Dear Kidney Stones,
You have endured what is known to be the most painful affliction of humans aside from pregnancy.
The kidney stone is actually a small rock that forms in the kidney. It can either stay in the kidney or move further down a tube (ureter), which leads from the kidney to the bladder. This tube carries urine from the kidney to the bladder for excretion.
The problem arises, when a stone gets stuck somewhere in the tube causing severe pain, and blockage of the kidney.
While anyone can form a stone, some are more likely than others to develop it.
These include:
• Males
• Caucasians
• Those overweight
• Those with kidney infections
•. Those who have family members with kidney stones
• Those who have had a kidney stone before
• Those who eat a lot of meat and eggs
• Those who do not drink enough liquid
The kidney stones occur most frequently in the spring. Some believe this be due to the fact that we become dehydrated, as we go outdoors for physical activity after the long winter.
Getting enough fluid is an important part in prevention of stones.

The symptoms of a kidney stone include:
• Severe pain in the side and back below the ribs
• Pain that spreads to the belly
• Pain that comes in waves
• Pain on urination
• Cloudy or foul smelling urine
• Fever and chills
• Urge to urinate
What causes the kidney stone?
The stone forms from different crystals in the urine that can come together, usually when one is dehydrated or has a lot of crystals. There are many different types of stones, and the cause is better understood once the type of kidney stone is determined. For example, stones made of calcium may be caused by drinking too much milk, or dairy products, or from taking too many supplements.

What can you do when you have a stone?
• Drink water to try to flush the stone out (This may take two to three quarts a day).
• Pain relievers may help.
• Try to remain active.
There are certain medicines that can dissolve stones which may work.
Certain stones may be treated with ultrasound waves, known as lithotripsy in which the stone is blasted by sound waves into little pieces and then flows out in the urine.
Lifestyle changes may help. These include:
• Eating a diet low in salt and animal protein
• Limiting the use of calcium supplements
Some simple tips to reduce recurrence are:
• Drink plenty of water all day to flush the crystals out of the urine.
• Drink less beer – in addition to dehydrating you, it contains crystals which can form stones.
• Eat less meat – they are high in certain crystals which can form stones.
With the proper lifestyle change, you can definitely reduce your chance of developing another kidney stone.

* Reprinted with permission of The Tablet

Dear Red Urine,
Before addressing your question, I would like to bring our readers up to date on the Ask the Doctor TV Show.
We will be returning early September, for all new shows in season number 17.
For those who need an extra “fix” of the show, I will be doing an Ask the Doctor session at the Health Fair that my good friend, Dr. Emil Baccash, organizes each year at the Virgin Mary Church, 216 Eighth Ave., Park Slope – 11215, at 1 p.m. on Sunday, May 6. It will be great to see who can come.

Bleeding in the urine is known as hematuria (hē-mə-t(y)ur-ē-ə\).
There are two types of hematuria. In one type, the urine looks normal and a microscope is required to detect the blood cells.
In the second type, there is bleeding that changes the color of the urine, and is known as gross hematuria.
In some cases the bleeding may go away on its own. An example of this is urine in the blood that comes from strenuous exercise.
It takes very little blood to cause the urine to change colors. It usually isn’t painful and there may be no other symptoms present. Blood can come from any part of the urinary system, which includes the kidneys, bladder and ureter (tubes that carry urine from the kidneys to the bladder), and in men, the prostate, as well.

Some causes of blood in the urine include:
1. Urinary tract infections – The symptoms present include an urge to urinate, pain or burning with urination and a peculiar smell to the urine.
2. Bladder or kidney stone – The stones can cause either gross or microscopic blood in the urine, and usually has pain associated with it.
3. Enlarged prostate – There may be difficulty urinating, whether gross or microscopic blood is in the urine. Infection of the prostate known as prostitis can cause the same signs and symptoms.
4. Kidney diseases – Certain infections can cause the kidney cells to inflame. With the swelling of the kidney, the blood vessels become swollen as well, and blood can leak into the urine.
5. Cancer – yes, the dreaded “c” word can be a cause, although not that common.
6. Kidney injuries – this usually happens as a result of a car accident, fall, or sports injury. There can be microscopic blood or bright red bleeding in the urine.
7. Medication – aspirin, penicillin, heparin blood thinners, and certain anti-cancer drugs can cause blood in the urine.
8. Strenuous exercise can cause gross or microscopic bleeding.
9. Certain medications or food can cause the urine to change colors. Examples of this are beets, berries, and rhubarb. There is no blood in the urine in this instance.

It is important to see your doctor at once should you see any evidence of blood in the urine.
To help diagnose the problem, your doctor, may order urine tests, as well as a CT scan, sonogram, or MRI, to get a good look at the whole urinary system, including the kidneys, bladder, and ureters.
Sometimes the doctor will use a mini camera that goes directly into the bladder to determine if there are any tumors, infection, or pre-cancerous growth.
The treatment for hematuria will depend on the underlying condition. An example would be treating an infection of the kidneys with antibiotics.
Sometimes no treatment is necessary and the condition resolves on its own.
The bottom line is that your bleeding is most likely not caused by cancer, but you do need to have the problem checked out. Best of luck and please keep me informed of your condition.

* Reprinted with permission of The Tablet

Dear Clouded,
You might be surprised to learn that cataract surgery is actually the most common surgical procedure performed in America.
Let’s start with the basics: What is a cataract? Cataracts form when the lens of the eye becomes cloudy. More than half of Americans ages 65 and older have a cataract, and it is thought that nearly everyone will develop one if they live long enough.
The lens of the eye works much like a camera lens, focusing light onto the back of the eye on a structure called the retina. The lens also adjusts the eye’s focus, letting us see things clearly both up close and far away. The lens is mostly made of water and a substance known as a protein.
As we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over many years, it may grow larger and cloud more of the lens, making it harder to see.
Therefore, the main symptoms of a cataract are cloudy, blurred and dulled vision, which cannot be corrected by wearing stronger glasses or contact lenses. You may find the need for a brighter light to read. Increased sensitivity to glare may also be a problem.
There are also several types of cataracts; the most common is called a nuclear cataract, because it affects the inside of the lens. Another common form is a cortical cataract in which the outside of the lens becomes cloudy.

Risk Factors
Why do some people get cataracts at an earlier age than others?
Smoking greatly increases the chance of getting a nuclear cataract, the most common type in the United States. To lower the risk for cataracts, simply stop smoking.
Diabetes is another risk factor for developing cataracts. Keeping blood sugar under tight control and maintaining a normal weight can slow this.
Many studies suggest that exposure to ultraviolet light is associated with cataract development, so it is advised to wear sunglasses and a hat to lessen exposure.
An interesting study, conducted in Iceland in 2005, suggests that airline pilots have a higher risk of developing cataracts than non-pilots. It is thought this is due to exposure to cosmic radiation. A similar theory suggests that astronauts, too, are at increased risk from cosmic radiation.
People who use steroids are also more prone to cataracts. Some eye care experts believe that a diet high in antioxidants, such as beta-carotene (vitamin A) selenium and vitamin C and E, may slow down the development of cataracts. While this is not proven, it is always good to get as many of these vitamins in their natural form, in food, as opposed to pills. Heavy alcohol consumption is a risk factor as well.

Now that we have reviewed the symptoms and some possible causes, what are the treatments available?
Effective Treatment:
Cataracts are a curable eye condition. The surgery performed is rapid, safe and nearly always completely successful. Nine out of 10 people who have cataract surgery regain very good vision.
A cataract needs to be removed only if it interferes with one’s vision enough to prevent him/her from driving, reading or other essential activities. After the surgery, an artificial lens is implanted in the eye so that people no longer need to wear “Coke-bottle” glasses.
Remember, however, that just having a cataract does not mean you need immediate surgery. When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, appropriate lighting or magnification.

Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain regular vision.
I urge you and any of our other readers who are exhibiting signs of vision problems to check with your doctor to determine the cause. If cataracts are to blame, find out how your quality of life can be improved with this surgical procedure.

* Reprinted with permission of The Tablet

Dear Stressed Out,
I am sorry your work is so unbearable. Unfortunately,you are not alone in this problem, and especially in today’s economy, many people are forced to stay in jobs which are demanding, unsatisfying and often unpleasant.
Job stress is often associated with a demanding job, with little or no decision-making authority or opportunities to use one’s skills or creativity.
As a result of workplace stress, one may experience various health issues, including chronic fatigue, stomach problems, frequent colds, loss of libido, lack of sleep and generalized irritability.
As reality does not allow you to leave your job, here are things you can do to help reduce the unpleasantness:
• Control what you can — eat right, exercise, only drink alcohol in moderation, and get enough sleep. Take pleasure in small things, like a short walk around the park or planting flowers.
• Laugh a lot – it’s a great anti-depressant.
• Get a massage
We may not be able to avoid the stress of a bad job, but we can learn to better deal with it and focus on the good things in life.
As the song goes:
“When you’re worried and you can’t sleep, just count your blessings instead of sheep,
“And you’ll fall asleep counting your blessings.”
Until next week, be well.

* Reprinted with permission of The Tablet

Dear Plane Phobic,
Actually, your question is one that is very common. It seems that up to 30% of people develop signs of a mild cold or runny nose following a plane trip. There are reasons why this might happen and things people can do to prevent it.
The plane cabin has a very low humidity. This can be as low as 20% – lower than most deserts in the world. This causes irritation of your nose, throat and eyes and can predispose you to developing a cold.
A key way to combat this is to drink water before and during the flight. It is also important to avoid alcohol and caffeinated drinks, as these cause further dehydration.
To determine if you are properly hydrated, check the color of the urine. If it is clear, you are most likely well hydrated. If it is dark, you need to drink more water. You should also be sure that you drink enough water to urinate every hour that you are on the plane.
Use Vaseline in your nostrils to help keep them moist. Applying an eye cream below the eyes is also beneficial. To help humidify the air you breathe, cover your nose with a water-saturated cotton handkerchief and breathe. While this may make you feel self-conscious, you will feel better.
Due to changes in altitude, it is also possible for pressure to build up behind the eardrums. This can cause severe earaches. The following tip will help to relieve this pain: Take a wax coated drinking cup and put a paper napkin in the bottom of the cup. Ask the flight attendant to add boiling water. Drain off all the water. Lean your head down and sideways toward the cup to cover the blocked ear. Be careful that no hot water gets into the ear. As the steam reaches into the ear, the tubes will automatically clear, and unblock the ear. Earplugs may also help to prevent and lessen earaches that might occur during the flight.
Flying these days also involves a lot of tension, whether from baggage handlers, security checks, or long delays. Stress helps to create headaches and dryness in your mouth and eyes. To combat this, try a glass of hot water or decaffeinated tea. You can also try stress-reducing exercises. Taking deep breaths and imagining pleasant images can help as well.
Concerning stomachaches on the plane, anyone who has tasted airline food should not be surprised that these are a common occurrence. The meals that are served contain large amounts of salt, sugar, and fat, and can be difficult to digest. It is best to eat lightly and bring food from home.
Low-protein, low-fat food is best. You should avoid starchy foods which may increase abdominal gas. In addition, as the airplane altitude pressure is not fully corrected, the bowels may distend even more with the gas present. This can cause pain and discomfort.
The plane is a garden of germs. Whether it is in the bathroom or pillows, bacteria and viruses thrive in this environment. It is important to wash your hands regularly. Remember that the water in the bathroom is not sterilized for drinking and can make you sick. It is wise not to drink this water. If you brush your teeth, use bottled water.
People complain of swelling of the feet and ankles which occurs due to pressure changes on the plane. It is important to wear loose-fitting clothing and to take off shoes or wear slippers on longer flights. This will reduce discomfort.
When possible, walk around the cabin at least once an hour. You can also find exercises to follow in most in-flight airline magazines. These will help to exercise the calf muscles and reduce your risk of harmful blood clots.
Keep these tips in mind and enjoy your vacation.

* Reprinted with permission of The Tablet

Dear Exercise Averse,
I hate to tell you this, but I agree with your daughter regarding this matter.
It is important for people to stay active at any age. By active, I do not mean pumping iron in the gym, but merely walking instead of riding in the car, doing housework, or climbing the stairs instead of using the elevator and adding light weight training. Being active has been shown to have benefits, not only for the body, but also for the mind. As a matter of fact, Sumo wrestlers, who are very obese, are actually in good shape, due to their exercise and weight training schedule.

Normal Weight Obesity
A study published in recent years by the Mayo Clinic describes a condition known as “normal weight obesity.”
This term seems confusing and contradictory, but means that one’s body can appear to have a “normal weight,” and yet be at increased risk for things like heart disease.
The scales may tell you that you are O.K. weight-wise, but it is not an accurate depiction of what is occurring on the inside of the body.

Even if someone is not overweight by the scale, the person may have excess fat in his or her body, which puts the person at risk for fat-related disease such as diabetes and heart disease.
It seems that these people have a very high presence of fat, deep within their body, around the organs such as the kidneys and liver. Their muscle mass, or “lean mass” is low compared to the fat present. This ratio is very important in determining one’s risk for heart disease, diabetes, high cholesterol and other obesity-related problems.

This study showed that losing weight was not enough in trying to improve one’s overall health. Aerobic exercise, such as walking, combined with moderate weight lifting and resistance training, is an integral part in maintaining heart health and building lean body mass.
We also know that the location of fat in the body is very important in determining how harmful it is to you. Fat around the hips and bottom is “good fat” and actually helps protect you from heart disease and diabetes. Fat around the belly, however, is no good.

In fact, if a woman has a waist circumference of more than 35 inches, or a man has a waist of more than 40 inches, then they will be at increased risk.
Therefore, merely measuring one’s weight is not enough.
Waist size and muscle mass are much more important in calculating one’s risks.
Women with “normal weight obesity” double their risk of dying from heart and other obesity-related problems. One’s risk is determined by the amount of fat buildup in the body compared to lean muscle mass.

The amount of fat buildup in the body can be accurately noted by a CT scan. There are also machines available which can measure your body fat mass and help guide you as to the type of exercise you might need, such as a combination of walking and weight training.
Spring has sprung so get outside and enjoy an evening walk with your daughter a few times a week. Also, be sure to talk to your doctor about measuring your body fat and ways to increase your activity level.
Until next week, be well.

* Reprinted with permission of The Tablet

Dear Hoping to Help,
I am sorry to hear about your situation. Colon cancer is the second leading cause of cancer deaths in men and women.
The good news is that if caught early, it can be easily treated.
Right now there are 50,000 deaths in the United States each year. Most of these could have been saved with the proper screening.
Signs of colon cancer include: a change in bowel habits; a feeling that the bowel doesn’t empty properly; blood in the stool; and stool that looks thinner than normal.
Unfortunately, by the time the above symptoms occur, the cancer is usually advanced.
Most colon cancers occur in people with no risk factors; however, there are some conditions which place a person at higher risk than the rest of the population. These include: a family history of cancer of the colon; having Crohn’s disease or ulcerative colitis; and having certain inherited conditions, which affect many people in the same family.
For the most part, everyone over 50 years of age is at risk for developing colon cancer — not just those in the high-risk groups mentioned.
Studies continue to show (a major one actually was released last week) that having regular screening tests for colon cancer beginning at age 50 reduces deaths dramatically.
The screening tests can identify small growths known as polyps, which turn into cancer after many years. If they are removed early, a person’s life can be saved.
Studies have also shown that adopting healthy behaviors, such as: maintaining a healthy weight, staying physically active, and not smoking, can decrease your risk for colon cancer.
It is possible that making certain changes in diet, such as adding fresh fruit, vegetables, and whole-grain products may reduce the risk of colon cancer.
All this, however, cannot even approach the efficacy of a screening test in the treatment of colon cancer.
The screening test, known as a colonoscopy, should be performed at age 50 and repeated once every 10 years for most people. In this test a small tube is placed in the rectum while you are under mild sedation. It may be performed before age 50, depending on your individual situation such as a family history of cancer.
There are other tests available which may help as well, such as a yearly test to see if there is blood in the stool. However, can you imagine that just one colonoscopy every 10 years can put an end to most cancers of the colon?
You should speak with your doctor to see when and how frequently you should have your colon checked. There may be other tests your doctor can offer which may not be as useful, but I don’t even want to mention them in this column because most people should be able to tolerate the gold standard of colonoscopy.
In summary, I hope your letter will spur people to get this life-saving screening. Remember, polyps take many years to turn malignant so having a colonoscopy every decade starting at age 50 is usually recommended.

*Reprinted with permission of The Tablet

Dear Bitter Pill,
It was a very unfortunate situation that occurred in a reputable pharmacy in Chatham, New Jersey.
The wrong pills (breast cancer medication) were given to children for two months. This was instead of fluoride pills for their teeth.
Thankfully the odds are very low that an adverse reaction will occur in these children. It is important, however, to use this situation to prevent a deadly mix-up that could occur.
I have composed a list of ways to assure you of getting the correct pills.
As we have lost touch with our neighborhood pharmacist, due to proliferation of large drug stores, it is more important than ever to ask questions and take nothing for granted.

Here are 10 things you can do to stay safe:
1. Don’t be embarrassed to ask questions of your pharmacist. Part of that person’s job is to be a consultant.
2. Open the bag and look at the bottles or boxes that the pills come in. If anything looks different, or you don’t understand something, speak up.
3. Show the pills to the pharmacist before leaving.
4. Always understand the drug’s purpose. Find out benefits and potential problems by asking your doctor and/or your pharmacist.
5. Stick to one pharmacy. They will have a complete list of your medications that you can review with them. You will feel more comfortable asking questions.
6. When you bring in your prescription, carry a complete list of all the medications you are taking, and ask the pharmacist to see if it matches his list. You should also include over-the-counter medications.
7. When you get your pills check to see that the directions are the same as what your doctor told you.
8. Ask your pharmacist about potential food, drug, and alcohol interactions.
9. Ask your doctor if you should be taking any lab test to see how the medications are affecting you. This may include liver tests for people taking Lipitor, or digitalis blood levels, for those taking Digoxin.
10. You can use the Internet to view a picture of your pill and any inscription on it. A website, such as www.rxlist.com/pill-identification-tool/article, is a good example.

In addition to the above, ask your pharmacist about generic equivalent medications. They will look different from the brand name pill, but most times will offer the same result at a cheaper price. Many patients are required by their insurance companies to use mail-order pharmacies. Make full use of the consultative services offered by these companies. Once again, don’t be hesitant to call your pharmacist or insurance company if you have a question.
There will be more medication errors this year. You do not have to be a victim. The key is to become an informed patient. Know what medications you take and why you take them. I frequently have patients lament the fact that the time they have to spend with their doctor each visit is less and less.
By being organized, you can make the most of your doctor office visit. And remember that your local pharmacist is an excellent back-up for any questions you might have.
I hope this helps allay most of your anxieties about medication errors.
Until next week, be well.

*Reprinted with permission of The Tablet

Dear Tattooed,
I believe you are talking about an interview I did regarding a special type of tattoo, known as a medical tattoo. This type has specific medical information about a person as its main content.
Examples of the information included are health conditions, such as diabetes or epilepsy as well as allergies to medications such as penicillin. Some people currently wear bracelets to alert others about their medical problems. The bracelets are subject to breakage or loss, and the tattoo is a more permanent way of conveying the information. They are permanently placed on a person’s skin.
Tattoos, whether done for a medical reason or for “artwork,” carry risks, even when done under the best of circumstances. The dyes used for the tattoo are not rigorously controlled by the FDA, so it is important to be an educated consumer and visit only reputable tattoo facilities.
Some medical complications associated with tattoos, in addition to allergies to the dye used, include infection of the skin and the body, such as hepatitis and HIV. If not done in a hygienic facility, the possibility for infection is high. The facility should have the feel of a hospital, and the tattoo artist should wear gloves and use sterile technique.
Before getting a tattoo, inspect the bathroom of the facility. This can be a tip-off as to a facility’s hygienic practices.

The intent of medical tattoos is different from a tattoo done for artwork, however, both are subject to the complications above.
If you want privacy regarding your medical conditions, the medical tattoo may not be appropriate for you as many will be able to read your medical problems. This could affect future employment as the condition might be visible during an interview.
In addition, medical issues may change over time and the message may be different as you age.
In addition, the legality of certain medical tattoos is in question, particularly when they advise healthcare workers not to do CPR or resuscitate someone.
We currently use medical tattoos in hospitals. An example is in radiation for breast cancer in which the area to be irradiated is marked on the skin so it can record the exact location of the cancer should future treatments be needed. In addition, some plastic surgeons use tattoos when doing reconstruction of a breast after breas tcancer to simulate the nipple.
Before any tattoo is obtained, whether for artwork or medical reasons, careful thought must be paid to the decision as it will be permanent.
What might seem like a great idea now may not be 30 years down the road.

Medical tattooing is here to stay and I believe its use will increase.
While we may not agree with tattoos as “artwork,” we must make sure that our children and those getting tattoos are as safe as possible.
Here are questions all prospective tattoo clients should ask:
• Is the person doing the tattoo licensed?
• Does the tattoo artist wear gloves?
• Does the parlor use proper equipment (disposable needles and container of dye)?
• Does the parlor wash down all equipment, mats, and cabinets after each procedure with bleach?
The aftercare of a tattoo is very important. The bandage covering the area should be removed after 24 hours. Antibiotic ointment should be applied. One should use plain soap and water to gently clean the area — do not rub it. Moisturizer should be applied liberally.
At the slightest sign of infection (blisters, redness, pain and/or discoloration), go to your doctor.

* Reprinted with permission of The Tablet

Dear Worried,
This is a frequently asked question and is of great concern to all.
The word autism comes from the Greek word for “self.”
This describes the main part of being autistic. The child with autism is locked into his own world, with an inability to communicate or interact with others.
For unknown reasons, the number of children diagnosed with autism is rising. Children with autism will usually exhibit problems in three areas of development:
1. Social interaction — This is the hallmark of autism. As early as infancy, a baby may be unresponsive to people.
2. Language skills
3. Behavior — This may be the result of abnormal cell connections in the brain. They often avoid eye contact.
There is a wide spectrum of autism. In the extreme, autism is demonstrated by a complete inability to communicate or interact with other people. On the other end of the spectrum, the children exhibit autistic behavior, but have well-developed language skills (Asperger Syndrome). They might have social challenges and unusual behaviors or interests, but may be quite successful in life.

The age at onset varies with some children under one year of age exhibiting abnormal development and others regressing after a normal infancy period in which the child who previously did well, may begin becoming aggressive or losing language skills already acquired.
Some symptoms are: lack of eye contact; not babbling by age two; failing to respond to his name; not liking to be held; and not smiling.
The baby with autism usually starts talking later than two years of age. He may perform repetitive movements such as rocking or spinning. There may be preoccupation with certain objects. The slightest change in routine may make the child angry. Young children with autism have a hard time sharing experiences with others.

Causes/Risk Factors
What causes this dreaded disease? There is no known cause at this time. There is no link between vaccines and autism.
Some risk factors include having an older father, being a boy and having a sibling with autism.
Certain genes appear to be involved with autism. Some believe they make a child more susceptible to environmental factors, such as pollution.
There is no way to prevent autism.
With early intervention, there can be improved language and social skills. It is important to develop a treatment strategy with your doctor.
There is no medical test to make a diagnosis of autism.
To be diagnosed with autism, your child must have six or more of the following symptoms (agreed upon by a psychiatric organization):
• Avoids eye contact
• Plays alone
• Doesn’t share emotions with other people
• Is unaware of others’ feelings
• Starts talking later than two years old
• Can’t start a conversation – repeats words or phrases over and over again
• Repeats words or phrases as he hears them (has delayed speech and language skills)
• Doesn’t play make believe games
• Develops intense interests in objects
• Becomes disturbed at the slightest change in routine
• May be fascinated by parts of an object, such as the spinning wheels of a toy car
• Flaps his hands, rocks his body, or spins in circles

Treatment Options
There are several treatment options:
1. Behavior and communication therapy
2. Education therapy. Pre-school children who receive intensive behavioral interventions show good progress.
3. Medications to control symptoms. (20-30% have associated epilepsy.)
4. Creative therapies, such as art or music therapy.
5. Special diet — fat-free diet, gluten-free diet, vitamin A, vitamin C, vitamin B6, magnesium, and folic acid supplements
Even if a child has not been diagnosed with autism, he may be eligible for early intervention treatment services.
The sooner the intervention, the better the chance of success of leading a normal life.
I urge you to bring your grandchild to the pediatrician as soon as possible to see if he does in fact have autism, and develop a course of action to help him lead a normal and productive life.

* Reprinted with permission of The Tablet