We asked you to share your health concerns, questions and thoughts with us in NBCNewYork.com’s new “Ask the Doctor” column. Now our friends at ColumbiaDoctors Eastside give you the answers.
Got a health question? Go to our “Ask the Doctor” page and ask whatever’s on your mind. We may not be able to get to every question, but we'll answer as many as we can. Check back in the coming weeks for responses. If you have a serious concern, however, you should contact your doctor or go to an emergency room immediately.
Here are previous Q&A's:
Q: I'm 45, but still get occasional breakouts. I've tried many of the products on the market, but what is the best way to deal with this without drying out my skin?
A: Contrary to what most people believe, acne breakouts are common even well into adult life. Sometimes they can be a component of rosacea and not acne at all. Usually if there is rosacea, signs such as flushing that worsens with spicey foods and alcoholic beverages (red wine), will be present. I would recommend using a gentle cleanser such as Cetaphil to wash your face twice a day. Some of the medicated acne washes can be very drying.
In addition, try not scrubbing. Scrubbing with abrasive washes or exfoliants can actually worsen acne. Also, make sure you are using an oil-free moisturizer and makeup. You can try spot treating the individual spots with an over-the-counter benzoyl peroxide. If this does not solve the problem, you should see your dermatologist for stronger topical medication. Retin A works great for acne, but this is available by prescription. Your dermatologist can also do monthly chemical peels, which really help to smooth out skin, unclog pores and treat inflammatory lesions.
--Dr. Monica Halem, dermatologic surgeon, ColumbiaDoctors Eastside. She specializes in skin cancer surgery, laser and cosmetic surgery.
Q: I am 55 years old. I started feeling my legs weaken as I climb stairs a couple months ago and now my legs hurt a lot after walking two or three blocks. I am not able to walk faster and I have to rest frequently.
A: If it is confined to the legs, the pain may either be a result of nerve compression in the spine or a problem with blood flow to the legs. One can get a type of spinal compression called stenosis where the nerves from the spinal cord that travel to the legs and control strength and sensation are affected. The other possibility is that there may be some blockage of the blood flow to the legs as can happen when plaque builds up in the arteries going to the legs. Finally, these problems may occur in the face of worsening arthritis in either the hips or knees. Arthritis occurs when the protective cartilage in a joint wears out causing pain, muscle weakness, swelling or difficulty walking.
--Dr. Jeffrey Geller, hip and knee replacements, minimally invasive surgery, ColumbiaDoctors Eastside
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Q: A year ago, I began a new exercise regimen which included weights to strengthen my arms. My motto was "No pain, no gain," so I continued using weights even though the pain in my right shoulder was becoming intense, making sleeping difficult since a comfortable position could not be found. Finally, two months later, I made the decision to stop exercising to allow the shoulder to heal. Within five days, I had my first bout with extreme dizziness. It seems to be positional. Holding my head downward or turning to the left seems to induce the vertigo-like dizziness. The pain stretches from my neck down my right shoulder and occasionally down my back to the space between my blades. Doctors have used MRI on the neck and brain to rule out any significant findings and I have had EKGs, stress test, worn a heart monitor, blood tests, eye exam, ENT and balance center visits, physical therapy ... A neurologist suggested migraine syndrome early on and put me on Lyrica. However, a year later, the pain remains and no definitive diagnosis has been made. Where do I go next?
A: I am not sure all of these symptoms are related. No pain, no gain is not usually the best approach to improving fitness. Intense exercise can easily cause the shoulder pain you experienced. Rest was a good choice. Review your exercise program with a physical therapist for safety. At this time, the pain sounds as if it might be coming from your neck so an exam from a doctor or therapist can help. The dizziness does sound like vertigo. There are positional exercises that can help minimize the frequency and intensity of those episodes. I would address the bigger complaint first for maximum benefit.
--Vincent Perez, Director of Sports Therapy at ColumbiaDoctors Eastside, PT; team therapist for the New York Yankees and rehabilitation consultant to the New York Knicks
Q: My husband has been suffering from chest pains pretty consistently. He is relatively young - in his early 30s - and has had EKGs and several other tests to figure out what is wrong with him. More than one doctor has said that it is nothing, that it could be due to stress or an irritated muscle. My husband was advised to take Motrin whenever he feels this pain. I am really worried at this point. Any thoughts or suggestions?
A: Chest pain can be caused by many things and a thorough evaluation in patients with chest pain is mandatory. It can be due to blockages of the arteries of the heart, stomach acid/reflux, muscle spasm; inflammation around the heart or in the lungs, nerve problems or several other medical conditions. Your husband should be evaluated by a cardiologist and hopefully a diagnosis will be made.
--Marc Sabin Eisenberg, M.D., Cardiologist, ColumbiaDoctors Eastside
Q: What is the proper way to clean your ears?
A: The best way to clean your ears is to clean only the outside and not clean the inside at all! Our ear canals have glands inside of them which produce wax, which is a natural barrier to infections. So, never place a cotton swab inside of your ears to "clean" them, as you may be removing this barrier. In addition, damage can be caused, including cuts in the skin, eardrum perforations and trauma to the middle ear and inner ear which can cause permanent hearing loss. If your ears feel plugged or uncomfortable, see an ENT or your internist, so that the cause can be found and treated.
--Dr. Ian Storper, Director of Neurotology, ColumbiaDoctors Eastside
Q: I'm a female turning 51 in May. For several weeks I've had a ringing in my ear. I've seen a ear, nose and throat doctor and he advised me to have a CT scan of my sinus. He believes there might be a blockage. I do not feel that my nose is stuffed; perhaps I'm used to breathing this way for a very long time. Do you have any recommendations for finding out the cause of the ringing in the ears. I am on medication for high blood pressure.
A: The most common cause of a ringing sound in the ear is hearing loss. If the hearing is missing at certain pitches, the brain replaces the missing hearing with its own noise. The first step for the doctor to try to figure out the cause of the ringing is to ask careful questions and perform a detailed ENT physical examination. If there is a cause which can be seen, it is treated. If a cause is not obvious, a hearing test is checked. Depending on the result of the hearing test, certain treatments can be ordered. Sometimes, it is necessary to check an imaging study like CT Scan or MRI.
--Dr. Ian Storper, Director of Neurotology, ColumbiaDoctors Eastside
Q: I suffer from chronic sinusitis. Most medications do not give me any relief except Prednisone. I have many allergies such as grass, trees, ragweed, late fall pollen and plantain. Presently, I'm getting allergy shots, but I have lost my senses of taste and smell again. The allergies have been for about 40 years. Acupuncture used to work like a charm, but for the last three years, I have been sick more or less constantly. I've lost weight because of the taste and smell senses not being available all of the time. I really need some relief. Do you have any suggestions? I'm now seeing my third allergist and have just had my third CAT scan of the sinuses, the results of which have not been released. By the way, I have also just developed asthma, but my main problem is the allergies. If the allergies are somewhat in check, then the asthma isn't an issue. The doctors state that basically I'm a healthy woman, but have allergies and chronic sinusitis.
A: There are three ways that we handle allergies. The first thing is environmental controls. Once the allergies have been identified, usually by skin testing, we try to control exposures to what the individual is allergic to, if at all possible. If the most recent skin tests were more than a year ago or the environmental exposures have changed, such as a new pet, it may be worthwhile to do new or additional skin tests. There may be allergens beyond the typical inhalants, such as fragrance in toiletries and laundry products that are also causing symptoms. Consider the possiblity of foods or food additives such as MSG or sulfites adding to congestion. Environmental controls for pollen would include keeping the windows closed in the house and car, using air conditioning with a clean filter once the weather is hot and showering and washing hair at the end of the day, since pollen is sticky. Medications that have fewer potential side effects than prednisone, are greatly preferred for long term use. Often steam inhalations, followed by an OTC saline rinse, followed by a prescription nasal steroid spray used on a daily or twice a day basis will help.
The third approach is allergy shots, which are effective in 80 percent of allergic individuals to reduce symptoms and reduce medication needs. Because there are ongoing symptoms, the sinus CT may lead to additional recommendations in treatment, and it will be interesting to know what it shows. If there are frequent recurrent bouts of sinusitis without a structural abnormality on the CT, then an immune workup may be warranted. Further consideration needs to be given to what seems to be provoking the asthma symptoms and are medications controlling the symptoms.
--Dr. Marjorie Slankard, Clinical Professor of Medicine, ColumbiaDoctors Eastside
Q: I had a severe headache and severe nausea a couple of weeks ago -- never had an "attack" of that magnitude before. It took about four hours to subside. I am prone to headaches but not migraines. Should I be investigating the incident further?
A: I cannot diagnose your headaches from a note, however it sounds like you have recurring headaches. Most disabling headaches turn out to be migraine, and the diagnosis is not based on how severe the attacks are. So don’t be so certain the others were not migraines. Migraines are recurring, although they can be rare or frequent. They are often associated with light or sound sensitivity and often with nausea and sometimes vomiting. The triggers of attacks also might provide a clue. For example, migraines are often brought on by stress or relaxation following a stressful period, alcohol, periods, missing meals and over or under-sleeping. Typically, migraine attacks last four hours to three days, which also fits your description. It is always wise to have severe headaches evaluated to exclude serious causes as well as set up a management plan. Fortunately, we have rather effective treatments for most headaches.
--Dr. Mark W. Green, Director of Headache Medicine, ColumbiaDoctors Eastside
Q: My back has a lot of acne marks and bumps and I want them to be removed completely. What do I have to do or whom do I have to go to? I tried almost everything that is out there.
A: The first thing that needs to be evaluated is whether or not you still have active acne. The acne needs to be treated before the marks and bumps are addressed. Once the acne has cleared, you should wait a few weeks to months and see how the skin heals. If the marks and bumps remain, you may have discoloration due the inflamed acne, scarring, or both. When your body responds to a pimple, it makes an immune response that causes redness at the site. Depending on how inflamed the pimple is the redness may remain for weeks after the pimple is gone. This redness will usually disappear by itself if you are patient. If a brown spot remains after the pimple is gone, you likely have a condition called post-inflammatory hyper-pigmentation. This occurs because extra pigment has been brought to the area with the inflammatory cells. It too will fade over time and you can use a lightening agent called hydroquinone, or have light chemical peels done to hasten this process.
If enough inflammation occurs at the site of a pimple, the skin can be injured, leading to acne scarring. This can be seen as a raised area or an indented mark. Laser resurfacing with devices such as the Fraxel TM laser provides deep penetration of laser energy to the scar tissue to stimulate new collagen production, which can significantly improve the texture of the skin. Multiple treatments may be needed and can achieve excellent results. You should see a dermatologist for evaluation.
--Dr. Robyn Gmyrek, Dermatologist, ColumbiaDoctors Eastside
Q: My blood pressure is low -- the upper number is in the 70’s, the lower number is in the 50's. Is this ok?
A: Hypotension, or low blood pressure, can be due to many things. It is important to know if you have any symptoms with it, such as dizziness. Are you on any medications that can cause your blood pressure to be low? It is important that you see your healthcare provider and have him/her check your blood pressure to make sure the readings you are getting are accurate.
-- Dr. Marc Eisenberg, Cardiologist, ColumbiaDoctors Eastside
Q: I have very severe pains in the lower part of my stomach. It is so bad that I am doubled over in a lot of pain. It is constant every day. What can I do?
A: Pain in the lower part of the abdomen, below the belly button, is most likely related to gastrointestinal, gynecologic or a urologic problem. Since your pain is severe and constant, you should see a doctor ASAP. If the pain is improved with passage of a bowel movement, I would suggest seeing at first a gastroenterologist. If menstruation worsens the pain, consult a gynecologist. If there are associated urinary symptoms, consider seeing an urologist initially. After they obtain a more detailed history and do a physical examination, they will recommend an evaluation to determine the cause of your pain. Once the cause of the pain is found, treatment(s) will be suggested to alleviate it.
-- Dr. Susan Lucak, ColumbiaDoctors Eastside
Q: I have a really big stress problem. Whenever the littlest things go wrong, or aren't going the way I'd like them to, I freak out. When this happens I always get a huge headache, acne and a sick feeling in my stomach. Are there any techniques or things that I can do to relieve my stress or at least control it?
A: Many people experience anxiety, and times are particularly stressful now. It seems that when you get stressed, your body takes a hit. Symptoms like headaches, stomach problems and muscle tension are all forms of physiological anxiety. In order to ease these symptoms, you may want to try several things:
1) See if you can identify any irrational thoughts that you're having. You say that you freak out in response to even minor stressors. Part of the problem is that you're likely blowing things out of proportion, assuming the worst, what we call catastrophizing. You may also find yourself predicting future negative events. Both are cognitive distortions that increase anxiety. If you can identify these types of thoughts, you might begin to challenge their validity, examining evidence for and against your ideas.
2) Focus on what you can control in certain situations and try to distract your thoughts from what you cannot control.
3) Remind yourself of past experiences of coping with stress -- how you may have freaked out, but how inevitably the outcome wasn't as bad as you'd thought.
4) Engage in anxiety-reducing activities, such as exercise (including yoga) and rely on other self-soothing activities, such as watching television, reading a good book, or taking a bath. Activating your senses (cuddling up in a soft blanket or lighting a scented candle) can be particularly helpful with regard to decreasing anxiety.
5) Practice the art of relaxation. Try deep breathing and visualization exercises. Take slow, deep breaths all the way into the abdomen. Take a mental vacation by closing your eyes and picturing yourself in a relaxing locale (like the beach or the mountains).
6) Rely on support from family and friends. Sometimes talking out your stress can help reduce it.
If engaging in the above exercises fails to sufficiently decrease your stress levels, you may want to consult with a therapist or psychiatrist, as talk therapy and/or medication may be indicated.
--Stacey Rosenfeld, Ph.D, ColumbiaDoctors Eastside
Q: Sometimes after a strenuous workout, my right knee feels a little tense. Are there any stretches or techniques that I can do before or after to help alleviate this problem?
A: There are three stretches that would help with knee tightness, depending on it's location. Stretching the quadriceps by bending the knee behind you will help the front of the knee, hamstrings stretches are best if the tension is in the back and a side lying stretch for your iliotibial band would help for tension on the outside of the knee. While stretching before exercise is helpful and might help to prevent this, it is most beneficial to stretch after your workout. If this is a regular problem, you should review your workouts with a physical therapist to see if there is anything that could be causing the problem.
--Vincent Perez, Director of Sports Therapy at ColumbiaDoctors Eastside, PT; team therapist for the New York Yankees and rehabilitation consultant to the New York Knicks
Q: Sometimes when I get stressed out I get pains in the left side of my chest. I've gone to the doctor and they've checked out my heart and they said that I'm fine but it just seems weird. Should I be worried?
A: Chest pain or arm pain during emotional stress can be due to many things. A thorough cardiac workup is necessary as it may be due to blockages of the arteries of the heart, but also these symptoms may be due to reflux or muscle spasm/nerve root impingement from the disc in the neck. It is important that these symptoms be thoroughly evaluated.
--Marc Sabin Eisenberg, M.D., Cardiologist, ColumbiaDoctors Eastside
