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MEDICAL MAILBOX.

"Coincidence is God's way of performing a miracle anonymously."--Anonymous

Celiac Sprue

Dear Dr. SerVaas:

For five months, I had increasingly severe diarrhea, some nausea, much gas, and some abdominal discomfort. A barium enema, upper GI, flexible sigmoidoscopy, and many stool specimens were all negative.

I eliminated all fruit (except bananas), raw vegetables, lactose (except some yogurt with acidophilus), gluten, and sugar from my diet. I finally got the diarrhea under control, but after a month, when I tried to replace some bread in my diet, it recurred.

What can I do to heal the bowel so I can eat a balanced diet to maintain my health? I will deeply appreciate any help you can give me.

Roberta Saunders Riverside, California

Since your symptoms recurred when you consumed bread, you will be interested in a recent report that nearly one million Americans may be suffering from gluten intolerance and not yet realize it, according to the Center for Celiac Research at the University of Maryland.

Celiac sprue is a genetic digestive disorder characterized by an intolerance to gluten, a protein found in wheat, barley, rye, and possibly oats. Ingestion of gluten by those affected with the disease can damage the intestines and result in malabsorption of nutrients and severe diarrhea. Celiac disease may also trigger joint pain, anemia, skin lesions, and unexplained seizures. In children, the disorder can cause unexplained weight loss and failure to grow.

Post readers may remember the article "The Girl Who Couldn't Eat Wheat" in the December 1984 issue. Margie Leland was chronically ill until she was 13 years old and her condition was diagnosed. She gave up all gluten and, in six months, went from 70 to 100 pounds and grew 2 1/2 inches.

Celiac disease can also originate later in life. Families sometimes find that ancestors or relatives have been unable to digest gluten or, more often, that they had intestinal disorders of unknown origin.

Although a blood test can detect antibodies specific for celiac disease, only an intestinal biopsy can definitively confirm the diagnosis. Once detected, the condition is controlled with a lifelong adherence to a gluten-free diet. Obvious sources of gluten are breads and cereals. In addition, gluten can be "hidden" in such foods as beer, commercial soups, sauces, hot dogs, ice cream, chocolate, processed meats, and salad dressings.

Readers can receive diet instructions for people who can't digest gluten by sending a self-addressed envelope to "Medical Mailbox." To order a copy of the Post article "The Girl Who Couldn't Eat Wheat," please send a $2 contribution to the Medical Education and Research Foundation, 1100 Waterway Blvd., Indianapolis, IN 46202.

Physicians or patients may contact the Center for Celiac Research if there is a suspicion that the disease is present or if they wish to participate in the ongoing study. Call the center at 410-706-2715 or visit www.celiaccenter.org on the Internet.

Early Detection of Lung Cancer

Each year, thousands of cancer patients owe their lives to newer and better methods that can detect the disease while it's still treatable.

Dr. Geno Saccomanno--who recently passed away in Grand Junction, Colorado, at the age of 84--was a pioneer in the early detection of lung cancer. In the early 1960s, Dr. Saccomanno's work with uranium miners and heavy smokers led to an improved lab technique to collect and test sputum samples. Often referred to as a lung "pap smear," his method detected squamous cell cancer before the disease showed up on x-rays and at a stage when it could be successfully treated.

Today, researchers are hopeful that special CT scans can identify the more prevalent types of lung cancer. Dr. Claudia I. Henschke, lead investigator of the new study, believes the advanced technology could greatly reduce deaths from the disease.

"Our paper clearly says, without any doubt, that there is a dramatic improvement in detecting earlier, smaller lung cancer with spiral CT scans, rather than with chest x-rays," explains Dr. Henschke, who is also division chief of chest imaging at Cornell Medical Center in Manhattan. "By using our techniques, we would change the five-year survival rate from about 15 percent to about 80 percent.

"It is like taking cancer from the Dark Ages to the millennium," she adds. "Finding these tiny cancers opens so many new things that can be done, rather than treating the late stage."

We asked Dr. Robert Ginsberg, chief of thoracic service at Memorial-Sloan Kettering Cancer Center, for his reaction to the study and its potential. "I think it is exciting," he said. "I believe every smoker, every person exposed to smoke, should be able to get this free. That's where the tobacco money should be directed." He cautions, however, that only small numbers of lung nodules detected by CT scan are cancerous, and more work is needed to determine cost and cure rates.

Lung cancer is the leading cause of cancer death in the United States, killing 160,000 people a year.

Bothersome Ear Noise

Dear Dr. SerVaas:

For nine months, I have been bothered with my "heartbeat" in my right ear. It doesn't hurt, just bothers me and does get nerve-racking. Twice I went to a doctor, and each time he said "allergy" and gave me medication. Unfortunately, I have never experienced any difference or improvement.

You must have heard of others with this problem, and any help will surely be appreciated. My blood pressure is fine, no blocked arteries, blood tests are fine. I surely hope you can find room and time to give me an answer in The Saturday Evening Post.

Vivian White Lubbock, Texas

Yes, we have heard of this problem. Last year, a good friend told us that she was having a similar experience. Fortunately, the annoying sound ceased after several months and has not returned.

We sent your letter to Dr. Jack Summerlin, an associate clinical professor of head and neck surgery at Indiana University Medical Center in Indianapolis to find out why a heartbeat might be heard in the ear. He responds:

"This appears to be a form of tinnitus that can accompany any condition that produces damage or impairment of any sort in the auditory system. No single treatment can relieve all forms of tinnitus, since it can arise from so many different causes.

"If the pulsations are in phase with the patient's heartbeat, then the tinnitus is most likely an objective tinnitus, meaning it can be heard by the examiner as well as the patient. Subjective tinnitus, on the other hand, is heard only by the person affected.

"Pulsatile tinnitus is sometimes due to hardening of the arteries in and around the ear and requires appropriate medical attention. A good way to start an evaluation is an otorhinolaryngological (ear, nose, and throat) examination to look for reasons in the ear that can cause such symptoms. If the otological (ear) evaluation fails to yield the cause, consultation with a vascular specialist would be appropriate. Arteriography can be very helpful in evaluating this problem; moreover, life-threatening but treatable lesions will be missed without its usage."

People with tinnitus often find that playing background music blocks out, or masks, ear noise and is especially useful when trying to fall asleep. Loud noise makes tinnitus worse. Certain drugs--such as aspirin, caffeine, and nicotine--can also aggravate the condition. About 5 percent of the population suffers from chronic tinnitus.

Spongy Kidney

Dear Dr. SerVaas:

Could you please tell me the cause of a spongy kidney? Is this condition caused by diet, is it inherited, or is there some other reason? Thank you for taking time to answer this question.

We sent your letter to Dr. Jesus H. Dominguez, professor of medicine at the Indiana University School of Medicine.

He responds:

"`Spongy' kidneys are, likely, kidneys that have a benign condition formally known as `medullary sponge kidney.' The kidneys do not resemble a sponge at all because the only affected portion is localized to dilated tubules contained in the renal papilla. This region is the urinary system that collects the tubular fluid, which eventually constitutes the final urine.

"The name medullary sponge kidney is derived from the appearance on x-ray of the small aggregates of fluid sacs, or cysts, in the renal papilla. These cysts coalesce into structures that resemble clumps of grapes or sponges. The abnormality is inherited, and it is possibly autosomal dominant (i.e., females and males acquire it in about 50 percent of affected families).

"The main problem with this condition is the complication of kidney calcium stones, which occurs often and results from excessive amounts of calcium in the urine. At other times, blood may appear in the urine (hematuria). Hematuria is a complication of either kidney stones or microcrystals that form on the affected (dilated) tubules. Fortunately, medullary sponge kidney does not progress to end-stage renal disease, or even to mild renal failure. However, in some families, medullary sponge kidney has appeared in association with a more serious condition called `adult polycystic kidney disease.' This association is rare, and it is not entirely clear if these two conditions are, in fact, related. A kidney ultrasound test may be helpful in distinguishing the two conditions, as it would be positive in adult polycystic kidney disease.

"My main recommendation for patients with medullary sponge kidney is to try to prevent kidney stone formation. To this end, it is important to assure adequate intake of water, enough to make about two quarts of urine per day. Dietary and medication intervention should proceed after consultation with the treating physician."

Health Tips

* Mayo Clinic physicians say a simple way to determine how much water you should drink each day is to divide your weight in half. This number, in ounces, is your recommended daily fluid intake. Beverages with caffeine or alcohol are dehydrating and do not count toward your daily water consumption goal. Water regulates body temperature, removes wastes, carries nutrients and oxygen to cells, cushions joints, prevents constipation, and removes some toxins.

* We came across the following information on the Internet about surviving a heart attack when alone. Indianapolis cardiologist Dr. Chuck Orr confirms that it is "true, credible, and harmless." He adds that its effectiveness has "individual variability." The advice is credited to an unnamed 89-year-old physician.

Without help, the person whose heart stops beating properly and who begins to feel faint has only about ten seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and vigorously.

A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds without letup until help arrives or the heart is felt to be beating normally again. In this way, heart attack victims can get to a phone and, between breaths, call for help.

Fat-Free Foods

Dear Dr. SerVaas:

What are the complaints about fat-free foods made with olestra (brand name Olean)?

O. Johnson Kalamazoo, Michigan

Olestra molecules--made from soybean or cottonseed oil heated to high temperatures and blended with sugar--can't be broken down in the digestive system because they are too large.

For this reason, they add no fat or calories to foods, but the resulting substance inhibits the absorption of fat-soluble vitamins and other nutrients like carotenoids.

Some researchers say carotenoids help prevent cancer. There are over 200 different kinds of carotenoids. Olestra products are fortified with vitamins A, D, E, and K, but not carotenoids.

While most people eating snacks made with olestra will notice no digestive changes, some may experience abdominal cramping or loose stools a day or two after consuming it.

Men and Breast Cancer

Dear Dr. SerVaas:

In 1997, my husband was diagnosed with breast cancer. This was a real shock to us because we had never heard of men with this disease. Ten years earlier, his older sister was diagnosed with breast cancer. I am glad to say that both are survivors.

I believe that God and my husband's great sense of humor have kept him strong. During his eight months of chemotherapy, he only missed two weeks of work. Once he told a nurse that he had been charging a dollar for people to see his mastectomy scar, but he would let her see it for free. She couldn't believe he was actually kidding about it.

We are always reading articles on women with breast cancer and are concerned that no one is warning men that they could have it, too. The doctor told us that the chances for men to have it are about 80,000 to 1. [This year 1,300 men are expected to be diagnosed with breast cancer.]

Please inform men that they, too, can have breast cancer.

Beth Pike Five Points, Alabama

Patch for Post-Shingles Pain

Dear Dr. SerVaas:

In the July/August "Medical Progress" report, mention was made of a Lidoderm patch to relieve persistent pain after shingles. Is the product available? I showed the article to my family physician, and he had no knowledge about the patch.

I was diagnosed with shingles in February 1999, and I continue to have acute pain in the initial area of the shingles (left side of my navel to my spine). Hopefully the patch would give me some relief.

Sophie T. Neumann Coon Rapids, Minnesota

Patients and physicians may call 1-800-462-3636 for complete prescribing information. Lidoderm (lidocaine patch 5%) became available in mid-September.

Target Heart Rate

Dear Dr. SerVaas:

I recently started exercising on a regular basis and heard someone at the gym talking about a formula to determine a "target heart rate." What is meant by a target heart rate, and where does the number 220 come from?

Congratulations on commencing an exercise program. We asked Kay Mikesky, an Indianapolis health and fitness instructor, to answer your questions. She explains:

"Heart rate can be used to help determine if you are exercising too hard or not hard enough to reach your fitness goals. For most young adults, a target heart rate in the range of 150 to 170 beats per minute indicates a safe and effective level of exercise. For older adults, a rate of 130 to 140 beats per minute may suffice because of a typical decline in maximal heart rate with aging.

"There is a simple formula to determine target heart rate (see box above right). The number 220 is part of the equation to approximate maximal heart rate and is believed to be the highest heart rate that an infant can achieve and maintain for a minute or two. We subtract our age because we lose about one beat per minute every year. This is, of course, a rough estimate. To be precise, it is necessary to have a maximal graded exercise test (a stress test usually performed on a treadmill or bicycle ergometer that takes persons to their point of maximum effort)."

Relief from Heel Spurs

Dear Dr. SerVaas:

In the July/August edition of The Saturday Evening Post, you had a "Medical Mailbox" article on heel spurs.

I went through this a number of years ago and was directed by my doctor to a treatment of things being applied to the affected area for about three months.

At the end of the treatments, with no real improvement in my problem, I was advised that I could buy a little pad to fit into the heel of my shoe. Upon using this, my problems vanished almost overnight, and I was able to continue pounding the pavement downtown every day on my job. I haven't used it for over a year, with no problem.

It was a big relief, as I am 75 and hate to be laid up and not able to go to work, doing what I enjoy so much.

I hope that the pads will be of some benefit to others who are suffering from this very annoying and painful problem.

S. Kenneth Yorke British Columbia, Canada

We wrote to Mr. Yorke to find out where others who suffer from heel spurs might order these pads. We also asked what kind of work he so enjoys in Canada. Mr. Yorke responds:

"Your letter of August 10th, regarding the heel-spur problem I had experienced, arrived the other day.

"The pads are available at Safeway Stores (plus assorted drugstores), are made by Scholl's, are priced at two for $4.99, and include a couple of other little cushion pads.

"After I retired--upon completing 33 years with my original employer--the next day I started in energy conservation, providing locally made products that cut electricity costs tremendously. I supplied hospitals, schools, banks, housing managers, and hotels. A number of them were good enough to draft a letter acknowledging their savings, which, of course, helped to convince others that I could do the same for them.

"I have tapered off this year, taking a few more holidays, sort of smelling the roses while we have our noses.

"I trust the above information will be as helpful to others as it certainly was to me."

Target Heart-Rate Formula
Maximal heart rate (approximated) = 220 - your age --

Resting heart rate = lowest of the day, taken upon waking --

Lower end of the target heart-rate range = (max
 HR - resting HR) x 0.5 + resting HR --

Upper end of the target heart-rate range = (max HR - resting HR)
 x 0.85 + resting HR --


RELATED ARTICLE: Medical Progress

New research says that an old, inexpensive drug can help people with advanced stages of congestive heart failure. Aldactone (spironolactone) blocks a hormone called aldosterone that contributes to heart damage. In the study, adding the drug to standard treatments cut deaths and hospitalizations by about one third. It's not known whether the drug would help patients in earlier stages of the disease.

The FDA recently approved a new drug for Type II diabetes, the most common form of the disease. Actos, marketed by Eli Lilly and Company, is one of a new class of drugs that heighten the body's sensitivity to insulin. The oral pill may help eliminate the need for insulin injections. Type II diabetes develops when the body either does not produce enough insulin or doesn't efficiently use the insulin it does produce.

Yale University researchers say that women under 50 are more than twice as likely to die after a heart attack than are men the same age. "More research is needed to explain women's higher risk," says lead investigator Viola Vaccarino, M.D., Ph.D. Some women with heart attacks may only experience shortness of breath or feel discomfort in the upper part of the stomach, throat, or neck.

The Federal Trade Commission warns that self-test kits for HIV sold on the Internet are unreliable. The FTC recently tested the kits on samples known to contain the AIDS virus. All gave a negative result. Consumers who have used an HIV home-test kit should be retested. The only FDA-approved kit is the Home Access Express HIV-1 Test System, which requires laboratory analysis of a blood sample collected at home.

The FDA has approved a new estrogen-replacement drug made from plants. Cenestin, manufactured by Duramed Pharmaceuticals, is indicated for treating the hot flashes and night sweats often experienced by women who first enter menopause. The estrogen composition of Cenestin is similiar to that of Premarin, the most-prescribed menopause drug in this country.

Individuals with an acne-like skin disorder called rosacea may benefit from Dr. Barry Marshall's discovery that most ulcers are caused by H. pylori bacteria. Researchers in Turkey recently reported that the same antibiotic regimens designed to reduce levels of the ulcer-causing bacteria in the stomach also helped relieve symptoms of rosacea in patients who tested positive for H. pylori.

Children born to mothers with untreated thyroid disease have lower IQ scores, according to New England researchers. The new data show that management of the mother's thyroid during pregnancy has long-term impact on the psychological development of the baby and suggest a need for routine thyroid screening of pregnant women.
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Title Annotation:questions and answers on health problems
Author:SerVaas, Cory
Publication:Saturday Evening Post
Date:Nov 1, 1999
Words:3332
Previous Article:You Be the Judge.
Next Article:Letters.
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