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### Human:\nwhat can i do about brown spots on my face and hands?\n\n### Assistant: age spots technically called “solar lentigines ” are well-defined uniformly colored areas of brown or grayish pigment that generally appear on the hands face neck and chest. despite the name these spots are the result of prior sun exposure not age. you can treat age spots several ways. the most popular at-home treatments are over-the-counter (otc) hydroquinone (hq) preparations which inhibit melanin production in the skin. but they tend to be more effective for treating melasma or hormonally-induced irregular pigmentations than for true age spots. dermatologists often have better results with prescription-strength retinol and hq creams which work faster than otc formulations. dermatologists also use microdermabrasion chemical peels chemical spot treatments laser treatments and light therapy to lighten age spots. some of these procedures require just one treatment; others take two or three sessions. remember to have a dermatologist check your age spots yearly to make sure they truly are benign. and if you notice changes in color size shape or feel tell your skin care specialist right away.

### Human:\nis it possible to be fat and fit?\n\n### Assistant: yes you can be overweight and in good shape at the same time. in fact physiologists now believe that being overweight and fit is far healthier than being skinny and out of shape. how much healthier? one recent study of 2 600 people shows that subjects who were unfit were four times more likely to die than those who were very fit —whether those fit people were normal weight overweight or obese. that’s because exercise — no matter how much you weigh — reduces your risk of a broad range of ailments including cardiovascular disease cancer and diabetes.

### Human:\nhow much of an impact does vitamin d have on breast cancer?\n\n### Assistant: in the most recent largest study (meta-analysis) of vitamin d calcium and the prevention of breast cancer both vitamin d and calcium seemed to be protective for the development of breast cancer. the best results were among women with the highest intakes of vitamin d and calcium as compared to the lowest levels of consumption. the top quarter of women having the highest blood 25(oh)d levels had a 45% decreased risk of breast cancer. another study of 562 women found that the 142 women with a diagnosed breast cancer had on average lower blood levels of 25(oh)d. women with the highest levels of 25(oh)d had a significantly reduced risk for breast cancer. surprisingly use of vitamin d supplements sunbathing and fish intake did increase blood levels of 25(oh)d -- but the lifestyle factors did not directly impact the risk of breast cancer. conversely mccullough and colleagues studying almost 22 000 women found no impact of blood levels of 25(oh)d on the risk of breast cancer. a study of almost 42 000 swedish women did not identify linkages between breast cancer risk and sun exposure nor vitamin d intake through diet or multivitamin use.

### Human:\ni just finished my chemo treatment and want to know how i can tell if i'm going to have neutropenia?\n\n### Assistant: this is something you cannot determine on your own. your doctor or nurse will tell you. because neutropenia (low white blood cell count) is common after receiving chemotherapy your doctor may draw some blood to look for neutropenia. for more information on neutropenia please visit: www. preventcancerinfections. org

### Human:\nhow can i age with vigor?\n\n### Assistant: in 2008 i was asked to lead a half marathon team for more magazine’s annual spring run in central park. my team of peeke performers was comprised of women who were cancer survivors and included women who had triumphed over cancers of the breast thyroid lung and bladder. one woman ran with just one lung and did great. all of these women were extraordinary but one was a real character. that’s elaine doll dunn. like me she’s got a wicked wit and plenty of sass. tall and regal she looked ageless and in reality was 71 years young. she carried herself with grace and elegance but her impish grins gave away her real personality— a powerful survivor who brushed off her bladder cancer as a speed bump along a winding hilly and joyful life journey. that’s elaine. we did lots of pr for the half marathon including a segment on "good morning america. " her one-liners kept me laughing and her endless energy was astonishing. after completing the half marathon elaine insisted i come to south dakota and keynote her marathon in the spearfish canyon about 45 miles outside of rapid city. to sweeten the deal she informed me that the marathon weekend coincided with biker week where over 250 000 harley enthusiasts descend upon the town of sturgis (not far from spearfish) and basically rally tour the countryside and yes indeed have a party or two. i had a funny feeling she would become quite a fount of enlightenment for me. and i was right. as you know by now this coming sunday august 22nd i’ll be competing in the iron girl triathlon with a group of my patients the peeke performers. i was thinking about this upcoming race as i addressed elaine’s marathoners who were experiencing the usual pre-race day blend of anxiety and excitement. as i looked around the room i noticed that at least half the crowd of runners was women well into their 60’s and beyond. and i knew why. presently 73 years old elaine has been a living inspiration for women who dared to push their envelope at any age. and she’s been doing this for many years. her motto is: “i postpone death by living by suffering by error by risking by giving by loving. ” anais nin here’s a quick sampling of her achievements. at each age she: 52 — climbed 900 foot devil’s tower in wyoming 53 — had a major role in last of the red hot lovers. 54 — placed second in a body building contest that was not age grouped! 55 — ran the centennial trail 113 miles across south dakota from wind cave national park to the top of the sacred bear butte 56 — was challenged by bladder cancer and won. 57 — married jerry dunn during the disney world marathon and finished the race. they were interviewed on the today show just after the ceremony at the magic kingdom. 58 — climbed mt. kilimanjaro and won the marathon there the day after we got off the mountain. 59 — won the swimsuit competition in the golden times newspaper and was featured on the front page and as the centerfold. 60 — ran from the atlantic to the pacific ocean across panama 60 miles to celebrate her 60th birthday. 61 — became mrs. south dakota and participated at the national level for mrs. america. she was 30 years older than the other contestants. 62 — ran a marathon of marathons 26. 2 marathons in the year 2000. one of these was completed with three of her children who were running their first marathon. 65 — completed a doctor of philosophy in psychology researching the self-efficacy of women who begin marathoning after the age of 40. 71 — was the recipient of the spirit of dakota award annually honoring one woman whose leadership qualities courage strength and community commitment illustrate the best of south dakota womanhood. alright elaine’s quite an exceptional woman and i’m not asking anyone to start rock climbing at the age of 60 or pick up marathoning. however i just wanted to drive home the point with my velvet sledgehammer that it’s never ever too late in life to wake up get up and challenge yourself for mental spiritual and physical growth and fitness. become fearless and don’t be afraid to put it out there no matter your age. here’s the lesson. never say “i’m too old to do that. ” old is an attitude that gets in the way of living your life to the fullest. approach new challenges you may want to participate in with this phrase on your lips “that sounds interesting. i’ll give it a whirl and see what happens. ” don’t look at numbers. focus on the quality of every breath you take. age is after all just a number.

### Human:\ndoes white tea have the same health benefits as green tea especially fat burning benefits.\n\n### Assistant: both white and green teas come from leaves of the same plant (camellia sinensis) and are the least processed of all the teas. for this reason green and white teas have similar health benefits. green tea is used more in studies because it is readily available and more popular than white tea. the key difference between the two teas is white tea leaves are picked earlier (younger) and are less processed than green tea. the benefit is higher levels of antioxidants and polyphenols with research showing white tea may be the most effective tea in helping prevent cancer. i don't know of any studies showing that they are comparable on fat oxidation but i would assume it would be similar. so if you enjoy white tea drink away and reap the health benefits. for more on key differences in teas see this article <link>

### Human:\nhow does krill oil help with fighting cancer\n\n### Assistant: krill oil a rich source of omega 3 fatty acids docosahexaenoic acid (dha) and eicosapentaenoic acid (epa) plays a key role in a healthy diet. according to the american cancer society there is some research that fish oils with these omega 3 fatty acids such as krill oil decrease the rate of cancer cell growth but not all studies agree. the most evidence for the benefits of fish oil is improving heart health including risk factors such as high triglycerides. always check with your healthcare provider about taking supplements during cancer treatment. for more on the benefits of krill oil see this webmd article <link>

### Human:\ncan you live without a pancreas?\n\n### Assistant: yes. the pancreas has two main functions: secretion of insulin which controls blood sugar levels and secretion of digestive enzymes and hormones. although not a perfect solution these functions can be replaced through insulin injections and oral pancreatic enzymes with meals. surgery to remove the pancreas completely is rarely done so very few people have no pancreas at all. much more common is having a pancreas that doesn’t work properly. in people with type 1 diabetes the pancreas stops making insulin but continues to make digestive enzymes. in cystic fibrosis and chronic pancreatitis both insulin and enzyme production are often impaired. after surgery to remove part of the pancreas (such as for pancreatic cancer) in some cases the remaining pancreas can’t make enough insulin enzymes or both. people with diabetes are at higher risk for heart attacks and strokes and low pancreatic enzymes can lead to vitamin deficiencies. artificial replacement doesn’t work as well as a healthy pancreas but it allows many people with pancreatic insufficiency to live full active lives. is a person able to live without a pancreas

### Human:\nshould liver cancer patient consume significantly less water per doctor's instruction? why is this? . the male patient is very old age 98 and has liver cirrhosis with digestion issues. the doctors advised not to consume more than 1 liter liquid per day including all contents of liquid in the various forms of meals that are consumed. why is water is not good for liver with problems? dehydration and weakness due to loss of energy with reduced food intake and water consumption is questioned. water intake should help body to retain strength and energy. your response would be appreciated.\n\n### Assistant: often times with liver disease like cirrhosis edema or what is often referred to as ascites occurs which means fluid accumulates in the abdominal cavity putting pressure on other organs including the kidneys. while the patient can still be dehydrated too much water can cause the fluid accumulation to worsen. sodium levels can also decrease and fluid is then restricted. if you are not interested in aggressive therapy at this point in his care talk to his doctor about other treatment options. good luck!

### Human:\nhow can i convince the medical insurer to pay for newly on-the-market drugs (re cancer patient stage 4)? . my sister has metastasized breast cancer. afinitor appears to be the drug treatment option with the most hope. how can i convince the medical insurer to ok (and pay for) this drug treatment? what are the most likely to succeed methods to put the pressure on them for the purpose of extending my sister's life with these new medical treatments?\n\n### Assistant: insurance companies pay for medications when a drug has received fda approval for treatment or there are advanced clinical trials (phase iii and above) which show that the treatment is effective. what is hard for patients and families to sometimes understand is that insurance companies only pay for proven therapies not experimental therapies. this is especially hard when the disease is cancer. fortunately the national institute of health and drug manufacturers are very involved in clinical trials for new cancer drugs or new indications for cancer drugs. clinical trials are very important because cancer drugs are generally very toxic and expensive and we need scientific evidence to decide on the best treatment options not anecdotal successes. because each cancer patient’s situation is different we want to make sure that a drug works for a particular patient. not all breast cancer patients are the same. some have limited disease some have advanced disease some breast cancers occur before menopause some after and hormonal and genetic characteristics can vary from patient to patient. afinitor (everolimus) is fda approved for breast cancer in combination with aromasin (exemestane) for certain postmenopausal women. the breast cancer must be advanced hormone-receptor positive her2-negative and in patients who experienced a recurrence or progression of their cancer after treatment with hormone therapy using femara (letrozole) or arimidex (anastrozole). if your sister fits in this category then her cancer doctor can write a letter to the insurance company citing her qualifications. another important avenue to pursue for cancer patients is clinical trials. you can look up clinical trials on the web site <link> by cancer type and features in your zip code or state. there are several ongoing breast cancer trials using everolimus (afinitor) that may be applicable to your sister. talk with her cancer doctor about clinical trials and assistance in working with the insurance company to get the best treatment for your sister.

### Human:\nhow can i get control back in my life after a cancer diagnosis?\n\n### Assistant: once you have dealt with the shock of a cancer diagnosis you will need to be as organized as possible in order to make your cancer journey as livable as possible. your treatment: choose caregivers whom you like and trust. choose one oncologist to be your most trusted adviser and ally to help you make the best decisions at every juncture of your cancer journey. your loved ones: although there is only one person going under the surgical knife or receiving chemotherapy cancer still affects an entire family and more. seek the help of professional counselors who will help you cope with cancer as well as provide guidance on how to communicate effectively with your loved ones about your situation. your support system: family and friends will want to help you cope with cancer but they will need guidance on how best to do so. let them help you with chores children and transportation to and from treatment. your mind: the diagnosis and treatment of cancer no matter how successful the result frequently causes depression and anxiety and nearly always uncertainty. learning how best to cope with these is vitally important to getting through the treatment phase and especially during long-term survivorship. your work: you and your employer will want to know how much time you will need to deal with cancer. do not try to maintain a full work schedule during arduous treatments. consider short or long-term disability depending on the rigors and after-effects of treatment. your finances: even if you are highly likely to survive your cancer the diagnosis is a good reason to get your financial situation in order for the sake of you and your loved ones. your time: the ultimate goal is for you to have your life so organized that you can deal with cancer treatment almost on autopilot. this will also enable you to have time for yourself which is an essential component of the recovery process.

### Human:\nwill plastic surgery make my vagina smaller?\n\n### Assistant: many genital plastic surgery techniques are based upon gyn surgical procedures used for medical problems such as reconstruction after cancer treatment gender change repair of cystocele/rectocele etc. unfortunately there are few good studies showing benefit where there is no overt medical problem. . the american college of obstetricians and gynecologists has noted the lack of both safety and effectiveness data for genital plastic surgery. the possible complications for such surgery might include: infection changes in sensation pain with intercourse and scar tissue. one gyn who has been performing genital plastic surgery for a number of years concluded that agreed-upon terminology and training standards are still lacking.

### Human:\nwhat other diseases have the same symtoms as als?\n\n### Assistant: amyotrophic lateral sclerosis (or als) is also known as lou gehrig’s disease. its symptoms are caused when the nerve cells that send signals to the muscles slowly begin to die. at first als may cause weakness in an arm or leg or even in the face. but the weakness gradually progresses to include both arms and legs. muscles may start to twitch. it may become harder to use fine motor skills for tasks such as writing. eventually talking swallowing walking and even breathing are affected. other medical problems can also cause some of these symptoms. these include: • spinal stenosis or narrowing of the spinal canal • pinched nerves in the neck or back • lead poisoning • hiv/aids • thyroid and parathyroid disease • vitamin b12 deficiency • brain tumors • lymphomas • other neuropathies or nerve damage there are other more rare conditions that can also cause these symptoms. if you or a loved one has symptoms of als you need to seek the help of a neurologist. your doctor can refer you to one. if als is diagnosed then you might want to find an als center attached to the neurology department of a major teaching hospital. outlook -length of recovery from cervical spine tumor recovery-loss of arm & partial leg function

### Human:\nhow does chemo effect blood sugar levels? . the morning after chemo treatment my blood sugar was 208 i'm usually in range under 120 with an occasional 140. my type 2 diabetes is diet controlled.\n\n### Assistant: some chemo drugs can elevate blood sugar levels. it's important to talk to your doctors about whether or not you need to add medication during your cancer treatment to help keep blood sugars controlled. good luck!

### Human:\nwhat is an iron infusion? . an iron infusion is simply a liquid dose of iron given in the veins.\n\n### Assistant: an iron infusion is simply a liquid dose of iron given in the veins. iron is an essential mineral that we get from eating foods such as meat eggs and leafy greens. iron is needed to make hemoglobin the oxygen-carrying substance in red blood cells. many people especially women having regular menstrual periods have low iron levels (iron deficiency). if iron remains low for weeks or months the body makes fewer red blood cells and a low blood count (iron-deficiency anemia) can result. for the overwhelming majority of people with iron deficiency taking iron pills every day replaces the missing iron and low blood counts return to normal. in a few people iron pills aren’t sufficient to keep up with iron losses. this can occur when there is ongoing bleeding or the intestines can’t absorb the swallowed iron. in other people oral iron may cause a bad reaction. people in these special situations may need to receive an iron infusion to replace the missing iron. an iron infusion is most often given at a doctor’s office or hospital. a nurse places an iv and a bag of fluid containing dissolved iron drains into the person’s veins. some conditions or situations that may require an iron infusion include: • people with inflammatory bowel disease with severe iron deficiency • people with end-stage renal disease on dialysis • people with cancer and anemia • people taking erythropoietin or similar drugs to stimulate red blood cell production iron infusions are generally safe but severe reactions to the drug preparation do occasionally occur. these can cause shortness of breath itching spasms or (rarely) a life-threatening allergic reaction called anaphylaxis. how many times do you have to iron infusion to not feel tired?

### Human:\nhow can i help prevent an infection during my cancer treatment?\n\n### Assistant: in addition to receiving treatment from your doctor the following suggestions can help prevent infections: clean your hands frequently. watch out for a fever. if you have a temperature of 100. 4ºf or higher for more than 1 hour or a one-time temperature of 101ºf or higher it’s very important that you call your doctor immediately even if it is in the middle of the night. get the seasonal flu shot as soon as it is available. shower or bathe daily and use an unscented lotion to prevent your skin from becoming dry and cracked. these cracks can allow germs to enter your body. clean your teeth and gums with a soft toothbrush and if your doctor or nurse recommends one use a mouthwash to prevent mouth sores. try to avoid crowded places and contact with people who are sick. do not share food drink cups utensils or other personal items such as toothbrushes. cook meat and eggs all the way through to kill any germs. carefully wash raw fruits and vegetables. protect your skin from direct contact with pet bodily waste (urine or feces) by wearing vinyl or household cleaning gloves when cleaning up after your pet. wash your hands immediately afterwards. use gloves when gardening. try and keep all your household surfaces clean. visit www. preventcancerinfections. org to learn more about steps you can take to prevent an infection during your chemotherapy.

### Human:\ni'm due for my next round of chemotherapy but just learned i have neutropenia. what is this and what does it mean?\n\n### Assistant: neutropenia pronounced noo-troh-pee-nee-uh is a decrease in the number of white blood cells. chemotherapy drugs work by killing fast-growing cells in the body. this means these drugs kill cancer cells as well as healthy white blood cells. since white blood cells are the body’s main defense against infection this means you are at an increased risk for getting an infection while you have neutropenia. i also suggest that you visit www. preventcancerinfections. org to learn more about your risk for developing neutropenia during your chemotherapy. many times neutropenia produces little symptomology and is only diagnosed through other unrelated serum blood testing. neutropenia is an abnormal low number of neutrophils. neutrophils are a form of white blood cells that help the immune system to fight-off infections. the bone marrow produces these cells which release chemicals when the body is being attacked by bacteria such as caused by wounds. your bone marrow creates these cells. they then travel in your bloodstream and move to areas of infection. they release chemicals to kill invading microorganisms. during chemotherapy interference with the bone marrow’s ability to produce neutrophils may occur resulting in even more intense neutropenia. treatment of neutropenia is directed at its cause such as eliminating certain medications (antibiotics psychiatric drugs & antiepileptic meds etc. ) and other causes. it is advisable to control the neutropenia before starting chemotherapy. i wish you well on your journey to renewed health.

### Human:\ni have no medical insurance. am i eligible for a free mammogram and if so how and where?\n\n### Assistant: well the provisions about the preventive care really deal with insurance plans that are in the market. so what the affordable care act did was say starting with plan years jan. 1 2011 from that point on as plans are renewed individuals will no longer pay a co-pay for everything from getting their kids' immunizations to having mammograms or cancer screenings because we really want to encourage people to get checkups in advance to get situations identified which may cause serious health problems and get them found. in a case where someone. has no health insurance at all the best possibility really is to find the nearest community health center and community health centers are throughout the country talking to her health department about where is the closest community health center. community health centers are being expanded through the affordable care act but they are community-based providers of primary care and preventive care who deal with individuals who have full insurance who have partial insurance and people who have no insurance coverage at all. everything from cancer screenings often there's dental care available and checkups for kids. it's very high-quality low-cost care and that would be the best option.

### Human:\nis there any otc method of removing freckles from your face?\n\n### Assistant: there is not a product to eliminate freckles. however if you have sunspots or darker areas that have developed later in life after sun exposure there is a prescription-strength bleaching cream that can be used to reduce the color. whether it is freckles or sunspots it is important to have the discoloration checked out to make sure it is not an early sign of skin cancer. a dermatologist can aid in a skin cancer screen which takes about 15-20 minutes. the doctor can also assist with getting you a prescription for bleaching cream if the discoloration is not cancerous.

### Human:\nwhat is mcv?\n\n### Assistant: mcv stands for mean corpuscular volume. it’s the average volume of the body’s red blood cells measured in femtoliters (one-quadrillionth of a liter). cell-counting machines calculate mcv from a blood sample. a normal value may vary between laboratories but is usually between 80 and 96 femtoliters (fl). an mcv above 100 fl is called macrocytosis. when anemia (low red blood cell count) is also present it’s called a macrocytic anemia. causes of macrocytic anemia include deficiency of b12 or folic acid medication side effects alcohol abuse and certain blood cancers. macrocytic anemia can also occur in healthy people who are rebuilding their blood supply (after surgery for example). an mcv below 80 fl is called microcytosis (or microcytic anemia if the red blood cell count is also low). microcytic anemia can be due to iron deficiency blood loss (in women most often from menstruation) chronic illness or a condition causing abnormal hemoglobin like sickle cell disease or thalassemia. it’s not unusual to have an mcv that’s slightly abnormal without any serious condition identified as a cause. often in these cases the mcv becomes normal again on its own when it’s next tested.

### Human:\nwhat are the risks of long term use of hormone replacement therapy?\n\n### Assistant: the main concern with prolonged ht is an increased risk of breast cancer. the risk seems to be greater in women taking combined therapy (estrogen plus a progestogen) than in women taking estrogen alone. and it may be that starting ht right away after menopause is also associated with greater risk. the good news is that the risk returns to baseline within several years after stopping ht. you should also be aware that combined ht can make it more difficult to read your mammogram (both while you're taking hormones and in the first years after stopping). as a result you might be called back for additional views or biopsy of suspicious areas. right now most experts recommend limiting ht to several years. the nams 2010 ht position statement ( www. menopause. org/psht10. pdf ) suggests that longer use is acceptable for a woman if she believes that the benefits outweigh the risks (especially if she's had trouble stopping therapy). the other condition includes women with low bone mass or osteoporosis who cannot tolerate osteoporosis drugs. the one exception to limiting ht to a few years is the woman who has had premature menopause either because of natural failure of her ovaries or surgical removal. in that case most experts are comfortable advising you to continue ht at least until the age of natural menopause about age 50 at which time you can reassess. if you've been taking hormones for a very long time you might want to start by discussing a lower dose. many clinicians now prescribe half the dose we used to use.

### Human:\nwhy can’t i urinate?\n\n### Assistant: not being able to urinate at all despite a strong urge to is an urgent problem. usually the severe discomfort or pain that results drives a person to seek medical attention quickly. more commonly people have difficulty urinating. in men this is usually caused by an enlarged prostate gland. the urethra the tube through which urine passes travels through the prostate on its way to the penis. the prostate slowly grows with age and in some men this squeezes the urethra and reduces urine flow. medications can shrink or relax the prostate improving urination. if medication fails prostate surgery can restore urine flow. women who can’t urinate sometimes have a urinary tract infection (uti) and antibiotics may be necessary. other causes of blocked urination include medications kidney stones tumors in the abdomen or pelvis or a narrowed urethra from past infections.

### Human:\nmy mom has stomach cancer and it is bad what do i do and look for win it is her time to go home\n\n### Assistant: i am very sorry to hear that your mother is so sick. from your question it sounds like she is still in the hospital. before she is sent home ask her if you can talk to the doctor who is taking care of her. you will need her permission for the doctors and nurses to talk to you about her illness. this is to protect her privacy. have a list of questions ready to ask the doctor. depending on your mom’s health you might want answers to some of the following questions. • is there any special diet that she will be on? if so can you talk to a dietitian? • will you need any special equipment at home to help take care of your mom? (like a bedside commode or hospital bed) • will homecare nurses be coming out to help her? • will she be in any pain and if so what can you do to help her? • will she be having any further treatments? • what can you and your mom expect over the next several days or weeks? when should you call the doctor? • is she on any new medication? if so how does she take it and are there any side effects? • would hospice care be appropriate at this time? • are there any support groups for cancer patients and their families in the area? hopefully you will get all the answers that you both need. your mother is very lucky to have someone like you to be her advocate.

### Human:\ndo i need a yearly pap. i'm 60 years old. post menopausal. i've had three children. i've had yearly pap smears all of my life up until age 55. all of them have been benign. do i need to continue having them? i am asexual.\n\n### Assistant: probably not an annual pap unless you have a family history of uterine or cervical cancer had some risky sexual exposure in the past and are not having any gynecological symptoms. remember that a pap smear is just a test. there are other important components on a pelvic examination that should not be skipped. a pap smear only reveals cervical or endocervical cells that may be cancerous. the pelvic examination can find other abnormalities in the uterus ovaries and pelvic area. like suspicious masses etc. hopefully you are getting a mammogram colonoscopy and other preventative tests needed at your age.

### Human:\nwhat is cystoscopy?\n\n### Assistant: cystoscopy is endoscopy for the urinary system. in endoscopy a doctor inserts a flexible tube with a lighted camera at the tip into the body. a video screen provides a real-time view of the body’s interior. in cystoscopy a doctor inserts the endoscope (cystoscope) into the urethra (urinary opening). the doctor can then advance the cystoscope into the urinary bladder. cystoscopy is generally done to identify potential problems in the urinary system. for example the doctor could see a tumor in the bladder and take a small piece (biopsy) for testing. cystoscopy is usually an outpatient procedure or may be performed in the hospital for people who are more seriously ill.

### Human:\ndoes resveratrol really work?\n\n### Assistant: resveratrol which is a compound found largely in the skins of red grapes has gained a lot of media attention and has been touted as having many beneficial health effects. resveratrol is a component of ko-jo-kon an oriental medicine used to treat diseases of the blood vessels heart and liver. it came to scientific attention during the mid-90s as a possible explanation for the “french paradox” — the low incidence of heart disease among the french people who eat a relatively high-fat diet. since then it has been touted by manufacturers and examined by scientific researchers as an antioxidant anti-cancer agent and phytoestrogen. it has also been advertised online as “the french paradox in a bottle. ” if you do a literature search and look at well-accepted peer review journals there is very little published to support any of these effects of resveratrol. new work produced by both amgen and pfizer has cast doubt on the manner in which the health supplement is said to work. prominent researchers supposed that it worked by activating a certain gene sirt1. this activation is thought to produce the benefits of a caloric restriction diet even among those with high fat and high caloric intake. in 2009 in chemical biology and drug design amgen scientists published experimental results that indicate resveratrol does not in fact activate sirt1. pfizer scientists in the journal of biological chemistry in 2010 offered similar results showing that resveratrol (and related substances such as srt1720) do not active sirt1 and did not reduce blood sugar in mice fed a high-fat diet. thus it suggests that resveratrol doesn’t work at all (though it’s not possible to translate mice studies into human studies). despite what is promoted on many national television shows on health none of the claims has been demonstrated in any valid human study. while present in other plants such as eucalyptus spruce and lily and in other foods such as mulberries and peanuts resveratrol’s most abundant natural sources are vitis vinifera labrusca and muscadine grapes which are used to make wines. it occurs in the vines roots seeds and stalks but its highest concentration is in the skin. the resveratrol content of wine is related to the length of time the grape skins are present during the fermentation process. thus the concentration is significantly higher in red wine than in white wine because the skins are removed earlier during white-wine production lessening the amount that is extracted. grape juice which is not a fermented beverage is not a significant source of resveratrol. since wine is the most notable dietary source it is the object of much speculation and research. resveratrol is also available from supplement pills and liquids in which it is sometimes combined with vitamins and/or other ingredients. it is also an ingredient in topical skin creams. the supplements are generally labeled as containing from 20 to 500 mg per tablet or capsule. however the purity of these products is unknown. and because dietary supplements are loosely regulated it should not be assumed that the labeled dosage is accurate.

### Human:\nhow can i gain weight?\n\n### Assistant: eat more! that’s what nearly all weight gain strategies come down to although it’s not always quite that simple. people with certain health conditions are at risk for poor nutrition: celiac disease inflammatory bowel disease cystic fibrosis cancer chronic obstructive pulmonary disease (copd) human immunodeficiency virus (hiv) infection many others. people who are losing weight with these conditions should ask their doctor for a referral to a nutritionist. a low appetite is often part of the illness and eating higher-calorie foods is advised. some of these illnesses can also cause poor absorption of nutrients and testing and treatment can address this. in any medical condition if muscle mass has been lost it’s important to include protein in the diet to help rebuild muscles. healthy young men and teenage boys often want to gain weight usually in the form of muscle. their challenge is usually eating enough to keep up with the calories they’re burning in their active lifestyles. to gain weight by building muscle it’s necessary to eat a lot of protein. weight-training athletes may require 75 to 100 grams of protein or more daily. healthy lean protein sources include chicken eggs fish and beans. whey protein supplements can be mixed in with drinks soups or sauces. soy protein supplements are not advised except in small amounts because some of the soy may be converted to estrogen in the body. it’s best to talk to your doctor or a nutritionist before starting a high protein diet if you have any health conditions especially liver or kidney disease. gaining weight can be just as difficult as losing weight for some people. an essential component of weight gain is eating enough calories each day. a registered dietitian will be able to calculate and estimate your calorie needs using the harris-benedict equation or there are also websites available to help you do this on your own. in order to gain weight theoretically you need to eat more calories than what would normally be necessary for you to maintain your current weight. keep in mind it’s still important to eat healthy and make the right food choices. don’t use this as an excuse to eat whatever you want because you’ll end up gaining fat that way. you’ll need to exercise too especially by incorporating strength-building exercise which will help to build muscle mass to add to your weight. the surgeon general recommends at least two days per week of strength training exercising each major muscle group. of course the more exercise that you do the greater the benefits you should notice. keep in mind however that you do need rest to allow your muscles to recover. make sure that you’re getting enough protein in your diet as well. only protein has the essential amino acids necessary for muscle growth and development. a registered dietitian can also help you to determine your protein requirements. ask your doctor before taking protein supplements or beginning a high protein diet. i’ve recommended a good article for more information: <link>

### Human:\ni haven't been able to smell anything or taste for a while now what can be the cause for this?\n\n### Assistant: our senses of smell and taste are intertwined. our ability to smell is what makes us able to “taste” the flavor of the foods we eat. many things can interfere with the ability to smell and taste. among the most common offenders include allergies nasal polyps and sinus infections. in these cases the loss of smell often comes on gradually. there can also be a gradual loss of smell and taste as we age. infections in the mouth may cause problems with both taste and smell as well. a sudden loss of smell is more likely caused by a virus (like the flu) or head trauma. zinc deficiency is also known to affect the sense of smell. some zinc nasal sprays on the other hand have been implicated in complete loss of smell. both alzheimer's and parkinson's disease can affect the sense of smell but other symptoms would likely be present first. rarely a tumor in the brain or sinuses can be the cause of a decrease in smell or taste. you will have to see your doctor to get to the bottom of this. and depending on the cause you may need to see an allergist ear nose and throat specialist or dentist to finally get some relief. good luck to you! whats cause you to loss taste bud no smells i havent been able to taste or smells in a while chronic sinus infection

### Human:\nwhy can't i urinate?\n\n### Assistant: not being able to urinate at all despite a strong urge to is an urgent problem. usually the severe discomfort or pain that results drives a person to seek medical attention quickly. more commonly people have difficulty urinating. in men this is commonly caused by an enlarged prostate gland. the urethra the tube through which urine passes travels through the prostate on its way to the penis. the prostate may slowly grow with age and in some men this squeezes the urethra and reduces urine flow. medications can shrink or relax the muscles in the prostate and bladder improving urination. if medication fails prostate surgery can restore urine flow. women who can’t urinate may have a urinary tract infection (uti) and antibiotics may be necessary. other causes of blocked urination include medications kidney stones tumors in the abdomen or pelvis or a narrowed urethra from past infections. stallic1835@cinci. rr. com lon16don

### Human:\nwhat should i do to prepare for a transesophageal echo?\n\n### Assistant: before a transesophageal echocardiogram tell your doctor if you have any problems with your esophagus such as hiatal hernia swallowing problems or cancer. on the day of a transesophageal echocardiogram do not eat or drink anything for six hours before the test. take all of your medications at the usual times as prescribed by your doctor. if you must take medication before the test take it with a small sip of water. if you have diabetes and take medication or insulin to manage your blood sugar please ask your doctor or the testing center for specific guidelines about taking your diabetes medications before the test. someone should come with you to your appointment to take you home as you should not drive until the day after the test. the sedation given during the test causes drowsiness dizziness and impairs your judgment making it unsafe for you to drive or operate machinery.

### Human:\nwhat is arthropathy?\n\n### Assistant: arthropathy just means “joint problem. ” doctors often use arthropathy interchangeably with arthritis which means "joint inflammation. " there are some forms of arthropathy that are distinct from arthritis: neuropathic arthropathy: nerve damage from diabetes or another nerve condition results in slow damage to joints. in diabetic people arthropathy usually affects the foot and ankle. (arthritis may also be present. ) hypertrophic pulmonary osteoarthropathy: the ends of bones in the ankles knees wrists and elbows start to grow abnormally and painfully in an adult. the tips of the fingers become rounded called clubbing. this form of arthropathy occurs more often in people with lung cancer. hemarthrosis: bleeding into a joint like the knee can occur after injuries or medical procedures and is a common problem in people with hemophilia. arthritis is common and other arthropathies are uncommon so in most cases when a doctor says arthropathy it means arthritis.

### Human:\nwhat temperature is considered a "fever" for cancer chemotherapy patients?\n\n### Assistant: if you have a temperature of 100. 4ºf or higher for more than 1 hour or a one-time temperature of 101ºf or higher this should be considered an emergency. you should call your doctor right away even if it is in the middle of the night. it’s important for you to remember though that even if you don’t have a fever but just aren’t feeling well you should call your doctor right away no matter the time of day. www. preventcancerinfections. org is an excellent resource to learn more about the risk of getting an infection during your chemotherapy.

### Human:\nwill my insurance costs go up under health reform?\n\n### Assistant: i assume by “insurance costs” you are talking about patients’ spending on medical care in the form of deductibles copayments and coinsurance. for most people the answer is “no”. the health reform law requires that insurers pay the full cost of a wide range of preventive services including cancer screenings immunizations and fda-approved contraceptives. the law places limits on insurance plans’ administrative overhead spending and profits and requires plans to pay for a certain percentage of health care costs (though most plans already satisfy this requirement). it also eliminates insurers’ limits on total lifetime benefits and limits the size of deductibles in small firms’ health insurance plans. some people may be eligible for subsidies to help them offset their out-of-pocket costs on medical care. the health reform law reduces payments to medicare advantage plans (private plans that enroll medicare beneficiaries). enrollees in medicare advantage plans may have to pay more for their care in the future.

### Human:\nis a pap smear or hpv test recommended for women?\n\n### Assistant: your age may be one of the more important determinants in whether hpv testing is recommended. among younger women infections with hpv are very common. often a younger woman’s immune system is able to fight off an hpv infection. thus some type of pap smear may be the best choice for screening. by contrast if a women in her 30s or older has a positive test for high risk hpv it might be assumed that she has a more worrisome persisting infection. 90% of cervical cancers occur in unscreened or under-screened women (demay 2000). so you do need to get screenings but the type and interval of screening is going to depend upon your age and probably high risk hpv screening tests. liquid based paps do reduce the number of “false negative” results in the majority of women. ask your gyn if your pap will be a liquid type and if it will be reviewed by automated and human screeners. if you have one of the high risk hpv subtypes by dna testing request a copy of the results for your files so you will know which subtype you have. even if you have received a hpv vaccination you should will still need a pap smear. the recommended interval is still under discussion.

### Human:\nhow do you erase age spots on the face at the age of 65?\n\n### Assistant: your first step is to make sure that the "age spot" is not an early skin cancer. once this is excluded your dermatologist can prescribe a combination of exfoliating agents and brightening compounds that may contain hydroquinone bearberry or kojic acid to even your skin tone.

### Human:\ni have become addicted to brushing my teeth with baking soda and rubbing alcohol. are there any dangers to this?\n\n### Assistant: alcohol as you know is a highly addictive substance and repeated use can lead to oral cancer. baking soda has some benefits but is too abrasive to use regularly. get "addicted" to an ada approved toothpaste. craved foods or non-foods = body desperate for missing minerals. eating craved items fails to get minerals the system needs increasing use to perceived "addiction". body "knows" what's needed seeks what resembles? what's missing. could be salt sugar etc. too. older cultures ate special clays for this: problem solved! pregnant mothers sought special clays--probably higher in magnesium to counter eclampsia. others chose different clays. many have used mezotrace or simply kelp snacks to fix this; either of these have all the minerals in good balance. even just eating lots of veggies helps. mezotrace is a fine powder sprinkles on food usually at health food stores. kelp snacks are sold in lots of stores now--tasty! you will most probably stop craving baking soda once your body gets it's needed minerals. most do; amounts differ per person. one sister literally snowed on her dinner plate with salt; took fresh veggies lost the salt shaker. get needed nutrients only that it does and craves sources of minerals strongly enough to drive serious cravings. i cannot explain how a body knows what to seek out just that it does but often fails to get them due to mans' manipulation of our food sources over time. various clays have been used for this supplementation for thousands of years.

### Human:\nis it possible to get breast cancer after a complete hysterectomy?\n\n### Assistant: this is a little complicated. i think it will help to go over the terms that doctors use for female pelvic surgery. a hysterectomy is the surgical removal of your uterus. a “total hysterectomy” means that the entire uterus and cervix are removed. having a hysterectomy does not increase your chances of getting breast cancer. a “complete hysterectomy” is a non-medical term that is sometimes used to refer to surgery that removes the uterus as well as the ovaries and tubes. removing the ovaries can reduce your risk for breast cancer. if your ovaries are removed (oophorectomy) along with your uterus your doctor may suggest hormone replacement therapy. this is usually estrogen-only rather than combination therapy. according to the american cancer society this type of estrogen-only replacement does not increase the risk for breast cancer. in fact it appears to decrease the risk. i hope this answers your question. here is a webmd article that discusses some recent research concerning hormone replacement after hysterectomy and breast cancer risk.

### Human:\nhow often should i see the dentist for my dentures?\n\n### Assistant: if you have dentures your dentist or prosthodontist will advise you about how often you need to visit but every 6 months should be the norm. regular dental visits are important so that your denture and mouth can be examined for proper denture fit to look for signs of oral diseases including cancer and to have your teeth professionally cleaned.

### Human:\nwhy is having an infection such a big problem for cancer patients on chemotherapy?\n\n### Assistant: infections are a serious health issue for cancer patients because an infection during chemotherapy can be life threatening. because of your cancer and your treatment you may not be able to fight off infections like you normally do. in fact about 60 000 patients with cancer who have received chemotherapy are hospitalized with neutropenia in the united states each year. more than 4000 of these people will die of their infection. visit www. preventcancerinfections. org to learn more about steps you can take to prevent an infection during your chemotherapy.

### Human:\ni’m newly diagnosed with cancer. what are some important things for me to know?\n\n### Assistant: hearing the diagnosis of “cancer” is quite simply a shock to the system. the first reaction is often panic followed by a tidal wave of emotions: “how can this be? ” “why me? ” “i’m scared and not able to handle this. ” but handle it you must. the following is a list of essential things that anyone newly diagnosed with cancer should know. 1. understand the diagnosis. there are many different types of cancer even within the same broad category. for example breast cancer has three general categories: hormone receptor positive (for the estrogen and/or progesterone receptors) her2 positive and triple negative (hormone receptors and her2 are negative or not present); the three types are often treated very differently. nearly every type of cancer has different sub-types and it is important to know which one you have. 2. do not jump the gun and think the worst. not all cancers of the same type act the same. some “bad” cancers may be curable. get all the facts straight and get them only from the experts who treat the disease not from physicians who are not cancer experts and not from well-meaning friends and family who “know someone with…” 3. meet first with local specialists. what other tests are needed to fully determine the stage or extent of the cancer in the body? do you need surgery chemotherapy and/or radiation? have these questions answered first in your community near where you live or work. physicians that specialize in treating cancer have been highly trained whether they practice in a community setting or at a large medical center. since cancer treatment may not be a one shot deal but can involve six months or more of therapy it is important to make these treatments as convenient and safe as possible. having a good cancer center close to home can make a world of difference. 4. consider a second opinion. the need for a second opinion depends on the quality of the first opinions you receive and on your preferences as a patient. do not think that the grass is greener elsewhere and that an incurable cancer is curable at a more heavily advertised center. if the cancer specialists in your area have an excellent reputation and you like their approach to you and your cancer then you may not feel that another opinion is necessary. on the other hand if you feel that surgery is better performed at a high volume center for example or you just want the peace of mind that comes with confirmation of treatment recommendations then a second opinion is right for you. the best doctors do not dissuade patients from seeking other opinions nor from receiving cancer care close to home when that is more convenient.

### Human:\ni have skin tags in both underarm areas. how many skin tags can typically be removed in one office visit?\n\n### Assistant: skin tags are common acquired benign skin growths that look like a small piece of soft hanging skin. skin tags are harmless growths. some individuals may be more prone to tags -- between 50-100 tags. males and females are equally prone to developing skin tags. obesity and being moderately overweight (even temporary increases) dramatically increase the chances of having skin tags. normal-weight individuals with larger breasts are also more prone to skin tags under their breasts. some small tags spontaneously rub or fall off painlessly and the person may not even know they had a skin tag. most tags do not fall off on their own and stay around once formed. the medical name for a skin tag is acrochordon or fibroepithelial polyp. skin tags can occur almost anywhere on the body where there is skin. however the top two favorite areas for skin tags are the neck and armpits. other areas include the eyelids upper chest (particularly under the female breasts) buttock folds and groin folds. tags are typically thought to occur in high-friction locations where skin rubs against skin or clothing most often. in general there is no limit to the number of skin tags that can be removed at one office visit as long as your overall health permits the in-office procedure.

### Human:\nwill health insurance through the marketplace cover genetic testing for breast cancer?\n\n### Assistant: yes in most circumstances insurance should cover the genetic test for breast cancer.

### Human:\nwhat causes a large uterus?\n\n### Assistant: there are a few reasons for why the uterus measures larger than the dates. the most common reason is you are further in the pregnancy then you think. but since you had an ultrasound exam this is not the case. another reason could be you are carrying more than one child like twins. but if you had an ultrasound exam they should have seen this (although this can be missed). uterine fibroids (benign muscle tumor) of the uterus can make the uterus larger then you think. the other thing it may be is your doctor is wrong. it is just an estimation. i would not be too concerned about it at this time. when you see your doctor ask him about what the ultrasound exam showed. you can also call the office and speak to someone to read you the ultrasound results. uterus larger than the dates:? = wrong date (lmp) =polyhydramnious (excess amount of amniotic fluid in uterus) =larger baby (macrosmia) =multiple pregnancy =molar pregnancy =uterine fibroids =pelvic mass uterus smaller than the dates.? =wrong date (lmp) =oligo hydramnious =smaller baby (microsmia) =head engaged too deeply =genetic (maternal paternal small size) =intrauterine growth restriciton (iugr) =intrauterine death (iud)

### Human:\nwhich preventive care screenings and tests will be free after september 23? will they need a doctor's referral?\n\n### Assistant: well you don’t need a doctor’s referral. hopefully you’ll go to the doctor to get the screening but you don’t need any special visit in advance of the screenings. and the preventive care option will cover a wide variety of things. so for parents children’s immunizations and vaccines will be covered a whole variety of cancer screenings will be covered mammograms and colon cancer. the u. s. preventive care task force which is a group of medical providers who are in the public health service actually look at preventive services that are the most effective and update their recommendations on a regular basis and they grade them a through d of what is effective for which age category and what kind of condition. and any screening that gets an a or a b will be automatically included in the kind of preventive care that’s offered without co-pays and without co-insurance. it’s very good news for people. … if you’re a 58-year-old woman with a chronic condition you would be recommended to get a pap smear yearly even if you’re healthy a mammogram yearly; you may have a screening or two for diabetes or for other conditions. you will be looking at potentially $300-$400 out of pocket and that for a lot of people is a pretty high financial burden particularly now in this downturn. …we’re updating medicare benefits so medicare beneficiaries will be able to have preventive care and have an annual wellness test. we’re getting to illness at the outset making sure that we can stop people from getting sick as opposed to paying for the care once they get sick makes good sense. and i think this is a great benefit that will be coming effective again on or after september 23. and it’s really good news for lots of folks.

### Human:\nwhat does it mean if your thyroglobin ab are very high but all the others are normal? and how does that affect the body? . i am wondering if the thyroglobin ab being high could correlate to the weight gain(15+ lbs a month and can't lose it) breast enlargement(2 cup sizes) fatigue and lack of menstration. i have been tested for cancer(negative) and i have no family history of these issues. from the research i have done i cannot find an answer so i am hoping that someone could enlighten me so i would have a stepping stone the next time i went to the doctor about this.\n\n### Assistant: a high thyroglobin antibody level in and of itself does not mean you have thyroid disease. they are found in nearly 20% of all women. however high levels of thyroglobulin antibodies associated with other thyroid antibodies are found in 80 to 90% of people with immune mediated inflammation of the thyroid (hashimoto’s thyroiditis). this is the most common type of thyroid hormone deficiency in the u. s. thyroglobulin antibodies are also found in pregnant women relatives of patients with hashimoto’s thyroiditis and in people with other immune mediated diseases such as type 1 diabetes. the usual course of hashimoto's thyroiditis is gradual loss of thyroid function. antibodies to thyroglobulin are considered to occur as a result of damage to the thyroid from special white blood cells (t cells). common symptoms of thyroid hormone deficiency include fatigue being cold all the time weight gain constipation dry skin and menstrual irregularities. since these symptoms occur in other diseases it is important not to always blame thyroid deficiency as the cause. fortunately laboratory tests for thyroid function make this diagnosis relatively easy. however because loss of thyroid hormone develops over time and antibodies can herald problems you will want to follow-up with your doctor about your thyroid tests and your symptoms.

### Human:\nwhat foods will increase albumin? . my husband's albumin level is 2. 4 and the low level is preventing him from participating in a clinical trial for lung cancer.\n\n### Assistant: a low albumin can be caused by a variety of factors including nutrition medications and fluid status. talk to his doctor about how much fluid your husband needs and potential contributors to his low albumin. as long as he has no diet restrictions getting adequate protein can help. protein sources include eggs chicken fish meat cheese/milk nuts/nut butters and beans. aim for at least one protein source at each meal and with snacks. make sure his diet is balanced with other foods to balance out his diet. sample day: b-fast: omelet with veggies and toast snack: greek yogurt topped with nuts and fruit lunch: turkey chili with side of fruit and bread snack: smoothie with added protein powder dinner: fish whole grain & veggies

### Human:\ndo you have any advice on how i can avoid splotches and keep my freckle face healthy?\n\n### Assistant: my advice for freckles is to keep them protected from the sun or they will become darker larger and look more like age spots. also they may camouflage a more serious mole that needs a biopsy to determine if it’s a risk of cancer. in addition to daily use of an spf 30 sunscreen to protect from both uva/uvb rays skin-brightening agents can be applied twice a day for a more blended youthful appearance. brightening agents that are approved for purchase include licorice extract niacin and low dose hydroquinone 1% to 2% strength. finally general skin health steps such as moisturizing with key antioxidant vitamins like vitamin e c and vitamin a will help keep your freckles closer to how they looked when you were young.

### Human:\ni am having trouble swallowing my food. it feels like i the food wont go down. i have very little teeth. i want to eat but every time i do the food won't go down and i end up having to throw it up.\n\n### Assistant: you need to see your doctor right away if you are having trouble swallowing your food. there can be many possible causes for trouble swallowing. some can be very serious. here are a few of the things that can cause difficulty swallowing: • the esophagus (the tube that runs from your mouth to your stomach) may be partially blocked by a tumor or web. it may also be narrow due to severe reflux. • a swelling in a surrounding area such as the thyroid or lymph node may be pressing in on the esophagus. • there could be a problem with the nerves or muscles that are involved in swallowing • poor teeth can be preventing food from being properly chewed • diseases such as diabetes or scleroderma may prevent the esophagus from moving the food along webmd has a very good article on difficulty swallowing that can give you some more information. but do call your doctor now and make an appointment to have this checked out.

### Human:\nnumbness of the tongue causes. my husband has type 2 diabetes and has been expierencing numbness of the tongue. he also has peripheral aertial disease. could either one of these cause the numbness of the tongue?\n\n### Assistant: there are many things that can cause numbness or tingling of the tongue. some of these include: • problems within the brain—such as multiple sclerosis stroke or brain tumor • problems with a nerve in the mouth or the face—most commonly the result of dental procedures such as tooth extractions. • vitamin or mineral deficiencies—such as low vitamin b 12 folate iron • infections—such as yeast infections or the tingling that comes before a cold sore • burning mouth syndrome • certain medications • toxic exposures diabetes can cause nerve damage but that usually affects the feet and the hands. peripheral artery disease also affects the arms and legs. your husband should see his doctor to see what is causing his discomfort. he may be referred to an ear nose and throat specialist to help find the cause. i hope he gets some relief soon.

### Human:\nwhat is a tracheotomy?\n\n### Assistant: in medical terms the suffix “-otomy” means to cut or separate. in a tracheotomy a surgeon cuts a small hole in the front of the trachea (windpipe). tracheotomy is most often performed on people who require weeks of mechanical ventilation (dependence on a breathing machine). tracheotomy is also performed in emergencies for choking; for people with neck cancer; as an extreme treatment for obstructive sleep apnea; and for other less common conditions. after the surgeon cuts through the skin and trachea she inserts a plastic tube into the hole. this tube is called a tracheostomy tube (“-ostomy” means an artificially created passage out of the body). oftentimes the surgery and the tube itself are referred together simply as a tracheostomy.

### Human:\nwhat causes thrush?\n\n### Assistant: small amounts of the candida fungus are present in the mouth digestive tract and skin of most healthy people and are normally kept in check by other bacteria and microorganisms in the body. however certain illnesses stress or medications can disturb the delicate balance causing the fungus candida to grow out of control causing thrush. medications that upset the balance of microorganisms in the mouth and may cause thrush include corticosteroids antibiotics and birth control pills. illnesses or medical situations that make candida infection more likely to develop include uncontrolled diabetes hiv infection cancer dry mouth or pregnancy (caused by the hormonal changes that occur with pregnancy). people who smoke or wear dentures that don't fit properly also are at increased risk for thrush. in addition babies can pass the infection to their mothers during breast-feeding.

### Human:\ni lost my brother to breast cancer. since having children i still get some milk out of the nipple. is this normal?\n\n### Assistant: it is important for women to know that breast cancer can be a man's disease as well. this also means that a genetic link can come from a male relative. fortunately the symptom you describe is not likely to be linked to breast cancer risk. it is not uncommon for women to be able to get small amounts of nipple discharge after having breastfed. the usual triggers for this to occurs are: nipple stimulation a a part of sexual foreplay hot showers birth control pills or "checking for discharge" by repeated squeezing. sometimes women will notice discharge from one or both nipples. this prompts concern especially if she has not recently breast fed. generally we tell women that bilateral white or clear discharge which is only present with nipple stimulation is likely to be "normal. " as mentioned above being on birth control pills can sometimes enhance breast discharge. certain psychiatric medications—especially the antipsychotics —can initiate nipple discharge. bilateral spontaneous secretions can be prompted by a pituitary problem or hypothyroidism. both low thyroid and elevated prolactin (from the pituitary gland) can be checked for using simple blood tests. the most concerning nipple discharges are those which are red/bloody unilateral and coming from just one or two ducts. if you were my patient i would check a sample of the discharges for undiscernable blood (using the fecal blood card). i would do a careful breast exam and might send you for a mammogram or ultrasound—depending upon your age. i prefer to be safe rather than sorry--even when the discharge sounds non-pathologic. so get it checked out even though it is likely that you will be told it is ok.

### Human:\nwhat is the benefit of aloe vera?\n\n### Assistant: aloe promotes wound healing. applied to damaged skin some studies show aloe penetrates into the tissues and exerts anti-inflammatory effects. aloe leaves have been used for centuries as treatment for minor cuts and burns. today aloe is often processed into a gel or lotion that can be smeared on the skin easing pain and itching. aloe may be helpful in treating psoriasis seborrheic dermatitis and genital herpes. aloin a component of aloe taken by mouth is a laxative that can help relieve constipation. aloe has been tried as treatment or prevention for a multitude of other conditions including lung cancer diabetes and hiv. there is no conclusive evidence that aloe is of benefit in these conditions.

### Human:\nwhat is fluoroscopy?\n\n### Assistant: fluoroscopy is a continuous x-ray (think of it as an x-ray video). doctors use fluoroscopy to see inside the body in real-time during medical procedures. fluoroscopy machines vary in shape and size but they are usually quite large. as during a regular x-ray two plates are positioned in front and back of the person. the one in front is moveable and is positioned in front of the appropriate body area. during the procedure the doctor periodically activates the fluoroscopy machine and live x-ray images are displayed on a video screen. fluoroscopy delivers radiation to the body. the radiation risk from fluoroscopy is low. although fluoroscopy theoretically can increase the risk for cancer later in life the risk of not doing the appropriate procedure must be considered as well. the national cancer institute states that the benefits of properly performed fluoroscopy almost always outweigh the radiation risk to an individual.

### Human:\ncan reishi mushroom be used to srink fibroid tumors?\n\n### Assistant: you can use them if you want but there are no scientific studies that show fibroids can be shrunken by this non-traditional non-medical method. typically problematic fibroids will need to be removed surgically.

### Human:\nwhat are aging spots?\n\n### Assistant: aging spots or solar lentigos primarily result from sun damage. age spots have also been mislabeled as liver spots. (they do not have any correlation with liver disease. ) the majority of age spots are benign (noncancerous). if you notice any changes in the border color or diameter of any lesions on your skin you should be evaluated by your dermatologist.

### Human:\nwhat can cause black colored stools?\n\n### Assistant: the most serious cause of black stools is bleeding from somewhere in the gi tract. bleeding in the stomach esophagus or intestines can turn into a black color by the time it leaves the body as stool. this can be caused by bleeding ulcers stomach inflammation broken blood vessels in the esophagus called varices or tumors. this type of bleeding can be life-threatening. the bleeding can also come from a nosebleed or from the mouth if blood is swallowed. black stools can also be caused by supplements such as iron or medicines such as pepto-bismol. certain foods like blueberries or black licorice can also turn the stool black. your doctor can tell if there is any blood in the stool by taking a stool sample from the rectum and performing a simple test in the office. if you are having any black or tarry stools call your doctor right away.

### Human:\nwhat risks do the new pap smear guidelines pose to patients?\n\n### Assistant: the gravest risk for less frequent pap smears would be the development of a cervical cancer. fortunately cervical cancer is relatively slow growing with precancerous changes showing up well before true invasive cancer.

### Human:\ni recently finished a round of chemo and started to not feel good; i have a slight fever. should i call my doctor?\n\n### Assistant: call your doctor right away even if it is after hours. fever (a temperature of 100. 4ºf or higher for more than 1 hour or a one-time temperature of 101ºf or higher) may be the only sign that you have an infection and an infection during chemotherapy can be life threatening. it’s important for you to remember that even if you don’t have a fever but just aren’t feeling well you should call your doctor right away no matter the time of day. visit www. preventcancerinfections. org to learn about other signs and symptoms of an infection.

### Human:\nwhat are the symtoms and complications of vitamin d deficiency in adults age 30-35?\n\n### Assistant: i think a lot of it depends on how long you've been deficient and to what degree. it is well accepted that a lack of vitamin d increases the risk of osteomalcia (bone/muscle pain) osteopenia (lower than normal bone density) osteoporosis and bone fractures in adults. so in addition to working with your healthcare provider about getting your levels back up you may want to check your bone density to see if there's more you can do. most the symptoms of vitamin d deficiency are subtle or absent in the initial stages. low vitamin d levels have also been linked to the development of immune disorders heart disease and certain cancers but more research is needed to draw conclusions. the good news is you can correct your levels now to help keep you healthy for the years to come. for more on vitamin d read this article on webmd.

### Human:\nwhat causes a low white blood cell count?\n\n### Assistant: white blood cells are produced in the bone marrow. as they mature white blood cells are continually released into the bloodstream. white blood cells circulate throughout the body ready to fight infections. they live about two or three weeks when they are broken down and recycled by the body. a normal white blood cell count is between about 4 500 and 10 000 cells per microliter. many conditions can cause a low white blood cell count: • infection (which usually increases the white blood cell count but may decrease it). • drugs especially chemotherapy. • human immunodeficiency virus (hiv). • severe alcohol abuse. • radiation therapy. • cancer affecting the bone marrow. • connective tissue disease (such as systemic lupus erythematosus). many african-americans have a naturally lower white blood cell count. this is caused by a gene mutation that may have evolved as a defense against malaria. most often a low white blood cell count is temporary and improves on its own.

### Human:\ncan medications pass from one person to another through mucous membranes oral or skin contact or sexual contact?\n\n### Assistant: yes. medications that are applied topically can be absorbed by touching skin to skin. there are some medications that are so strong in effect (such as cancer medications) that simply touching them can cause side effects. there is no list of these medications. so it is important to ask your local pharmacist or check with your physician.

### Human:\nis there a certain time after my chemotherapy when my neutropenia may be the worst?\n\n### Assistant: find out from your doctor when your white blood cell count will be at its lowest since this is when you’re most at risk for infection. this period of time is often called nadir and occurs between 7 and 12 days after you receive chemotherapy. this period can be different depending upon the chemotherapy you get. you should carefully watch for signs and symptoms of infection during this time. visit www. preventcancerinfections. org for more information about nadir.

### Human:\ncan being over weight cause arthritis in your feet?\n\n### Assistant: while excess weight doesn't necessarily cause arthritis in places like your feet it can exacerbate it or make it progress in a more rapid fashion. excess weight puts additional stress on joints making arthritis symptoms worse. losing weight will not cure arthritis but it can help slow down the progression of the disease. for more details on how this works see this webmd article. weight bearing joints like knee and ankle are most likely affected by arthritis. being overweight is a known risk factor of arthritis and even putting on 10 pounds may worsen the arthritis. while treating arthritis in obese and overweight individuals weight loss is considered as an important strategy.

### Human:\ncould minor surgery cause signs of multiple sclerosis exacerbation such as clumsiness dizziness and muscle spasms?\n\n### Assistant: people will frequently relate onset of symptoms to certain life events (surgery car accident etc). it is not clear if there is cause and effect but we know that stress can affect the immune system. there is also some work to suggest that ms patients may have exacerbations more frequently when under stress than not. so call your neurologist and discuss what is happening. david

### Human:\nbroken or sprained wrist. i tripped and fell. i don't know if my wrist is broken or sprained. it doesn't hurt much if i leave it resting on my leg or even typing this but if i try to carry something like my laptop or notebook which i usually do with no problem it hurts badly. also i can move it left to right with minor pain but up and down causes the same pain as holding something. also i can move my thumb pretty well with barely any pain. is it broken or sprained?\n\n### Assistant: the only way to make a determination if you have a sprain or a fracture is to have an x-ray of your wrist. there are not home self-exams that could rule out a fracture simply based on symptoms. you will need to see a medical provider. there are many degrees of fractures and sprains (and you can actually have both) so an x-ray is needed to offer a definitive answer.

### Human:\nwhat is the best way to stop hormone replacement therapy?\n\n### Assistant: once you and your clinician have decided that it's time to stop what's the best approach? the simple answer is that we don't know. formal studies to evaluate this question have failed to show that either going cold turkey or tapering off is better. so the choice is really yours. the important thing is to know that women in general have about a 50/50 chance of experiencing hot flashes again (although maybe not as severe as initially) after stopping. some studies suggest that symptoms peak within 3 months after stopping hormones. after you stop take some time to evaluate how you feel before beginning any new medication so you don't get the two effects confused. there are a couple of other things to keep an eye on once you've stopped ht. if you develop vaginal dryness or recurrent urinary tract infections ask your clinician about vaginal estrogens. nonhormonal lubricants and moisturizers can also help with dryness. and you might want to ask about a bone density test. we know that women who stop ht often lose bone. depending on your bone density score and risk profile you might be a candidate for an osteoporosis drug (bone-sparing). at any rate discuss calcium and vitamin d supplements weight-bearing exercise and fall prevention with your clinician. another good idea is to have your cholesterol rechecked in about 3 months after stopping ht because hormones can affect "lipid levels" (both good and bad). and if you're taking a thyroid medication for an underactive thyroid your dose might need to be adjusted. thanks for your reply!

### Human:\nhow do i become a better runner as someone with moderate experience running?\n\n### Assistant: don’t get stuck constantly doing the same thing. challenge your current routine by experimenting with different types of runs. for example incorporate long runs to build endurance intervals to increase speed or hills to increase strength. you might find that experimenting with these different types of runs can add to the enjoyment you experience while running and can help to promote better running performance. next consider occasionally doing cross-training which in this case means doing exercise other than running. for example try adding swimming biking or strength training to your current exercise routine. cross-training helps to prevent burnout whether physical or mental and can help prevent overuse injuries. sometimes repeatedly doing the same exercise can be monotonous and redundant and you might get bored and want to discontinue with your exercise. adding variety to your routine can help keep exercise enjoyable for you. finally allow yourself time to rest and recover. over-training can hurt your progress and lead to injury such as stress fractures. resting is as important as the time you dedicate towards running.

### Human:\nwhat causes an arrhythmia?\n\n### Assistant: arrhythmias may be caused by many different factors including: coronary artery disease. electrolyte imbalances in your blood (such as sodium or potassium). changes in your heart muscle. injury from a heart attack. healing process after heart surgery. irregular heart rhythms can also occur in otherwise normal healthy hearts. what is the difference between atrial tachycardia and svt?

### Human:\ncan you have a bad tooth pulled and then wait a year to replace bone and have a dental implant inserted?\n\n### Assistant: theoretically yes. but i believe it may be better to do the bone graft at the time of extraction. ask your dentist if there are any payment arrangement options that you can use to help you pay for the treatment you need.

### Human:\nif you let your child suck his thumb or use a pacifier will he need braces when he’s older?\n\n### Assistant: thumb sucking and the use of a pacifier can lead to an open bite where the teeth in front don’t come together. if a child stops early enough the bite will come back together on its own. when you take your child for his orthodontic screening around 8 years old they will tell you if braces are needed.

### Human:\nmy son is on depakote and is showing signs of bone loss. what can we do?\n\n### Assistant: many older anti-epileptic drugs (dilantin tegretol phenobarb) have been identified to cause bone loss. more recently depakote has also been shown to potentially contribute to bone loss. problems with bone health frequently are a concern in an older age person with epilepsy but can [a]ffect younger individuals as well. in this setting you and your doctor could discuss switching to a different anti-epileptic drug that may have less of a problem with bone health. alternatively if this is clearly the best medicine for your son's seizures he could be treated for his bone loss initially with vitamin d and calcium with other meds added if needed. this is not an urgent situation as bone loss occurs slowly over many years but it is something you need to pay attention to and discuss with your doctor.

### Human:\nmy son fell and one of his permanent front teeth fell out. the tooth was put back in its socket. what can we expect?\n\n### Assistant: the accidental loss of an adult tooth is a grave event and very tricky to treat. even the best techniques sometimes fail to permanently save the tooth. bear in mind that there is a distinct possibility that your child may lose the tooth even if every precaution is taken. root canal gum surgery and orthodontic care all may be necessary to ultimately save the tooth. and sometimes that may not work.

### Human:\ncan doing facial exercises help relieve wrinkles?\n\n### Assistant: the short answer to this is no. in fact the reason we use botox (botulinum toxin) in the field of dermatology is to reduce the movement of facial muscles so that their overuse will not create fine or deep creases in places like the glabella (between the eyebrows) or across the forehead.

### Human:\nhow can i find a good orthodontist or oral surgeon for my daughter?\n\n### Assistant: first i would ask your pediatric dentist for a referral. if that doesn’t work contact the local dental society in your area.

### Human:\ndoes aerobic exercise interfere with muscle gains from weightlifting?\n\n### Assistant: your body prefers not to use amino acids the building blocks of muscle as an energy source unless it has to because it’s simply not the most efficient way for your body to get the energy it needs. your body will typically use the more efficient means of attaining energy first. weight lifting and aerobic exercise can complement each other well but if you have concerns with not being able to gain muscle mass keep the aerobic exercise at a moderate amount. it might be best to refrain from doing overly excessive endurance aerobic events. try doing high intensity interval training. interval training involves coupling short bursts of high intensity exercise with less intense recovery periods. for example you could run on a treadmill for 1 minute at 8mph and then jog for 30 seconds at 6mph repeating for a total of 10 to 15 minutes. this is just an example to illustrate the point; you can do different intensity levels and different work to rest ratios. consider also doing circuit training which is a workout regimen involving resistance training with very little rest in between exercise sets. this form of exercise is high intensity and helps keep your heart rate elevated so that it can function as aerobic exercise while providing a foundation for muscular strength and endurance. lastly make sure that you are getting enough protein in your diet. the essential amino acids necessary for muscular growth and development can only be obtained through dietary intake. if you’re not getting enough protein you won’t be building muscle regardless of your activity. if you're training for an endurance event like a marathon when you might run 60 miles or more per week you'll almost always see a decrease in your muscle mass. for most of us who do more moderate amounts of physical activity there will be minimal if any loss in muscle mass from aerobic exercise -- so there's nothing to worry about. if you do plan on lots of aerobic exercise and are concerned about losing muscle try starting with 20-30 minutes of moderate aerobic exercise (at 50% to 70% of your maximum heart rate) two to three days per week and see how it goes.

### Human:\nwhat is the treatment for a tooth growing out of the roof of a child’s mouth?\n\n### Assistant: sometimes teeth do not have enough room to erupt into the mouth and can be impacted in the palate. the best way to deal them it is to get treatment with an orthodontist and an oral surgeon to uncover the tooth and to guide eruption into the mouth.

### Human:\nhow can you tell a child has strep?\n\n### Assistant: when your child has a sore throat it’s important to find out if it’s strep throat or not. ever wonder why? strep (officially called group a streptococcus) is a bacterial infection that needs to be treated with antibiotics. and all the other sore throats caused by the virus of the week just need time and tlc to resolve. why does strep need to be treated? while many people clear the throat infection on their own untreated strep can do some pretty serious damage in other body parts. untreated strep can infect the heart brain and joints. that’s called rheumatic fever. and it’s why we need to know if that sore throat is due to strep bacteria. doctors have always known that strep prefers to infect school-aged kids instead of babies toddlers or preschoolers. but a recent study in the journal pediatrics confirmed this. about 37% of school-aged children who see their docs for a sore throat will have a strep infection. but only 24% of children under five years of age have strep when they have a throat infection. bottom line: little kids usually get viral sore throats big kids are more likely to have strep. so how do docs know when it’s strep throat (besides doing a strep test of course). here are 10 things that make me think of strep: 1. 5 years of age or older? 2. sore throat without runny nose or cough? 3. sore throat with headache and/or stomachache? 4. sore throat and fine pinpoint sandpapery/rough feeling rash (called “scarlet fever”)? 5. sore throat and raised dots on the tongue (called “strawberry tongue”)? 6. sore throat and a persistent fever for more than a couple of days? 7. (for girls) sore throat and a really red vaginal area? 8. sore throat and really red skin around his/her anus? 9. strep going around your child’s school childcare or your house (late fall winter spring)? 10. a history of getting strep throat before? if you think your child has strep don’t panic. even if your child has had the illness for a few days antibiotics will do the trick to clear the infection and prevent rheumatic fever. just make an appointment to see your child’s doctor!

### Human:\nwhy should babies under 1 year old not eat honey?\n\n### Assistant: it's because honey (and other products such as improperly canned foods or some corn syrups) may contain bacteria called clostridium botulinum that can cause botulism in infants. the symptoms of botulism include severe muscle weakness poor feeding and breathing problems and occurs in about 100 infants every year. babies (especially those younger than 6 months) are at risk because their digestive systems are not mature enough to handle the bacteria. fortunately most babies receive medical treatment and can recover fully.

### Human:\ni m 26 year 54kg 168cm height guy my bone mass n strength not imprving even i have taken all calcium also do gym daily\n\n### Assistant: it looks like you are working hard to gain muscle strength and bone mass. as for bone mass you also need vitamin d because without it calcium cannot be deposited into bone. the best thing to do is get a blood test to see if you have enough vitamin d in your blood. your healthcare provider can help you decide on the appropriate level of supplementation if your vitamin d is low. without knowing your workouts and diet it's difficult to comment on your muscle strength goals. this webmd article will provide you with the basics. you can also see a certified personal trainer for additional help. good luck!

### Human:\nwhat causes dry mouth?\n\n### Assistant: there are several causes of dry mouth also called xerostomia. these include: side effect of certain medications. dry mouth is a common side effect of many prescription and nonprescription drugs including drugs used to treat depression anxiety pain allergies and colds (antihistamines and decongestants) obesity acne epilepsy hypertension (diuretics) diarrhea nausea psychotic disorders urinary incontinence asthma (certain bronchodilators) and parkinson's disease. dry mouth can also a side effect of muscle relaxants and sedatives. side effect of certain diseases and infections. dry mouth can be a side effect of medical conditions including sjögren's syndrome hiv/aids alzheimer's disease diabetes anemia cystic fibrosis rheumatoid arthritis hypertension parkinson's disease stroke and mumps. side effect of certain medical treatments. damage to the salivary glands the glands that produce saliva for example from radiation to the head and neck and chemotherapy treatments for cancer can reduce the amount of saliva produced. nerve damage. dry mouth can be a result of nerve damage to the head and neck area from an injury or surgery. dehydration. conditions that lead to dehydration such as fever excessive sweating vomiting diarrhea blood loss and burns can cause dry mouth. surgical removal of the salivary glands. lifestyle. smoking or chewing tobacco can affect saliva production and aggravate dry mouth. continuously breathing with your mouth open can also contribute to the problem.

### Human:\nwhy can't i urinate?\n\n### Assistant: not being able to urinate at all despite a strong urge to is an urgent problem. usually the severe discomfort or pain that results drives a person to seek medical attention quickly. more commonly people have difficulty urinating. in men this is commonly caused by an enlarged prostate gland. the urethra the tube through which urine passes travels through the prostate on its way to the penis. the prostate may slowly grow with age and in some men this squeezes the urethra and reduces urine flow. medications can shrink or relax the muscles in the prostate and bladder improving urination. if medication fails prostate surgery can restore urine flow. women who can’t urinate may have a urinary tract infection (uti) and antibiotics may be necessary. other causes of blocked urination include medications kidney stones tumors in the abdomen or pelvis or a narrowed urethra from past infections. stallic1835@cinci. rr. com lon16don

### Human:\ni'm 45 years old. in the last six months my four bottom front teeth have shifted. is it worth going to an orthodontist?\n\n### Assistant: although it’s completely up to you i would recommend having a comprehensive exam with your general dentist to rule out a periodontal or gum and bone problem. then you can see the orthodontist.

### Human:\nhow important is it to maintain proper form when weight lifting?\n\n### Assistant: most people agree that "proper form" during lifting is important but data to prove that proper form will prevent injuries or improve performance does not exist. in the american college of sports medicine position statement "progression models in resistance training for healthy adults " it is written "it is important to note that proper technique is used for any exercise velocity in order to reduce any risk of injury " but no research is provided to back up this statement. there's another factor to consider when thinking about form. that is if proper form were to be proven effective for injury prevention and performance improvement what would the form look like? for instance during biceps curls you're supposed to stand up straight and keep your shoulders back and weightlifting books contain suggestions like sitting up straight and relaxing your shoulders when doing leg extensions but so little of this advice is evidence-based that it's questionable if it should be recommended universally. perhaps more important is the fact that we all have different anatomy and biomechanics and so our bodies move differently when doing all sorts of activities. no one not even professional athletes throws a baseball exactly the same or swings a golf club the same or serves a tennis ball the same and so why should weightlifting be any different? this is not to say that one should be reckless when lifting but perhaps there is more to injury prevention than just proper form. the consensus amongst strength-training professionals is that many weightlifting injuries are due directly to individuals who lift aggressively with weight that is too heavy for their musculoskeletal system and that improper form is only indirectly the culprit. for instance if an individual is performing biceps curls with weight that is so heavy that they must lean way back to cheat the dumbbells up then they might put tremendous strain on the lower back and end up injuring a vertebral disc or straining a lumbar muscle. the poor form may have put the body in a position of weakness and vulnerability but it was the excess weight that was the root of the problem. here are some simple tips to keep in mind when weightlifting: for beginners: 1. select weights that you can comfortably lift 12-15 times to fatigue. as the months go by and you get stronger you can progress to heavier weights and fewer reps (8 to 12). 2. select simple exercises that target specific muscle groups and require less skill and coordination than complex multi-joint exercises like squats lunges power lifts and dead lifts. for example seated leg extensions might be a better choice than giant lunges across the gym until you feel comfortable with your skill. for everyone: 1. stop lifting if you feel strain in a joint. burning in the belly (middle) of the muscle is okay. 2. listen to your body. this is critical. focus on the muscle group that you are working and make sure you feel it there and not everywhere else. if you don't feel it in the muscle then adjust the angle of your arms or legs or hands until you do feel it. if you need help doing this then ask an experienced lifter to help or hire a trainer to instruct you. after all if you're going to spend time lifting you might as well maximize your workout. in summary if you (a) take your time and lift mindfully and (b) feel it in the belly of the muscle you're trying to work and not in the joints and (c) you select weights that your body can handle without having to cheat or force the weight up then the chances of injury are probably going to be reduced. proper form helps to ensure two things that you’re working the intended muscle and that you’re helping to minimize your risk of injury. basic strength training is designed to isolate a target muscle or muscle group through a set range of motion or action meant to improve muscular strength and endurance or to improve athletic performance. in other words not following proper form may leave you with less than desired results since you may not be working the specific muscle as intended. as for proper form helping to prevent injury there really isn’t much research to prove that claim necessarily. common sense however would suggest that performing high risk behaviors may increase your chances for injury. twisting jerking excessively forceful or high impact motions or movements may increase the risk for injury in an unconditioned person as will perhaps using muscles other than were intended for certain exercises. proper form alone or as part of series of actions can help to control your movement and technique to prevent injury.

### Human:\nwhat could cause me to be almost impossible to wake up in the mornings?\n\n### Assistant: this is a very common problem. there are many causes of this as well. the commonest disease that results in severe sleepiness is sleep apnea however that does not generally make it so difficult to wake up in the morning. narcolepsy is another sleep disorder that is more common than many realize. in this disorder patients have daytime sleepiness coupled with very vivid dreams episodes of feeling paralyzed upon awakening disrupted night time sleep and episodes of muscle weakness induced by strong emotions such as laughing. several people have described these symptoms. the most difficult to treat however is idiopathic hypersomnia. in this condition people just cannot seem to get enough sleep regardless of how much they sleep. getting up in the morning is very difficult. physicians will typically do sleep studies and daytime sleep studies to arrive at this diagnosis and will treat it with various stimulants such as provigil nuvigil adderall and others. all these medications often have only marginal effect and physicians and patients must try various combinations to get to the best possible effect. sometimes when getting up in the morning is difficult physicians administer these medications at different times to fascilitate morning awakening. other disorders such as circadian rhythm disorders (maladjustment of the internal body clock) can also cause difficulty waking up and sleepiness during the day. persisting with a sleep specialist is very important. often more than one or two visits are needed to get to the bottom of such difficult problems.

### Human:\nshould i have a follow up on my foot? . i walked into my childs toy last friday. i hit it on the left middle of my foot. it instantly swelled up. i went to the er later that night. they took x-rays said there was not anything wrong. well now 5 days later all of my toes are bruised and above my toes. if i hit the side of my foot it hurts and if i walk on it too much it hurts. its still hard to bend my toes and i really don't understand what my toes have to do with that part of my foot. should i go back to the doctor?\n\n### Assistant: yes. go back to your doctor to have your foot checked. he or she will have to look at the foot to decide what is wrong. your foot has 26 bones. there are 5 long straight bones called metatarsals beneath the top of the foot. each of these ends in bones called phalanges which are the toes. tendons that move the toes are attached to these bones. any bruising or swelling in the foot can affect the ability to move the toes by pressing on these tendons. bruising or bleeding can also spread throughout the foot and up into the toes. possibilities include a bad bruise sprain or a small fracture that did not show up on the first x-ray. this is not unusual. your doctor will decide whether further x-rays or other testing is needed.

### Human:\ncan type 1 diabetics gain weight using yeast pills? . i am a maie type 1 diabetic. i am 5'4 in height and weigh 108lbs. i am trying to gain weight and my doctor says that my metabolism burns up everything i consume quickly. i was told that by taking yeast pills that i may be able to gain some weight. is this possible and what are the risks. i want to know what my weight should be and how i can attain that.\n\n### Assistant: i cannot find any research that shows taking yeast results in weight gain. as for your weight you body mass index in borderline normal weight meaning you are on the lower end of normal. this bmi calculator can give you more personalized info and help you decide where you want to be. i highly recommend you visit to a registered dietitian who can take your diabetes into account while advising you on diet. you can find one at eatright. org. exercise especially resistance training and a balanced diet can help you build muscle which can increase weight over time. for more on healthy weight gain see this article.

### Human:\nam blood sugar 86 - ate water 4 hamburger patties 1/4 c almonds 1/4 c cashews 1/4 cup plain yogurt next am 99 how? . i have candida and have been monitoring my blood sugar to ensure it doesn't go too high and further my problems. i don't understand how i can go from blood sugar of 86 one morning to 99 the next when i had no more than 31 carbs all day. please help me understand where i'm making my mistake. . water = carb free. 4 hamburger patties = (<1 each). 1/4 cup cashews = 8 carbs. 1/4 cup almonds = 8 carbs. 2 tblsp plain yogurt = 11 carbs in a cup\n\n### Assistant: diet is not the only factor that increases blood sugar. if you don't have diabetes your blood sugar will be tightly controlled either by increasing insulin to combat high carb intake or utilizing stored forms from the liver and muscles to be put back into the blood stream. so even though you take in little carbohydrates your body will aim to keep levels within a normal range. when the diet remains low in carbohydrates and the stored sources run low the body then turns fat into glucose but this also produces ketones which can have unpleasant side effects. don't forget your brain needs glucose! according to the institute of medicine individuals need 130g of carbohydrate for the brain to run efficiently. i would check with your healthcare provider or registered dietitian for the appropriate diet for your condition. if you have diabetes it's best to see a diabetes educator to help with any changes in diet as medication is also likely to change.

### Human:\ndoes biotin help reduce lactic acid build up. i started kick boxing and doing a lot more activity in an effort to get back into shape. i was told biotin would help break down the lactic acid build up in my muscles\n\n### Assistant: although biotin does play a role in amino acid metabolism there are no studies (that i can find) that show taking biotin decreases lactic acid production. if someone is deficient in biotin it could limit performance or muscle formation but that is unlikely. if you are getting enough through diet you probably don't need to supplement. for more on lactic acid and biotin see these articles: exercise and lactic acidosis biotin supplement guide

### Human:\nmy orthodontist wants to remove some of my son’s teeth for a better orthodontic result. should i get a second opinion? . the other option i was given included having surgery for his jaw. we could just get braces without doing any preparation beforehand. but then he may need braces again -- or surgery -- as an adult.\n\n### Assistant: it sounds like you don’t like something that you’ve heard or like there may be a trust issue between you and your son’s orthodontist. i think a second opinion is always a good idea in that case.

### Human:\ni brush my teeth floss and scrape my tongue twice a day. i don’t see any tartar. can i go for a cleaning in 9 months?\n\n### Assistant: yes you can. but the preferred timing is every 3-6 months based on your dentist's recommendation. you may think that you are removing all of your dental plaque but you cannot see below the gum line in the deep dark spaces that allow the bad bacteria to grow and proliferate. these are the bad bacteria that eat away bone and cause the premature loss of teeth. research has shown that the “bad bacteria” which can eat bone recolonize at about 90 days after a professional cleaning.

### Human:\n<link> pro factor t 2000 review choosing the best body building work out is completely dependent on the individuals real features along with ambitions. healthy proteins comprise connected with amino acids which are utilised because basis on the muscle tissue development method. as well as because of the number of muscle mass which is engaged inside activity . <link>\n\n### Assistant: please. please. refrain from using webmd medical sites for your advertising. your inappropriate postings take up valuable space for people seeking answers to their medical concerns. be respectful.

### Human:\nhow can i avoid midlife weight gain?\n\n### Assistant: the keys are three: mind mouth muscle. use your mind to control stress. . you may respond to stress by making poorer lifestyle choices such as not eating healthfully and not exercising enough. look at your nutrition -- in terms of quality quantity and frequency of eating. you should eat often. quality is all about eating whole foods fruits and vegetables whole grains lean protein. quantity is where a lot of people fall. the majority are baffled by what a serving size should look like. when eating out and in doubt eat half of it or less. be accountable for calories. you need a general idea of how many calories you need. an average woman not an athlete in her 40s or 50s needs about 1 500 to 1 600 calories a day on average if she is exercising. a middle-aged man average height and not an athlete but exercising needs about 1 800 to 2 000. muscle of course refers to the need to exercise and of course to weight train.

### Human:\nshould i hold off on weight training until i lose weight?\n\n### Assistant: absolutely not. lifting weights will not only help you lose weight but maintain the loss. here's why: muscle keeps your metabolism revved up burning calories fat and glucose (sugar). when you lose weight up to 25% of the loss may come from muscle resulting in a slower metabolism. weight lifting will help preserve or rebuild any muscle you lose by dieting. muscle helps you with aerobic exercise. the stronger you are the better you will be at any aerobic activity. weight training improves your body's muscle-to-fat ratio (you end up with less body fat and more muscle) which improves both your health and your fitness level. gaining muscle will help you look better as you define and tone your physique. building strength helps you feel good about yourself. although the scale may show a slight weight gain when you start lifting weights (usually five pounds or less) you probably won't look heavier because the gain is in muscle and your clothes may even fit more loosely. strength training along with cardiovascular exercise can boost your metabolism and can help you expend calories to lose weight. strength training however also has the added benefit of helping you to preserve muscle as well. if you lose weight while only doing cardiovascular exercise some of the weight loss may come from body fat as well as muscle. you want to preserve muscle because it can help to keep your metabolism elevated since muscle burns calories at a higher rate than fat. strength training can also help to promote a more “toned” appearance which would be another added benefit to you as well. the surgeon general recommends that you strength train all major muscle groups two or more days per week. consult your doctor before starting an exercise routine. no you should remaind that it's a continuous process. if you stop it your weight will start increasing.

### Human:\nwhat is left ventricular hypertrophy?\n\n### Assistant: left ventricular hypertrophy is enlargement of the muscle of the left ventricle one of the four chambers of the heart. left ventricular hypertrophy is common and often causes no symptoms. over time left ventricular hypertrophy can progress to congestive heart failure with symptoms of shortness of breath with exertion and fluid retention. keeping blood pressure under good control is important to prevent and treat left ventricular hypertrophy. rarely severe left ventricular hypertrophy can run in families a condition called hypertrophic cardiomyopathy. people with this condition should see a cardiologist in order to prevent complications over time.

### Human:\ncan you get cavities under your braces? if so how are those cavities treated?\n\n### Assistant: with braces teeth can decay just as easily as they would without them. your oral hygiene including frequent brushing water picking fluoride rinses and supplements and frequent cleanings during orthodontics treatment is imperative. usually cavities can be fixed while braces are still on. but sometimes they do have to be removed first.

### Human:\nhow successful are dental implants?\n\n### Assistant: success rates vary depending on where in the jaw the implants are placed but in general dental implants have a success rate of up to 98%. with proper care implants can last a lifetime. depends which clinic you are going to. i had come from australia just to get my dental work done. and i am so happy that i made the right decision. i had come to this dental clinic in mumbai and got my 4 root canal dental implants and bone grafting done. the treatment is not only affordable but also of superior quality as well. you can know more about the clinic on <link>

### Human:\nmy wife is in her fifties and hasn't had a period in over three years. could she still get pregnant?\n\n### Assistant: when a women has had a natural menopause. we suggest that birth control be used for 12 months after the last natural period. the reason is that some women will have a temporary interruption of ovulations/periods creating months of no periods. then periods and possible fertility can resume. this is especially common during the four years preceding menopause and the year following probable last natural period. bottom line after three years in a woman over 53 years old pregnancy is unlikely. . get off the pills! i was taking ortho-tricycline for years 50 yrs old ended up in hospital with "cardiac event" got to choose a cardiologist chewed me out royally for taking birth control pills @ my age (and my gyno had recommended them to help me sail through menopause). little did i know they could have killed me. cause high blood pressure blood clots--i was a heart attack waiting to happen and dr. said i definitely was headed for a stroke! get the blood test to show if you are in menopause to know for sure. use condoms get a hysterectomy whatever but don't kill yourself! when young the pill is great; no place for the over 50 crowd.

### Human:\nis it better to apply heat or cold to sore muscles after stenuous exercise?\n\n### Assistant: most helpful answer everything i have read says cold. if there is tissue damage the cold constricts blood flow which reduces spread of cellular components which can cause rupture of nearby cells making the injury worse and longer to heal. heat is not usually applied to an injury until 72 hours have passed. this is to increase circulation and promote healing. more recent research shows movement of skeletal muscles produces hormone-like substances that promote and speed healing of damaged or inflamed tissues throughout the body. so if you can move do. lastly a small meal of four parts carbs and one part protein within 90 minutes of exercise will help speed muscle recovery. the body will use that energy and protein to quickly try to re-construct those damaged tissues. this information is from exercise physiology. ice is typically among the first thing to do in the recovery process after strenuous exercise. icing your muscles helps to reduce pain and decrease swelling and inflammation. ice causes your blood vessels to narrow which will reduce your blood flow to the muscle or injured area. never place ice directly on your skin however. wrap an ice pack around a thin cloth and place on the affected muscle for ten minutes at a time. you can use ice multiple times per day for a few days after exercise but make sure to allow for your skin to return to room temperature before icing after each 10 minute interval. heat is typically applied to uscles or injuries that do not have swelling or inflammation. heat will cause your blood vessels to expand which improves circulation and allows more blood to go to the affected area. heat can be useful for chronic injuries and muscle soreness or it can be used before exercise to stimulate blood flow and help prepare the muscle for exercise. heat should also not be directly applied to skin and should be used for short 10-15 minute intervals. always check with your doctor before starting treatment of an injury especially if the condition worsens or fails to improve. within the first few days of an injury ice can help the process of healing. applying ice to injured tissue can cause blood vessels to shrink and this makes them less capable of releasing chemicals that lead to swelling inflammation and pain. after a few days it probably best to apply heat to sore muscles. this makes muscle spasms less likely and relaxes injured muscles. however because the events behind every injury are different speak with your doctor first. i have just spent the last 6 weeks in physical therapy. they always apply heat or have me get on a bike to heat up my muscles for 15 minutes before i go through any table massage work. next i do all my exercises then they end the session with 10 minutes of ice. somtimes what contributes to soreness is 1) lack of warm-up so insuffcicient oxygen was available to fuel the work. and 2) lack of cooldown which will help the muscles recover by completing any partial combustion of sugars for energy leaving residual metabolites such as one feels with the muscle burn of working beyond anerobic threshold. anerobic threshold can be increased through more careful training. i can exercise well beyond my predicted 100% of age heart rate for periods of 10 20 and 30 minutes or more

### Human:\nwill eating with new dentures be difficult?\n\n### Assistant: eating with new dentures will take a little practice and may be uncomfortable for some wearers for a few weeks. to get used to the new denture start with soft foods cut into small pieces. chew slowly using both sides of your mouth. as you get used to your new dentures add other foods until you return to your normal diet. be cautious with hot or hard foods and sharp-edged bones or shells. and avoid foods that are extremely sticky or hard. you may want to avoid chewing gum while you adjust to the denture. also don't use toothpicks while wearing dentures.