thyroid disease.
--Treatment includes steroid creams, photo therapy and medicated creams.
--Michael Jackson went on Oprah in 1993 and admitted to having vitiligo, leading people to question if he had chemical depigmentation.
TREATMENT
--See family doctor or a dermatologist to make diagnosis.
