DoctorAdvice4u

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Dr. Roshin Rowjee
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MEDICAL Q&A

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* COLLEGE STUDENT ASKS FOR HELP, LIKELY HAS DYSTHYMIA

hi Dr. Roshin, I spoke to you a few weeks back at the gym. i wanted to make sure i didn't miss your call. hopefully we'll talk soon, until then hope all is well.”  (Alex, New Jersey)



Dear Alex (New Jersey),
After visiting with you this past weekend (April 29, 2016), I believe you have persistent depressive disorder, also called dysthmia, which is a depressed mood on most days for at least two years.  During episodes of depressed mood, a person presents with at least two of the following symptoms not limited to the following: 1) inability to sleep or oversleeping, 2) alteration in appetite (poor eating or eating too much), 3) sluggishness, 4) low self esteem, 5) lack of concentration, 6) altered sleep patterns (too little or too much sleep), and or 7) feelings of hopelessness.   

During our conversation, you mentioned you have ”self doubt, insecurity, no focus, no motivation, hopelessness, and lack energy” ongoing for the past, three years, which began in high school (2012); however, an exacerbation of these symptoms has occurred this past semester in college (Spring 2016).  In fact, you stated that you are “in danger of failing the entire semester curriculum due to unattended classes for majority of the semester. “  Furthermore, you mentioned that you “have thought about taking your life; but, you have never implemented a plan.” 

When chronic depressed feelings affect daily performance of activities, school, employment, and or personal relationships, this condition is likely beyond the coping stage, and professional treatment is needed.  The best treatment options available for dysthymia include antidepressant medications and psychotherapy (talking to a psychiatrist or psychologist).  Yet, I do believe psychotherapy, more than medication, can reverse your depressed mood.  During our conversation, what became evident was your unhappiness with the general direction of your life and career.  Thus, after listening to you, I suggested methods to ascertain a career including taking the ASVAB test, talking to your career counselor at your college, and volunteering in those careers that you find interesting.   Remember, college years are a time of self discovery, eventually channeling your energy into areas of interests and likes.  Thus, at age 21, give yourself time to network and discern your career preferences.  When the time arrives to select a career choice, always, follow your heart.  

I am comforted to hear that you practice a faith.  In the darkest of times, when uncertainty flourishes, God is with you, helping to guide your choices; thus, keep the faith.  I have talked to a licensed psychologist, who is willing to visit with you regularly or as needed to help you reverse dysthymia.  I will forward the psychologist contact information to you.   Of course, feel free to call me also, as needed, and stay in touch.   Thank you for your question and trust.  God Bless you and God Bless New Jersey.


Respectfully,


Dr. Roshin












* TEXAS MAN TEXTS FOR HELP.  1 HOUR LATER, APPENDECTOMY ORDERED

I’m really sorry to bother u.  I have a delima.  I have a lot of pain in my lower right side.  I have 100 degree temp and I’ve felt nauseous some.  When I move my bowels ther seems to be a little relief.  Not much.  Could be severe gas. Lol but I’ve never had it like this.  When I walk I’m stooped over due to the pain.” (Jimmy, Texas)



Dear Jimmy,
After reading your text message at 6:12 PM CST, February 29, 2016, I instantly knew that you may be facing a medical emergency requiring immediate attention; thus, I telephoned you without delay.  After you confirmed  a 100 fahrenheit temperature, nausea for hours,  and confirmed pain was in the general vicinity between your belly button and the lower right portion of your abdomen, I instinctively knew you likely had appendicitis.  Therefore, I mentioned to you, followed by a subsequent text, that “these are CLASSIC signs of possible appendicitis, which must be ruled out.  Call 911.  This is a medical emergency Jimmy.”   After you texted me “I’m on  way to ER,” I replied “Good.  Must make sure if appendix about to rupture, remove organ before it bursts.  Sending prayers to you.”  The appendix, an appendage organ attached to the  colon, functions to filter bacteria from the eventual stool.  Thus any inflammation to the appendix, called appendicitis, could rupture the organ causing massive spillage of bacteria into the bloodstream.  A bacteremia could become a sepsis  of the blood which could have fatal consequences; thus, seeking  medical attention without delay Is apparent. 
On March 2, 2016, you sent me a message that “ I'm home now. Going to take it easy for a bit.
This is one of the worst pains I've ever experienced. I wouldn't wish this on anyone.”   As of March 8, 2016, you said “ Due to heavy lifting requirements at my work I won't be going back to work till Tuesday the 12th. Thanks again.”  Post surgery patients should take adequate time off for full recovery before returning to strenuous activity; thus, although you have become restless (a good sign of overall recovery), allow your body time to heal and recoup at its pace.  I am thrilled to hear that you are on the mend and you will be back to normal daily activities in the coming week.  Jimmy, I am humbled by your continued thanks and comments; however, I am just glad, upon your sent text message, to have been in the right place at the right time.  God Bless you and God Bless Texas.

Respectfully,

Dr. Roshin




* PHILIPPINE LADY ASKS FOR ALTERNATIVE TREATMENTS FOR BROTHER'S KIDNEY CANCER

“oh i am in the philippines sir we are very poor and i have seen in your profile that you're a doctor so i grab this chance to talk to you.  sir do you have knowledge about kidney cancer
my brother sir.. we cant afford a doctor.
 what can be use as a alternative medicine for my brothers condition.” (Ana, Philippines)



Dear Ana,

Although we still have not made contact since your initial question(s) two weeks ago, as promised, I have provided information on alternative treatments to ease the complications and side effects associated with cancer.  These alternative suggestions are NOT a cure for cancer; rather, these suggestions will help ease the profound symptoms often associated with cancer.  Before incorporating these items into your diet and or use within your body, always consult a doctor. 


1)  CHINESE MEDICINE:
Ginseng, Dang Gui, Huang Qi, Angelica

2)  HERBALISM:  
Chamomile, Valerian, Limeflowers, Echinacea, Sweet violet, cleavers, red clover, burdock, St. John’s wort, Garlic, Yellow Dock, Thyme, Calendula, Poke Root, Plantain, Nettle Myrrh

3)  FLOWER ESSENCE:  
Mimulus, Rock Rose, Olive, Sweet Chestnut, Garse

4)  VITAMINS/ MINERALS:  
Fresh fruits and vegetables, Vitamin A/C/E

5)  AROMATHERAPY:  
Geranium, Rose, Rosemary, Bergamot, Sandalwood, Fennel (Aromatherapy is preferred over massage in early cancer to prevent cancer spread). 



Ana, I still wish to discuss your brother’s condition with you; thus, please send a Facebook friend request to “Roshin Rowjee.”   With better communication, helping your brother becomes easier.  Thank you for your trust.  

Respectfully,



Dr. Roshin









* PHILIPPINE LADY'S BROTHER WITH POSSIBLE KIDNEY CANCER REQUESTS INFORMATION

“oh i am in the philippines sir we are very poor and i have seen in your profile that you're a doctor so i grab this chance to talk to you.  sir do you have knowledge about kidney cancer
my brother sir.. we cant afford a doctor.  can you tell me about the symptoms
this is my brother sir.  He looks very ill.” (Ana, Philippines)



Dear Ana,
You wrote to me that your brother, ““he is really suffering he cant stand up he is always complaining about stomach ache. he dont like to eat and he is having a hard time to pee.”    In addition, you asked me  “sir do you have knowledge about kidney cancer.”   You sent one message last week on my DoctorAdvice4u website, and since your initial question, I have been trying to reach you for further discussion.   The reason I wish to visit with you is your brother’s symptoms may be a kidney stone, rather than kidney cancer.  I need to know who told you that your brother had kidney cancer.  Let us connect on Facebook (send friend request to “Roshin Rowjee”) and have an extensive chat.  


Thus, the rest of this column is devoted to general information on kidney cancer.  Kidney cancer, referred to as renal cell carcinoma, upon diagnosis, must be staged.  There are four stages of kidney cancer.  Stage I and II kidney cancer are confined to the kidney; however, Stage III and IV cancer spreads outside the kidney with Stage III effecting nearby organs and lymph nodes and Stage IV affecting the entire body.  


When kidney cells mutate (change from normal), a cancer forms and continues to grow until medicines and treatments are administered.    The stage of kidney cancer determines treatment options which include but are not limited to the following.  For early stage kidney cancer (Stage ! or II), the following treatment options should be discussed with your physician:  1) surgery to remove the tumor without removing the kidney, 2) surgery to remove the entire kidney (called a nephrectomy), 3) freeze the cancer cells (cryoablation), and or 4) burn the cancer cells with heat (radiofrequency ablation).  For advanced stage kidney cancer (Stage III or IV), a doctor would offer the following treatments not limited to the following:  1) Special drugs that target and prevent kidney cancer cell growth such as Sorafenib, Avastin, Pazopanib, Temsirolimus, Sutent, and Afinitor, 2) high energy radiation therapy, and or 3) immunotherapy which are drugs (called Interferon and Proleukin) that help a patient’s immune system fight the cancer.  


Ana, you wrote that “we cannot afford a doctor. there is no alternative,” and you asked me “what can be use as a alternative medicine for my brothers condition.”   There are no alternative medicines to cure kidney cancer or cancer in general.  Rather, alternative medicines and treatments are offered to ease the symptoms (weight loss, fatigue, fever, pain…etc) that accompany cancers.  As mentioned, surgery, drugs, and radiation are treatments that could rid a person’s body of the cancer.  
Please, let us connect and visit on Facebook allowing me to get a clearer picture of your brother’s condition.  I will write my next health column on alternative treatments to help ease symptoms and suffering in people with cancer.  May Jesus guide your family during this difficult time.  God Bless your brother, God Bless you, and God Bless the Philippines.


Respectfully,


Dr. Roshin







* PHILIPPINE LADY ASKS QUESTIONS ABOUT BROTHER'S STAGE IV GALLBLADDER CANCER


“Hi! Sir! You know? My brother in a hospital right now, and he has 4 stages of cancer, we hopeless doc, i know! I am affraid, i pray to god! But i know he has a porpose to us! Pls. Give me a good messege regarding my brother situation now! If you have time! Thank you!”  (Ms. Ville, Philippines)

Dear Ms. Ville,
Since you are a Filipino lady living and working in Israel, I know how difficult your brother’s cancer diagnosis, has been on you and your family.   I am glad we were able to visit on Facebook at length about your brother’s condition, and in this column, I have attempted to answer all your questions regarding his cancer.  I have to admit, columns I write concerning late stage cancer in patients, are the most difficult to write due to the sensitive life and death nature of prognosis.  Specifically, your brother has Stage IV gallbladder cancer.  When I asked you if you knew which type of Stage IV cancer your brother has, you said, “I dont know, I think A.”  You also mentioned “That cancer very fast! we can't detect Early,...what do you think, there's possible treatments for him?”

First, Stage IVA gallbladder cancer is defined as a cancer that has spread to a main, liver blood vessel or to 2+ organs not including the liver, and or involvement of lymph nodes.  Stage IVB gallbladder cancer indicates the cancer has metastasized to distant areas far from the gallbladder and or involvement of large, abdominal arteries, lymph nodes, or the lower spine.  The stage of gallbladder cancer is very important in determining treatment options.  

A Stage IVA cancer patient might consider the following treatment options not limited to the following:  Surgery to remove the gallbladder and adjacent, effected organs along with radiation therapy with or without chemotherapy.  A Stage IVB cancer (unresectable or metastatic) patient should consult the doctor about these treatment suggestions not limited to the following:   1) Percutaneous transhepatic biliary drainage followed by radiation therapy for palliative care, 2) surgery to relieve blocked liver ducts, 3) chemotherapy, and or 4) a clinical trial of new drugs (such as Tarceva) .  In general, Stage IV cancer options generally involve palliative care (keep the patient comfortable).  

The American Cancer Society 2015 data suggests that the 5-year survival rate for a person with Stage IVA cancer is 4% while the 5-year survival rate for a person with Stage IVB cancer is 2%.  However, remember, the outcome of any one patient is entirely independent of research studies.   Many factors determine a person’s prognosis such as overall health, age, past medical history, and how the cancer responds to specific treatment attempts.  Thus, keep the faith and you are correct with “gods well! He is our savior! “miracles can and do happen.
Thank you for your question and trust.  My prayers are with your family.  God Bless your brother (Ruben), God Bless you, God Bless Israel, and God Bless the Philippines.


Respectfully,


Dr. Roshin












*WHAT SHOULD YOU KNOW ABOUT THE ZIKA VIRUS?

Dear Readers,

After the first Zika virus case was confirmed this past May 2015 in Brazil, the Pan American Health Organization (PAHO) issued a global travel alert.  Since the initial advisory, virtually every country in South America, Latin America, and the Caribbean have active, confirmed cases of the Zika virus, with outbreaks now occurring in areas of Africa, the Pacific Islands (Samoa), and Southeast Asia. The World Health Organization expects the Zika virus to spread to every country in the Americas (North, Central, and South America), with two exceptions (Canada, and Chile).

The travel warning, in particular, is directed to pregnant women.  The Zika virus is contracted by the bite of the Aedes species of mosquitoes.  Thus, transmission occurs by infected mosquitoes biting non infected humans.  If bitten, the consequences, especially to pregnant women, are profound.  Specifically, in a newborn baby, the Zika virus causes a decreased head size, called microcephaly, along with poor brain and neurological development.  In fact, a mother already infected with the Zika virus around term (40 weeks) could transmit the virus to her newborn at delivery.  Since the summer of 2015, Brazil has recorded 4000+ cases of microcephaly in babies born to mothers infected with the Zika virus during pregnancy.  

However, at the moment, there are no confirmed cases of the Zika virus being spread from mother to baby through breast feeding.  Therefore, mothers are encouraged to breast feed their babies.  There has been one report of Zika virus transmission from sexual contact, and there has been another confirmed case of Zika virus transmission from blood transmission.  

Presently, no vaccines or medicines are available to treat or prevent the Zika virus infection.  Thus, upon being infected, Zika virus symptoms are likely to last a week and include the following conditions:  fever, rash, joint pain, muscle aches, headache, and or red eyes (called conjunctivitis).  When travelling to an active area (see map), travelers should cover their skin with long sleeve clothing and apply mosquito repellent generously on exposed skin.  Drink plenty of fluids to stay hydrated; however, consult your doctor before taking any medications (aspirin, ibuprofen, acetaminophen…etc.).  Zika virus symptoms are similar to Dengue fever symptoms; thus, a doctor must confirm that a patient does not have Dengue fever, a disease that promotes bleeding.

To the Brazilian community, thank you for your questions, trust, and shared stories.   With Brazil hosting the 2016 Olympics, the prevention of Zika virus is an important concern.  Rest assured that the Brazilian government is taking measures to contain the Zika virus within their country including the use of a genetically modified mosquito that helps prevent the spread of the Zika virus by passing along a gene that kills this insect’s offspring.   Thus I am sure the Summer Olympics will be spectacular. God Bless Brazil.  


Respectfully,


Dr. Roshin

 





 

 

 

 

 

 

 

 

 

 

 

 

* PHILIPPINE FAMILY ASKS ME TO WRITE EULOGY FOR BETHOVEN UBAYUBAY

Although we live thousands of miles apart, I am deeply humbled to be asked to write and speak reflective words on behalf of the family of Bethoven Ubayubay.   Today we celebrate Bethoven’s life and to honor his contributions to family, community, and our world.  Although I have never met Bethoven personally, our correspondence on Facebook this past year, through his wife and brother in law, have drawn me very close to his family.

I have come to know Bethoven as a fighter, a man who, in Mr. Ismael Nino Seno Sambaan words, mentioned that he was, “a very hardworking man, but despite he is not feeling well he always go to work.”   Bethoven’s wife, Ms. Cristita Sambaan Ubay-ubay mentioned that “he is a greatman have a stong determanation in life a good father good provider.”  Any man, who works through countless complications, never making excuses, providing for his family, and fighting his cancer to the very end, deserves all our respect.  Let us remember Bethoven for his undeniable courage. 

I have come to know Bethoven as an inspiration to other people, both family and community.  I have been told that his associates at Happy Wearhouse Enterprises Incorporated, a marketing and merchandising company, thought of Bethoven as “a very humble worker where all his colleague love him like a brother too.”  Mr. Saambaan said “my brother in law is close to me. he help me from my schooling up thia time before he passed away.”   Similar to his brother in law, Bethoven, as quoted by his wife said he has and will continue in memory to inspire his son, Beth Anthony, and his two daughters, Eden Joy and Crissabeth, to pursue their education and reach for the stars in pursuit of their dreams in life.  We must bow with respect to Bethoven, admiring a man who appreciates the value of education, and how knowledge can change the world for the better.  We respect Bethoven for his ideals.

Yet, I believe, our most important memory of Bethoven, is that he was a devout man of faith and peace.  Numerous people have mentioned, “ bethoveen is a very good man, don’t want any trouble.”  Bethoven preferred the confines of his home, rather than the church, to pray and to teach his children to follow Christ’s teachings from the Bible.  In fact, just before Jesus took Bethoven with him to heaven, December 20, 2015, his family said “even when he is about to die he made the sign of the cross.” 

As the 2016 New Year is upon us, let us enjoy Bethoven’s brief forty-four year love of life, family, friends, and community.  We have so much to be thankful for from Bethoven’s life.  In fact, Cristita said, “I learn that life is so short if i could spent time more to him chears all the good times we have in 24 years together.”  Let us leave today’s funeral, December 29, 2015, happy for Bethoven and Cristita’s shared love, and let us always remember the wisdom they shared with us, specifically, we must always cherish family, thank God for His gift of life, and enjoy every moment and stage of life to the fullest.  God Bless Bethoven, God Bless Cristita, God Bless Beth Anthony, Eden Joy, and Crissabeth, God Bless Ismael, and God Bless all the Philippine people for teaching the world the one value in life that is undoubtedly, most important, love.   Thank you.

*Thanks to Mr. Ismael Nino Seno Sambaan, a co-author, for providing thoughts, quotes, and perspective on Bethoven’s life.

Respectfully,

Dr. Roshin

 





* WHY DID NEW JERSEY WOMAN WITH SHINGLES DEVELOP A BLOOD CLOT?

 "Hey doc.  My sister had shingles 4 a week and then, out of the blue, she got a blood clot.  Whoa, why?  Merry Christmas.”  (Roy, New Jersey)

Hi Roy,
After visiting with your sister on Facebook this past week, she has many risk factors that likely led to her blood clot.   Specifically, she is slightly overweight (BMI = 25.7) , has a history of varicose veins, a diet that predisposes (causes) to clot formation, and she had a condition, shingles, resulting in her being in an extended stationary position as opposed to normal movements and activity.  Regardless of the duration, being in a stationary position for hours at time does increase the risk  blood clot formation, especially, in people with several risk factors.  Your sister must change her lifestyle, specifically, her diet high in fats should revert (change) to a diet high in fruits and vegetables with lean cuts of poultry and or fish.  For her varicose veins, your sister can wear compression stockings, which would prevent blood from pooling in her legs thus decreasing clot formation.  In addition, after consultation with her doctor, your sister, should start an exercise regiment to lower her body weight, and more importantly to increase her leg movements.  Walking, running, and any type of locomotion causes the calf muscles to contract propelling blood in the lower legs to move up to the heart.  Thus, all body movements prevent the blood from pooling in the legs, causing decrease clot formation.

In addition, any individual who has a planned surgery, resulting in long term bed rest or if a person has a history of Crohn’s Disease or Ulcerative Colitis, you should talk with your doctor about medications to prevent blood clot formation.  In fact some medications, such as birth control pills and hormone replacement therapy, increase the risk of clot formation; thus, you should talk with your doctor, if other risk factors are present in your medical history.

In those people with increased risk of blood clot formation, if swelling, intense leg pain, excessive warmth on touch occurring in one leg, sweating, unexplained fatigue, rapid heartbeats, and or feeling light headed occurs, you should consult your doctor immediately or call 911.  Time is of the essence for survival or preventing permanent damage to body tissues. 

I am glad that your sister was able to acquire timely medical assistance to counter the clot that had already formed in her right leg; however, she must alter her lifestyle to prevent future episodes.  Enjoy you Christmas and the holidays with your sister.  Thank youyou’re your question and trust.  God Bless you, God Bless your sister, and God Bless New Jersey.

Respectfully,



Dr. Roshin

 




* ENGLAND MAN ASKS IF ZERO SALT DIET HEALTHY?

“Health question.   Hi what are daily recoomendations of salt.  I am going onto a "no salt" diet, where I

have as close to 0mg of salt / day if poss. Was wondering if this is OK.”  (Mr. Awan, England)


Hello Mr. Awan,

Here in the United States, your question arrives amidst a new debate as to how much salt a person

should consume to avoid detrimental health benefits.  For the past two decades, the recommendation

for healthy, salt intake recommended between 1500-2300 mg per day, which is roughly (3/4 of a

teaspoon).  Furthermore, for decades, the predominance of medical research  has  shown that too much

salt, 2300-10000+ mg of salt per day, has a direct relationship with an increased risk of heart attacks,

strokes, congestive heart failure, heart disease, and other cardiovascular conditions.  Thus, the American

Heart Association, as mentioned above, recommends under 2300 mg per day salt consumption.  Yet, in

the last two years, new government health task force guidelines, along with the Institutes of Health

study,  now suggests that there was no rationale for a person to aim for lower, much less very low, salt

daily intake levels (<2300 mg per day), due to no significant adverse health outcomes. 

Salt is needed in our bodies to maintain and regulate blood pressure, as well as to perform muscle and

nerve functions essential for basic movements (walking, running, writing, driving…etc).   Thus, salt is

necessary for daily living, and along with a diet rich in fruits, vegetables, nuts, fish, chicken, limiting or no

trans fats, and a doable exercise regimen based on your medical history, you will achieve your health

goals expediently.

Thus, you should consult your doctor, as to gradually lowering your salt intake to levels that maintain

your blood pressure in the normal range (120/80).  By lowering blood pressure, less stress is placed on

the heart, and the health benefits are substantial.  Each person’s medical history, past and present,

allergy history, and daily routine are pertinent to how much salt consumption should be modified.  Thus,

as much as I appreciate your trust and reciprocated conversation, the final decision between how much

salt to consume should be between you and your doctor.  God Bless you and God Bless England.  Happy

Holiday season to you.

Respectfully,

Roshin




* HIV+ PHILIPPINE MAN CONCERNED ABOUT VERY LOW CD4 COUNT

“doc finally i catch u.  im getting better. i really feel better doc but why is it that my cd4 count was dropped to 20 last week? what are the factors made it so? is the aluvia and efavirenz a good combination of arv drugs? pls always be online doc pls”  Thanks doc (Mr. Pinoy, Philippines)
  

 

Hi Mr. Pinoy,
Not hearing from you for months at a time is good, especially since sometimes, no news is good news.  Yet, after visiting with you on Facebook this past weekend, your mentioning that “my cd4 count was dropped to 20 last week” MAY be reason for concern.  You said you have been taking the “aluvia and efavirenz” antiretroviral (ARV) drug combination therapy “im taking that drugs for almost a year” and “im physically okay and healthy doc, no more allergies and fatigue.”  When I asked you if you have been compliant with taking the ARV medications on time and as prescribed by your doctor, you said, “yes i cant believe it because im taking my arv drugs religiously doc.”

Aluvia is a lopinavir with ritonavir drug combination and when added to efavirenz, this triple therapy has proven to be very effective against the Human Immunodeficiency Virus (HIV).  As you are aware, CD4 cells are the “good guys” in your body that help fight the HIV virus; however, HIV’s purpose in life is to take over the CD4 cells replicating itself in the process.  Thus, as a person’s CD4 count decreases, the immune system’s ability to fight off infection is greatly diminished, and a patient becomes weaker and sicker with worsening symptoms.  The result is the HIV virus spreads throughout the body and the person acquires all types of Acquired Immune Deficiency Syndrome (AIDS) manifestations.   Specifically, a CD4 count <200 causes Pneumocystis Jiroveci, a severe pneumonia, and a CD4 count < 50, results in a person acquiring Mycobacterium Avium Complex (MAC), an  infection that allows other opportunistic infections to consume the body. 

Generally speaking, a low CD4 count combined with a high viral count is a very poor prognosis.  However, the CD4 count does not always correlate with how well a patient feels.  Similar to you, some people with low CD4 counts feel normal, while other people with high CD4 counts feel miserable.  The viral count does offer a better assessment of overall status; thus, you should ask your doctor to rerun the CD4 count and add a viral count, as soon as possible.  Although you stated “im physically okay and healthy doc” a decreasing CD4 count on future tests needs to be reversed with urgency. 

*** A possible explanation for your CD4 count of 20 could be that Efavirenz is contraindicated (not to be taken) in patients with a past history of hypersensitivity Stevens-Johnson syndrome, erythema multiforme, and or toxic skin eruptions.  In recent years, you have had a demonstrated Stevens-Johnson syndrome reaction; thus, this might offer a plausible reason for your latest decreased CD4 count. 

Therefore, you should ask your doctor if a different triple ARV drug therapy regimen could be tried with the net goal of increasing your CD4 count.  In addition, although you mentioned “no more allergies and fatigue” your doctor should place you on antibiotics to counter the MAC infection and other potential, future opportunistic infections.  A CD4 count <25 is life threatening; thus, although you stated feeling much better, if indeed accurate, changes must be made in your treatment plan.  The CD4 count, in the future, needs to increase back to normal, not decrease.  However, you might be one of those exceptional few people whose drug regimen does not mirror adverse symptom expectations.

Please keep me abreast of your next set of viral and CD4 counts, as well as, what your doctor(s) suggest is your next best step in countering the HIV virus.  Thank you for your continuing trust, and remember, I am always available online 24/7.  God Bless you and God Bless the Philippines.

Respectfully,


Dr. Roshin





* PHILIPPINE LADY ASKS ABOUT BROTHER'S GALL BLADDER CANCER


"Hello sir! I want to asked you somethings about urine gald bladder? Because my brother is suffering now and he has a cancer right now! And what we can do to help him? Pls sir, i need your help ! I am worried for my brother, thanks sir and god bless!" (Ms. Villa, Philippines)

Dear Ms. Villa,
I am sorry to hear sent news, on Facebook, that your brother has gallbladder cancer.  Gallbladder cancer is rare, and although a definitive cause is unknown, more than likely a mutation in the DNA of the organ produced the eventual cancer.  Gallbladder cancer prognosis is entirely dependent on the stage of the cancer.  Stage I occurs when the cancer remains entirely within the inner layers of the gallbladder organ, Stage II cancer invades outer gallbladder layers, Stage III involves adjacent organs nearby (liver , stomach) and lymph nodes, and Stage IV is the worst cancer causing metastasis (spread) throughout the body.  Although your question was sent without subsequent information or contact, do know that the earlier the stage and the earlier the diagnosis of gallbladder cancer, the more likely the cancer will be successfully treated.  Imaging (ultrasound scan, CT, MRI), blood tests, and or invasive procedures (exploratory surgery, cystic and bile duct assessment) help determine diagnosis, stage, and subsequent, best treatment options.  If the gallbladder cancer is in the early stages (Stage I/II), usually, surgery is done to remove the gallbladder and involved, adjacent organs.  However, if your brother’s gallbladder cancer is late stage (Stage III or IV), radiation and chemotherapy will likely be used in an attempt to rid his body of the cancer.  I hope you will be able to contact me, in the near future, with additional information or questions; however, in the interim, I hope my explanation on gallbladder cancer provides a better understanding of what your brother is enduring.  My thoughts and prayers are with your family.  God Bless your brother, God Bless you, and God Bless the Philippines.

Respectfully,

Dr. Roshin

 





* WHAT ARE THE HEALTH BENEFITS OF ALMONDS?

“ What are the health benefits of eating almonds?”


For centuries, the almond tree has produced a nut crop, packed with much nutritional value, that upon ingestion, has far reaching benefits to our health.  In fact, almonds are considered the nut packed with the most nutrients including and not limited to vitamin E, vitamin B (riboflavin), magnesium, zinc, potassium, calcium, phosphorus, iron, selenium, copper, niacin, folic acid, healthy fat, and protein.  Thus, almonds are beneficial for the initial development and eventual maintenance of brain health, maintaining bone density, reducing bad cholesterol (LDL) levels while increasing good cholesterol (HDL) levels, improving blood vessel health, lowering blood pressure, and acting as an anti-inflammatory.   Therefore, due to almonds anti-inflammation ability, this nut is often used as a remedy for respiratory conditions such as bronchitis, to open airways making breathing easier.   In addition, research has shown that since almonds are a high fiber nut, almonds reduce the risk of colon cancer, as well as constipation, by increasing the passage of food in the digestive tract.  Almond milk, made from a combination of almonds, barley water, and honey, is often used to ease urinary, digestive, and respiratory problems, and almond milk is effective to improve overall health after an illness.  Add improvements to heart conditions, reduction of anemia and diabetes risks, improved dental health, and providing a nice complexion, almonds are the only “nut” I wish to constantly be around. 
To whoever sent this question, I hope these facts aid your future choices; however, always consult your doctor prior to addressing personal health issues.  A consultation with your physician is urged since almonds have been known to cause life threatening nut allergies, as well as the formation of kidney stones, gallstones, and crystallization of the biliary(liver/gallbladder) and urinary tracts. 

Thank you for your question and trust.

Respectfully,

Dr. Roshin








* NEW WOMEN MAMMOGRAM GUIDELINES

 Dear Readers,


The ultimate goal of all physicians is to prevent the formation of disease. Thus, medicine offers various screening tests and exams to help prevent the onset of disease and cancer. On October 20, 2015, the Journal of the American Medical Association published the American Cancer Society’s revised breast cancer screening guidelines. These guidelines apply to women with an average risk of breast cancer, NOT women with an increased risk of breast cancer due to a family history of breast cancer, a genetic history of breast cancer (mutation, genes for breast cancer), and or radiation therapy to the chest in women before the age of 30. .

The updated breast cancer screening guidelines are as follows:
1) Regular self and clinical breast exams are no longer recommended.
2) Women age 40 to 44 have the personal choice to begin annual breast cancer screening with mammograms, if they wish to do so.
3) Women age 45 to 54 are recommended to have annual (yearly) mammograms.
4) Women age 55 and older can choose either yearly mammograms or having a mammogram completed every 2 years.

Remember, regular mammograms are necessary to detect breast cancers early enough allowing a better success rate for treatment of the cancer.

For further information or comments, write DoctorAdvice4u@gmail.com.

Respectfully,

Dr. Roshin






*PATIENT ON ANXIETY MEDICATIONS CONCERNED

“I'm on effexor and ativan for anxiety, the effexor has taken the edge off of the anxiety but it makes me feel like I can't think straight and cloudy head, I've been on effexor for almost 4 weeks, is that normal and will it go away in time?” ( 31 year old male)

Hello Sir,
Even without reciprocated rapport, your anonymous question speaks volumes.  Specifically, in an attempt to treat your anxiety symptoms, you are experiencing an apparent drug reaction, strong enough for you to ask questions.  Thus, first and foremost, you should revisit your doctor providing an update on your symptoms since being prescribed these medications.  Everyone responds differently to a treatment regimen; therefore, when your normal activity level is significantly affected, consultation is recommended with urgency.  Ativan (Lorazepam) is in a class of medications called Benzodiazepines and Effexor is in an antidepressant in a class of medications called Serotonin Norepinephrine Reuptake Inhibitors.  Both Ativan and Effexor have numerous side effects.  Common side effects of Ativan include drowsiness, dizziness, weakness of muscles, inability to sleep, loss of balance, forgetfulness, difficulty concentrating, nausea, vomiting, changes in appetite, and or rash.  Side effects of Effexor include  weakness, unusual sweating, decreased appetite, nausea, vomiting, drowsiness, dizziness, nervousness, anxiety, tremor, blurred vision, insomnia, and or impotence in men.  Thus, between these two medications, drug interactions are very likely to occur. 

Typically, Ativan is the stronger medication; thus, your doctor should alter the dose of this drug, or stop all together, changing to another class of medications or using natural herbal supplementation.  More importantly, your question, does not reveal or suggest a cause of your anxiety.  With utmost clarity, try to avoid medications, seeking therapy to identify the cause of your anxiety and follow recommended psychotherapy regimens (as suggested by a psychiatrist) to eliminate or manage the anxiety trigger(s) altogether.  Without following my suggestions, you will likely use medications for an indefinite period of time, and similar symptoms are likely to continue to occur. 

If further questions warrant, please feel free to write me at  DoctorAdvice4u@gmail.com.
May you find resolution to present circumstances.  Thank you for your question and trust.

Respectfully,

Dr. Roshin






* PHILIPPINE LADY ASKING QUESTIONS AFTER HER "MAMA" DIES

 

“Sorry Im dstrb.  You busy. K about my mama died last week because of pain.  The doctor say for my mama kidney and high sugar are complicated its true?  Ok 8 months after died mama sacrifice.  K mamas leg and body are big like ballon.  Have also and its very small body like child.  The Other people say the phililpines tradition mama have barang body.  Like a horor story plenty ensikt worm flies small animal.  You know the siquijor story like that.”  (Beth, Philippines)

 
Dear Beth,
With heartfelt sadness, I am sorry for the loss of your mama.  After visiting with you extensively on Facebook, I understand your pain and need for answers to your questions regarding your mother’s passing.  You mentioned that the doctor said your “62 year old mother, yes have diabetes.”   Diabetes mellitus is a disease resulting from too high blood sugar levels in the blood for too long a time.  When blood sugar levels are always high, a diabetic person can develop complications, many of which you mentioned in our discussion.  For example, in addition to your “mama kidney and high sugar,” you said she “Have heart problem also.”  Diabetes causes problems in the skin, eye, kidney, nerves, ears, heart, and brain (increased risk of Alzheimer disease).  You mentioned that the “Doctor say first only heart problem and have water inside.”  Diabetes affects the blood vessels by causing fat to build up in arteries.  When fat accumulates in the arteries, the vessels become smaller, and less blood goes to all the organs in the body.  Blood carries the nutrients organs need to function; thus, when blood does not flow to the organs, the problems that affected your mama begin and become worse over time, especially when diabetes is not treated. For example, less blood flow to the heart can lead to possible heart disease, chest pain, stroke, a future heart attack, and heart failure.  The “heart problems and water inside” and your “mamas leg and body are big like balloon” were due to your mama’s heart and kidneys failing.   There are medicines that will help treat diabetes; however, you mentioned, “Little no money for by medicine.”    You also said “the doctor admited but mama nk go the hospital.  Mama scared go the hospital and mama died in home.”  This is unfortunate that your mama was not able to be admitted into the hospital.  The hospital has medical professionals and equipment to help people cope with the symptoms of diabetes, kidney problems, and heart failure such as the excess water (called edema) throughout the body and heart.  However, you stated that your mama “have Barang means bad spirit.”   Although I am not familiar with Barang, I am sure Jesus wanted your mama to rest comfortably in heaven with His protection and no more suffering.  May you always be in peace and comfort with the loving memories of you and your mama together.  My peaceful thoughts and prayers I send to you too.  God Bless your mama, God Bless you, and God Bless the Philippines.

Respectfully,

 

Dr. Roshin






* PHILIPPINE MAN ASKS WHY BLOOD IN STOOL FOR OVER 1 YEAR

 

“hi roshin how are you do you remember me?
for may hemoroids.  why sometimes we have and sometimes is not.  what is the best way for heal my hemoroid.  what is the best cream to cure my hemoroid or medicine.  maybe i want to home treatment. when i'm poh sometimes my poh we have blood sometimes is not, almost 1 year.  ok thanks”  (“Kal”, Philippines)

Dear “Kal,”
During our conversation on Skype, you mentioned, “yes, you blood from anal area every month but its not to heavy.”  You also stated, “when i'm poh sometimes my poh we have blood sometimes is not, almost 1 year.”  Thus, before providing information on hemorrhoids, any blood located in or on the stool, should ALWAYS be examined by a doctor.  In fact, visiting a physician may save a person’s life especially if the blood is due to bleeding in the lower GI tract, due to ulcers of the stomach, inflammation in the colon, or the worst case scenario, a cancer.  The doctor will identify the source of your bleeding and provide the appropriate treatment.

Since you sent questions on Skype concerning hemorrhoids, the following general information is to help remedy the discomfort and pain associated with this condition.  Hemorrhoids are swollen veins located either in the anus or in the lower rectum.   The vein swelling is often attributed to chronic constipation and straining during a bowel movement.   Thus, the bulging veins cause extreme discomfort, pain, itching, irritation, and traces of blood on toilet paper during wiping of the anal area.  Thus, we doctors, are likely to initially treat hemorrhoids by recommending a home therapy sitz bath (warm water bathing the veins), changes in diet (high fiber diet/ drink more water), or medicine (medicated cream, suppository, or ointment), all of which will relieve and decrease pain and irritation.  If these treatments do not remedy the hemorrhoidal condition, the doctor will likely recommend stronger treatments including rubber band ligation (cutting off blood supply to hemorrhoid area), sclerotherapy (injection of medicine to decrease hemorrhoid tissue), and or use of a laser to eliminate the hemorrhoids.

You should try the initial treatments of a sitz bath, diet changes, and time to decrease hemorrhoidal inflammation.  If possible, a prescription cream (Preparation H, Tucks rectal, Lidocaine topical, Zypram rectal) should also be acquired to decrease the hemorrhoid flare.  If these treatments do not bring relief in the short term (1-2 days), you should go to the doctor immediately.
Bleeding from the anal area for at least a year requires prompt examination by a doctor.  Thus, Mr. “Kal” please go see a physician as soon as possible.  Your survival may be dependent on the doctor’s findings.  Thank you for your question and trust.  God Bless you and God Bless the Philippines.

Respectfully,





Dr. Roshin

 








* PHILIPPINE MAN WITH PANCREATIC CANCER ASKS ABOUT PROGNOSIS AFTER SURGERY.


“hi doc  how ru?
i have something to ask.  my husband having pranceatic malignancy thats the result of his mri last two mnths.   the dr. tell me that i rather to have second opinion cauz the in the ctscan negative.  and all his lavoratory is negative.  pls advice me dr. if i need to under go operation or not.  is operation is need of my husband
and wats my assurance of the operation coz i worry.  Tanx for your time.” 
(Ms. “Crist” - Philippines)


Dear Ms.”Crist,”
Although we visited on Facebook this past weekend, without seeing the MRI or CT scan images and impressions or reading the actual blood laboratory results, your husband’s doctor is in the best position to advise of the diagnosis of his condition and subsequent treatment options.  You mentioning that your husband “for 5mnths, almost half his weigh gone” and “he have abdominal pain and back pain not all the time,” likely suggests that pancreatic cancer does exist, and surgery is his best option.  Pancreatic cancer is very aggressive and symptoms typically do not appear until the cancer is in advanced stages. In fact, fewer than 20% of pancreatic cancers appear to be confined to the pancreas at the time of diagnosis. 

Depending on the stage and location of the cancer, many surgical options do exist.  If the pancreatic cancer is in its early stages, surgery could be potentially curative with removal of all the cancer.   However, if the cancer is widespread throughout the body and unable to be completely removed, palliative surgery is done to relieve symptoms but is NOT meant to cure the cancer.

If you are able to obtain a copy of the MRI and laboratory results, I should be able to determine the stage of the pancreatic cancer, the location of the cancer, and suggest surgical options; however, your husband’s doctor is definitely in the best position to consult with you on best available surgical options.   If the cancer is in the head of the pancreas, a Whipple procedure may be done.  If the cancer is in the tail or body of the pancreas, a distal pancreatectomy could be considered.   At times, a complete removal of the pancreas, called a total pancreatectomy might be considered.  Chemotherapy, along with radiation, are also viable options, which would be considered, dependent on the extent and spread of the cancer.

Survival rates, for all stages of pancreatic cancer combined, is a one-year relative survival rate of 20% and a five year survival rate of 6%.  As mentioned, the low survival rates are due to the patient’s cancer rarely confined to the pancreas at the time of diagnosis.  In most cases, the cancer has progressed to such a degree that surgical removal is impossible.  However, in those cases where resection of the cancer is possible, the average survival rate is 18-20 months with an overall five-year survival rate between 10-25%, especially if the cancer has not spread to the lymph nodes.

Without a doubt, time is of the essence to ensure your husband’s survival.  Thus, as much as I am humbled by your request for my opinion, without the images or test results, I am unable to make a determination, and I suggest that you and your husband take the doctor’s advice at face value.  If your husband does indeed have pancreatic cancer, time is precious.  Without delay, surgery must be done promptly to stop progression of the cancer throughout his body.   May your faith help guide your decisions.  Thank you for your question and trust.  God Bless your husband, God Bless you, and God Bless the Philippines.

Respectfully,

Dr. Roshin





* MY OPINION(S) ON PLANNED PARENTHOOD

 

Dear Professor,
“After our first lecture discussion, I wanted to know your views on planned parenthood and the videos showing the selling of baby body parts.”
– “Laura” (New York City, New York)



Hello “Laura,”
Planned Parenthood is a nonprofit organization that offers health care services to millions of Americans not limited to birth control, emergency contraception, long term contraception, sex education curriculum, screening tests for cervical, breast, and testicular cancer, tubal ligations, vasectomies, sexually transmitted diseases treatments, HIV services, and abortion.  Thus, Planned Parenthood provides services to women and people of all incomes and ages, regardless of political or religious affiliation.  Planned Parenthood also stands firm on their belief of a woman’s right to an abortion, the root of much recent and ongoing controversy.

Throughout my medical journey, I have visited with women who have had abortions in their lifetime, and all women mention that to this day, their abortion is a silent, incomprehensible pain that continues to haunt them.  However, at that time and pending individual circumstances, for some women, an abortion was their unregrettable choice. 

As a doctor, my personal views do not interfere with my professional obligations to do no harm to my patient(s).  Thus, the majority of this article has been written with personal viewpoints that do not infringe on my professional duties.  My views on abortion remain firm.

However, after my above mentioned conversations, I do feel that I have no right to regulate or delegate decisions on how a woman should tend to her body. Having mentioned that fact, I do believe our country must think broader, realizing the implications of how we handle the abortion issue emanates well beyond our borders.   For decades, I have always ascertained that “LIFE is the standard.”  Specifically, regardless of whether we reference plant, animal, or human life, we, humans, must do everything in our power to protect life.  Life is the most precious gift God has granted our planet.

The moment a sperm fertilizes an egg, called conception, life begins.  Organ development begins from the third to eighth week after conception, and these organs continue to mature as the fetus grows to term.   Thus, when compiling these facts, the viability of life is a nonissue.   Yet, in our country, arguably the most advanced in the world, even with so many means of contraception, we have abortions being conducted up through the twentieth week gestation. In my opinion, this is completely unacceptable, if not irresponsible.  Why, you might be wondering?   At twenty weeks, although dependent on the woman, there is a living, breathing baby (developing fetus) in the womb, and I question how two individuals, who engage in consensual sex, have a right to terminate a viable life, especially after the twelfth week.  These two people should take responsibility for their actions, especially, since emergency contraception is now readily available.  By not standing firm on protecting the fetus’ life, we send a message to the world, that not all life matters.  The consequences of this message are profound.  We have wars, beheadings, kidnappings, torture, rape, trafficking, enslavement, and a seemingly endless plethora of unconscionable acts transfixed on our world simply due to one fact, LIFE IS NOT HELD AS THE STANDARD. 

I understand that abortion is not a simple black and white issue; thus, exceptions will exist.  However, our country needs principled policy with a message that transcends all faiths, people, and religions…all life matters.  By doing this, we have a better opportunity to make peace a reality, not a mere suggestion.

Thus, if Planned Parenthood is conducting abortions followed by selling fetal parts, these are unconscionable acts, which the Justice Department should investigate and Congress should pass legislation that would prevent vending off human parts to bidders.  I believe, “abortions must never become a business.” 

Thank you for your question and interest, Laura.  Your mind is expanding with different perspectives on various issues.  Many subjects will be controversial; but, the university environment allows you to explore and question real world issues.  However, always remember, controversy can be tempered by always maintaining LIFE as the standard.  God Bless you and God Bless New York City.  

Respectfully,

Professor/ Dr.Roshin

 










* PHILIPPINE LADY LIKELY HAS X SYNDROME. WHAT IS THIS DISEASE?

Hi doc.. how are you? I got so afraid since yesterday my blood pressure reached 180/120.  I drank aspilet and apple cider vinegar and shun all salty food.  I wasnt able to sleep the whole night.  Last night i felt so nervous overnight.  No. Doc this is the first time it happened. What medicine doc?  I will have my blood chem on saturday. But for the meantine i hope you could help me make my bp stable doc. Im really worried.  Thank you very much doc.. i really so much appreciate your response and time.  God Bless you doc Roshin..”    “Evelyn” (Philippines)


Dear Evelyn,
Immediately after your “blood chem” work was completed, you sent a message that “I had my blood chem and the high results are.. sugar - 110 boundary mine is 148, cholesterol 220 boundary mine is 248, and my triglyceride is a little high too.  I ate so much cheezzy and salty food. Can we talk please?”  After we visited, numerous times on Facebook, you likely have metabolic syndrome (also called X Syndrome), a realm of conditions not limited to increased blood pressure, high blood sugar levels, high triglyceride levels, high cholesterol levels, and increased waist size from excess abdominal fat.  The most common cause of metabolic syndrome is an unhealthy lifestyle, specifically, eating fatty foods and not regularly exercising leads to other causes of this syndrome including obesity, insulin resistance, and hormonal imbalance.  What does this mean to you?  Untreated metabolic syndrome increases the risk of stroke, diabetes, heart disease, and many cardiovascular disorders including heart attacks.  What should you do?  For both immediate and long term impacts on your future health, you must change your lifestyle.  You should do everything in your power to lower your blood pressure by eating fresh fruits and vegetables, eating whole grains, nuts, and lean cuts of meat, fish, and dairy products low in fat.  All foods high in trans fats and cholesterol, fatty meats, fried foods, and whole milk should be completely eliminated from your diet.  In combination with a better diet, exercise more (take a 20-30 minute walk every day if possible), remove or reduce all salty foods (<1000 mg per day), quit smoking, eliminate or dramatically reduce alcohol consumption (1 drink per day), and relieve stressful triggers by meditating, doing yoga, or listening to peaceful music.  Do eat foods including garlic, coconut water, cayenne pepper, almonds, and pure cacao, all of which are proven agents to reduce high blood pressure. 

I am glad to have received your message (09/09/15),“regarding my hypertensiion im taking idezar now that i need to maintain and my BP gets stable now . Thank you for replying Doc.”

By altering your lifestyle and taking your medication as directed, you will see improvements in your health and quality of life.  Enjoy the process and enjoy life to its fullest.  God Bless you and God Bless the Philippines.

Respectfully,

Dr. Roshin











* TEXAS ELDERLY MAN ASKS WHY TRIGLYCERIDES HIGH?

 

Hi Doctor,
“My triglyceride level is high (166).  Why?”  Thanks Adam (Texas)

Dear Adam,
After viewing the extensive blood paperwork you sent me,  not only is your triglyceride level high; but, the test results show high glucose (119), high thyroid gland activity( low TSH of .281), high creatinine kidney levels (2.42), and noteworthy, a serious elevation of potassium (5.8).

Thus, upon our initial discussion by phone, my first comment was that your elevated potassium level must be immediately treated.  High potassium levels could lead to a heart arrhythmia, and if the abnormal, heart rhythm is left untreated, death could occur.  Fortunately, you mentioned, a nurse from the doctor’s office called in a prescription for a medication to reduce the potassium levels.  Without a doubt, bringing your potassium level down is good news.

However, with regards to your question, all the high blood levels, including your high triglyceride level, is likely due to your inactivity after cataract surgery.   Specifically, your inactivity resulted in an underactive thyroid gland, prompting your doctor to prescribe Levothyroxin, twice a day.  However, due to your very low TSH level, an indication of an overactive thyroid gland, your doctor should consider reducing the dose of the Levothyroxin medication.  Furthermore, an underactive thyroid gland causes decreased metabolism, resulting in your blood sugar levels rising. Similarly, your high triglyceride levels are likely due to inactivity as well as drinking alcohol during this inactive period.   Your creatinine level and a couple of electrolytes are elevated likely due to dehydration. 

What should you do?  Before your cataract surgery in May 2015, you mentioned exercising on a daily basis at a local gym.  Your exercise regimen consisted of walking two miles a day, light resistance exercise training, and occasional spa and water aerobics.   When you were exercising before your surgery, all your blood results were normal; thus, with confidence, you should resume your exercise regimen, after consulting with your doctor.  I believe resuming your exercise regimen will reset your thyroid gland’s metabolic rate decreasing your reliance on the Levothyroxin medication, exercise will reduce your blood sugar and triglyceride levels, and by exercising, you will likely drink more fluids, resulting in your creatinine levels reversing back to normal.  By resuming your exercise regimen along with a modified diet (no more sodas and alcohol), within a month, you should see normal test results. 

By following these simple suggestions, you will easily add another 25 years to your present age of 72.  With “new” eyes, exercising should be that much easier and fun.  Thank you for your question and trust.  God Bless you and God Bless Texas.

Respectfully,

Dr. Roshin

 











* 5 YEAR OLD BOY ASKS WHY BASEBALL PLAYERS EAT SUNFLOWER SEEDS

 

Hi Doctor,
“Why do America baseball playerz eat sun flower seedz?”  Bobby (New Jersey)



Dear Bobby,
At age five, you ask a very intelligent question, and quite honestly, your question would best be answered by asking a baseball player on the New York Yankees or the New York Mets why he and or his teammates eat sunflower seeds during games.   More than likely, a player would say that they eat sunflower seeds for the health benefits including providing an extra source of energy during the games.  In addition, a baseball player might mention that he chews sunflower seeds as a substitute for chewing tobacco, an agent that often causes mouth cancer.  However, did you know eating sunflower seeds has benefits to all people, men, women, and smart children, like yourself. 

Some of the advantages of eating  sunflower seeds include the following:
1) Lots of magnesium for energy and healthy bones
2) Lowers high blood pressure
3) Prevents migraine headache
4) Antibacterial and antifungal properties to rid body of parasites
5) Helps treat a cough
6) Treats worms in the digestive system (pinworms, hookwarms, giardiasis)
7) Stimulates brain function
8) Improves kidney function
9) Treats menstrual cramps
10) Good source of Vitamin E to keep heart healthy
11) Helps lower cholesterol
12) Treat lung infections (asthma, whooping cough)
13) Treat intestinal disorders such as dysentery 
14) Induces milk secretion for a young mother
15) High selenium levels inhibit proliferation of cancer cells
16) Helps prevent muscle cramps and muscle fatigue

Bobby, thank you visiting with me, while we sat on the PATH train.  Whether at school or in Little League, eating sunflower seeds will keep you clever in class and on the baseball field.   Keep up the good work.  God Bless you and God Bless New Jersey.

Respectfully,

Dr. Roshin








* TEXAS WIFE COGNITIVE DISABILITY, HYPERAMMONEMIA RELATED

Hi  Roshin.
What are the effects of high ammonia levels in the body for too long?  Bill, Texas



Dear Bill,
Your wife’s untreated, high ammonia levels, for over one year, have likely resulted in her present inactive, listless state and inability to perform normal daily activities.  High ammonia levels in the blood results in a condition called hyperammonemia. In fact, hyperammonemia is subdivided into two types: 1) primary hyperammonemia and 2) secondary hyperammonemia.  Primary hyperammonemia results in a patient’s body not having certain chemicals (called enzymes) to destroy the high ammonia levels in the blood. Secondary hyperammonemia results from reduced cell types necessary to degrade the ammonia.  Regardless of primary or secondary etiology, ammonia, a toxin in the body, remains high in the blood and consequences, including death, are possible.  Your wife’s liver failure is a type of secondary hyperammonemia, which led to another condition called hepatic encephalopathy.  Encephalopathy symptoms caused your wife’s confusion and bizarre “animal-like” behavior.  Yet, typically, lactulose is administered to a patient resulting in the immediate remedy and treatment of symptoms.  Even though your wife’s ammonia levels spiked from 38, October 8, 2013 (Reference Range 9-33), to 122, August 6, 2015, lactulose was not administered until almost a year had elapsed.  Your wife’s present state is likely a direct result from her prolonged, untreated, high ammonia levels.
 
 How does ammonia affect the body?  Virtually every medical study published this past decade states that hyperammonemia causes brain dysfunction involving “a spectrum of neuropsychiatric and neurological symptoms” not limited to impaired memory, lethargy, shortened attention span, confusion, seizures and epileptic attacks, cerebral edema, intracranial hypertension, muscle weakness, and dehydration.   Your wife’s past and present symptoms stem directly from her extensive history of liver failure and liver hepatitis.  The liver produces the enzymes that metabolize (degrade) the ammonia; however, with liver failure, these enzymes are not produced, thus ammonia levels remain high in the blood throughout the body.  Once ammonia levels are high in the blood, a tsunami of encephalopathy symptoms occur.

The Texas Medical Board prides itself on issuing cease and desist orders to unlicensed physicians and newly graduated medical students; thus, I assume they have the wherewithal to revoke the licenses of practicing physicians actively engaging in the harm of citizens within the state (* see personal note below).  Thus, you and or your lawyer can submit your complaint to the Texas Medical Board electronically at http://www.tmb.state.tx.us/form, or call the Complaint Hotline at 1-800-201-9353 and follow the automated prompts to request a complaint form. 

As a medical doctor myself, I take no pleasure in potentially effecting a fellow doctor’s practice; however, the facts point to a need for accountability for the lack of timely management of an otherwise easily diagnosed and treatable condition.  God led you to me, and I will not question His plan.  To all involved, my prayers are with you.

Respectfully,

 

Dr. Roshin

* PS:  Bill, this note is advisable that you and or your lawyer(s) routinely correspond with the Texas Medical Board representatives or risk losing your due process.  These comments are posted out of past precedence as mentioned by other professionals due to having paperwork requests meeting Texas Medical Board deadlines completed, only to have due process rights all but dismissed.  Some Texas Medical Board rulings appear subjective as opposed to remaining objective. 









* TEXAS WIFE UNTREATED AMMONIA LEVELS, LIKELY MALPRACTICE
Hi Dr. Roshin.   Could you help me understand why my wife is no longer active and has no motivation to do anything?  She has had liver hepatitis for many years, and although she has gone to doctors for many years also, she is not herself anymore.  Bill (Texas)
  

Hello Bill,
After visiting with you by phone this past week, I remain stunned by your revelations concerning your wife’s listlessness and inactivity to accomplish basic, daily activities.  After discussing further what has led to this week’s question(s), I was stunned reviewing your wife’s past blood work test results and subsequent lack of medical attention.  Specifically, your wife’s blood  lab results indicated progressively, increasing, high ammonia levels for at least one year,  possibly longer; however, there was no medical intervention by her doctor or a hospital (on her initial visit). To say I am beyond shocked that medical personnel did not make the correct diagnosis of hepatic encephalopathy with hyperammonemia  followed by immediate treatment, with lactulose, to lower the high ammonia levels, is an incomprehensible, understatement.  Ammonia is a toxin; therefore, with extreme urgency, once in the blood, this chemical must be removed immediately, or quality of life consequences are extremely likely.  I believe your wife is suffering the consequences of untreated, high ammonia levels for over a year.  Your wife’s ammonia lab results, as provided by you, are as follows:

October 8, 2013:         38     (9-33 reference range)
February 4, 2014        60     (9-33 reference range)
August 6, 2014          122     (9-33 reference range)

Even though you mentioned to both her doctor and hospital personnel on October 8, 2013, that your wife was “buttering eggs” instead of potatoes, amidst a high ammonia level of 38, lactulose was not provided as an immediate and needed treatment for hyperammonemia.  The lack of treatment resulted in your “hellish” year of your “wife acting like an animal, urinating randomly whenever and wherever, instead of going to a bathroom.”  When coupling your wife’s symptoms with her past medical history, and high ammonia level test results, her condition should have been easily recognized, diagnosed, and treated.  I am dumbfounded that lactulose was only provided September 20, 2014, which “almost immediately” rid your wife of her confusion and strange behavior. 

Although you mentioned being scared to seek legal counsel due to fear that no other doctor in your locale or the state would help treat your wife’s condition, I beg to differ.  Doctors and the Texas Medical Board representatives alike, have an obligation to intercede on behalf of the citizens of the state of Texas to protect patients against licensed physicians, who knowingly or unknowingly, harm patients with active, inappropriate medical care.  Sir, you have grounds for a malpractice suit, and due to your wife’s profound decrease in quality of life, completely contingent on the lack of appropriate, timely treatment, not pursuing an attorney for representation is irrational.  Although you “blamed yourself “for the inability to better understand your wife’s condition, in the end, the doctor(s) shoulder the responsibility for prompt diagnosis and treatment of any condition.  You are not to blame for events that have transpired.   As much as my DoctorAdvice4u health columns are written for general health advice and never a substitute for professional care, I have never advocated a malpractice lawsuit; however, in your circumstance, I suggest and recommend legal council to correct wrong doing.  Your wife’s future, medical bills have and will continue to be exceptionally expensive, adding yet other, necessary layers of accountability and rectification. 

I am humbled by your trust, and I offer prayers to your wife, you, and the doctors involved in your wife’s medical care.  May God bring a peaceful, resolution to all involved. 

I will write next week’s column on the consequences of untreated high ammonia levels in the body, as requested by you.   

Respectfully,

 

Dr. Roshin  

 



* TEXAS FATHER ASKS WHY CHILD'S HAND HAS NUMBNESS & TINGLING 
“ Hey Roshin. I needed to ask a question about my daughter. Her mother is an RN and not to worried about this. My daughter thumb on her right hand was number Thursday and today she says its still numb and a little swollen. She also said that her index finger was swelling. Her mom told her to wait till Monday to go to the doctor. She is 19 and in good shape. She doesn't smoke. She says she hasn't hit it or done anything to cause it to do this.”  Jimmy (Texas)

 

 
Hi Jimmy,
After visiting with your daughter, Jayce, by phone this past week, our conversation suggested the numbness and tingling sensation she feels in certain digits of her right hand could either be 1) carpal tunnel syndrome or 2) De Quervain’s Tenosynovitis.   Both carpal tunnel syndrome and De Quervain Tenosynovitis have similar symptoms not limited to numbness, tingling sensation, discomfort of the wrist and hand, pain of varying degrees, swelling, and inflammation.  However, carpal tunnel syndrome is caused by compression of the median nerve which innervates the middle and index  fingers as well as the thumb.  Jayce said that she has had numbness in her little finger and thumb which suggests carpal tunnel syndrome may not be the diagnosis lending more credence to De Quervain’s Tenosynovitis.  Both conditions are caused by repetitive, daily  movements of the hand (grip, grasp, clench, pinch or wringing) as well as chronic overuse of the wrist.  With De Quervain’s Tenosynovitis, an untreated condition could result in pain moving  from the hand region up the forearm into the arm.  Jayce mentioned that, presently, she has dull pain and weakness from the point of her elbow to her shoulder, which seems to suggest that her doctor might investigate De Quervain’s disease further.  Both carpal tunnel and De Quervain’s treatment initially uses anti-inflammatory medications to help decrease inflammation and subsequent pain, and splints to stop the day by day repetitive movements causing the pain.    However, if these conservative measures do not work, a steroid injection will be tried followed by surgery if necessary.  When I asked Jayce to conduct a Finkelstein test on herself, her comments suggested a possible, positive diagnosis for De Quervain’s.   Jayce mentioned she had similar symptoms four years ago, a MRI (of shoulder and arm) was performed but “nothing was found,” and she “does not want to go to a doctor to have the same things done” with no pain relief.  My suggestion is to take your daughter to her doctor; but, have the physician conduct his examination on her right wrist area.  I feel certain, the etiology of her pain is likely one of the two conditions mentioned, and at that point, the doctor can try the suggested treatment options or add other pain relief options.  I am humbled by your trust, and I look forward to hearing what  Jayce’s doctor diagnosis.  Stay in touch.  God Bless you, God Bless Jayce, and God Bless Texas.
 
Respectfully,
 
 
Dr. Roshin






* HISPANIC TEXAS LADY WITH FOREARM FRACTURES ASK FOR HELP

“Necesito ayuda para mi esposa se lastimo la mano.  Ella tiene 2 fracturos en la mano izquierda y no tenemos segura medico.”  Jose (Texas)
 
 
Dear Jose,
After visiting with you and your wife at your house, and while readjusting the splint on your wife’s left arm, I was better able to understand your situation and your request for assistance.  Realizing that you, your wife, and son are undocumented and without health insurance, money for outpatient care will cost a “fortuna.”  One appointment to an orthopedic surgeon was already missed due to a referral cost of $350.00.  Thus, specifically, your request was to explore other avenues within the community to help with treatment and subsequent costs.

Fortunately, your wife had a copy of the X-ray on DVD which she borrowed to me for further examination.  After standing on a chair and falling, your wife was diagnosed with a “displaced fracture involving the base of the ulna styloid and comminuted and mildly displaced/angulated fracture involving the distal metaphysis of the radius. No subluxation or dislocation. No lytic or blastic bone lesion.”   Put simply, your wife has distal radius and ulnar bone fractures (near the wrist).   At this point, the goal of treatment is to return your wife to her prior functional level.   After examining the X-rays, I believe your wife will require surgery for placement of a plate to assure the fracture heals in proper alignment followed by a short arm cast for 4-6 weeks before she is able to resume normal daily living.  The cast is necessary for rigid immobilization, ensuring adequate time for the injury to heal.  The ulnar styloid is seldom addressed in treatment as compared to the radius fracture; however, the orthopedist will make that determination.  Nonetheless, the referral to the orthopedic surgeon was scheduled to determine if a plate and possible surgery is necessary for your wife’s injury.

After numerous telephone calls among local connections, I was able to contact a doctor and two physician assistants who will examine your X-ray to determine if surgery and or a cast is the best treatment option(s) for you.  In addition, after visiting with administrative officials in the Texas county of your residence, charity care could help pay for treatment costs.  Charity care is entirely based on your household income .  Since you cut lawns and your wife does not work, a sizeable amount of the total bill may be covered or the orthopedic surgeon will lower the exact cost of the surgery substantially.  Realizing you have resided in Texas for close to twenty years, the good people and professionals in Texas are taking the impetus upon themselves to reduce the costs and help fellow community members, regardless of immigration status.

Upon leaving your house, the need for immigration reform is profoundly evident.   I admire your family’s drive to make a better life in the United States, and I pray your residence in America will become peaceful, reversing the constant worry of deportation.  Thus, on Wednesday July 29, 2015, I will drive your wife to the doctor translating the physician’s thoughts on her injury along with treatment suggestions.  Fortunately, most people who have sustained similar injuries, resume their normal activities within a month, and for you, I expect the same outcome.  God Bless you,  God Bless your wife, and God Bless Texas.
 
Respectfully,

 

Dr. Roshin


* PHILIPPINE MOTHER ALARMED BY SON'S NOSEBLEED

 “hi friend what are doing ?  hi sir can i question about the nose..Sir why the nose is nosebleed?        Bkt po nag kakanosebleed ang isang tao?  last night my child is nosebleed,what kind of medicen a take?
last night my child is nosebleed, what kind of medicen a take?  11 years old. He is a boy.  Ok thank you for your empormasion about that”
    Ms. DJan (Philippines)

 
Dear DJan
,
After visiting with you on Facebook chat, I understood your immediate concern for your son’s isolated, nosebleed event.  However, your child’s nosebleed is not life threatening and likely will not require further examination from medical personnel.  Specifically, you mentioned that your 11 year old son was picking his nose, and the resulting nosebleed lasted five minutes.   You were alarmed by the nonstop nature of the bleeding; yet, nosebleeds that require emergency consultation occur when 1) the nosebleed lasts greater than 20 minutes, 2) the patient swallows blood causing breathing difficulties, and or 3) a nosebleed occurs after head and neck trauma.  Thus, to stop a nosebleed, try the following suggestions, realizing that if these tips do not work; visiting a doctor in your locale is of utmost importance.

To stop a nosebleed:
1)  Always position the head leaning slightly forward to prevent blood from being swallowed into the back of the throat.
2)  Pinch the soft part of your nose for 10-15 minutes.
3)  Position your body upright, not lying down.
4)  After bleeding stops, apply an ice pack to the nose.

Since your son does not take any medications, and he has no allergies, his nose picking likely caused this particular nosebleed.  If in the immediate future, nosebleeds continue accompanied by heavy bleeding, with urgency, visit a doctor as soon as possible.  The doctor (ear, nose, and throat specialist) will be able to run tests ensuring your son does not have anemia or any other blood disorder causing the bleeding.  Other suggestions to help prevent nosebleeds include keeping the air in your home humidified, applying vaseline inside both nostrils, and or using a nasal mist spray for each nostril.  In your son’s case, he should STOP picking his nose, as I feel fairly certain, no further nosebleeds will occur.
Thank you for your question and trust, Ms. DJan.  Anytime you or other friends/people in the Philippines have medical questions, simply ask.  I am more than humbled to be in a position to be of service to people around our world.  God Bless your son, God Bless you, and God Bless the Philippines.
 
Respectfully,
 
Dr. Roshin











* NEW JERSEY MAN ASKS EUCALYPTUS HEALTH BENEFITS

 

Hey Man,
“What are the benefits of eucalyptus?”
   “Brian from the Gym”

Hi “Bryan,”
I know most gym members call you the “eucalyptus man” since you drop a mixture of eucalyptus oil mixed in water onto the coal furnace in the dry sauna room allowing everyone to enjoy the unexpected, benefits of one of eucalyptus oil’s properties, namely, a decongestant opening up nasal sinus passages.  Thus, upon exiting the dry sauna room, we are all breathing much easier.  Nonetheless, as requested, the reason  for today’s column is to enlighten the readers and you on the other medicinal benefits of eucalyptus. 

There are over 700 species of eucalyptus,  an evergreen tree bearing leaves in which eucalyptus oil is derived.  Once extracted from the leaves, eucalyptus’ properties are often used for the following purposes:
1) Powerful antiseptic
2) Decongestant (for coughs, colds, sinusitis, chest infections)
3) Helpd to eliminates inflammation
4) Muscle aches
5) Rheumatism
6) Diuretic
7) Deodorant
8) Painkiller (burns)
9) Cystitis (urinary tract infection)
10) Reduce fevers
11) Genital and oral Herpes
12) Reduce fever
13) Treat skin infections and cuts
14) Mosquito repellent
15) Disinfects Insect Bites

As always, consult with your physician or homeopathy specialist prior to using eucalyptus for any of the above mentioned purposes.   Thank you for your question and trust.  God Bless you and God Bless New Jersey.

Respectfully,

Dr. Roshin








* BRAZIL LADY'S BROTHER WITH LIVER METASTASIS ASKS
                FOR ALTERNATIVE CANCER TREATEMENTS


“Hi doctor, I read Brazilian Press. I need your help in this moment. My brother has lung cancer. First he had in the esophagus, did chemotherapy and healed. Once he started in a lung and is now in two. He is undergoing chemotherapy for almost a year and is in critical condition, as much to get tired to walk. It also has some lymph nodes in the neck and he says it hurts a lot. There are alternative treatments for it in addition to chemo? Here in the US it is best for this kind of treatment? If it is better, what we have to do to get permission for him to travel?  Thank you to much for now.”  Ms. “E” (Brazil)



Dear Ms. “E,”

After visiting with you, your brother’s cancer prognosis is devastating news, and please know my thoughts and prayers are with you and your family.  After we visited in person, you mentioned your brother’s lung cancer has metastasized to his liver, an indication that he has an aggressive late stage cancer, requiring a reciprocated, aggressive treatment response.  The first line therapy to combat any cancer is either or a combination of surgery, chemotherapy, radiation, or newer medications that target the specific factors promoting cancer cells to divide; thus, hearing that your brother has been  “undergoing chemotherapy for almost a year” is very good news to try to control any further spread of the cancer throughout his body.  In our discussion, you mentioned that initially, your family wished to use alternative therapy treatment options, rather than suggested first line treatments.   Over my year’s assisting people with cancer, I have learned that a cancer’s sole purpose in life is to grow until all the body’s healthy cells are outnumbered; thus, once a cancer is diagnosed, the patient and doctor, must always discuss the most aggressive means to fight and destroy the cancer immediately.  Alternative treatments can be supplemented (added) to first line cancer treatment options; however, alternative treatments should never be substituted for first line treatment options.   Although you could not recall the name of the lung cancer your brother has, our talk proved interesting, specifically, his cancer was unrelated to smoking, which is rare but a totally, plausible occurrence.   Most lung cancers originate from smoking tobacco products filled with cancer causing agents; however, his previous history of esophageal cancer, may lend an explanation for the origin of the lung cancer.
 
Nonetheless, the following are alternative therapies that can be used as a supplement to help fight the cancer‘s progression, spread, and reoccurrence.  Remember, chemotherapy is toxic “medications” used to kill the cancer; but, alternative remedies are natural supplements that work counter to the cancer’s spread and chemotherapy’s side effects.  Many of the listed alternative medications can be used during and after chemotherapy treatment; but, always consult a doctor prior to using the following mentioned products.
 
1)       CHINESE MEDICINE:  Ginseng, Dang Gui (protects liver), Huang Qi, Ginger, Angelica (stimulate white blood cells & antibody production)

2)       HERBS:  Valerian, Chamomile, Limeflowers, Echinacea, Sweet violet, Cleavers, Red Clover, Burdock, Yellow Dock, Garlic, Nettle, Myrrh, Thyme, Poke Root, Plantain, Calendula

3)       AROMATHERAPY:  Geranium, Rosemary/Bergamot/Sandalwood (for fatigue), Fennel (for nausea).  Talk to a homeotherapist prior to using these aromatherapy products due body massaging promoting spread of the cancer, before and after chemotherapy treatments.  Oils in a bath or a vaporizer should be used.

4)       FLOWER ESSENCE:  Mimulus (fear), Rock Rose (Anxiety), Olive (Exhaustion), Sweet Chestnut, Gorse (Hopelessness)

5)       VITAMINS/ MINERALS:   Eat fresh fruits and vegetables, no processed foods, Vitamin A (protects against cancer in smokers), Vitamin C, and Vitamin E

 
Realizing your brother remains “in critical condition,” your question regarding the power of prayer, “does it help?” the answer is an emphatic, YES!   In my opinion, faith, should also be included in first line therapy treatments, as the power of God and the power of positive thinking can and do work miracles.  God Bless you, God Bless your brother, and God Bless Brazil.
 
Respectfully,
 
Dr. Roshin

 











* EGYPT TEENAGER MAY HAVE THALASSEMIA, A BLOOD DISORDER

 

Hi Dr. Rowjee
"Earlier in June, I went to visit my family in Egypt and I noticed that one of my female cousins who is 16 years old has put on an extreme amount of weight. Knowing that she has always been eating healthy alarmed me. She told me that she has been suffering with hypothyroidism and Anemia since 2011. When you download the pics, you'll see the name of each one and the year. I also took pictures of her blood count from 2011, 2012 and 2015.  She says that she has been to many doctors but they have proved to be unreliable and would be very thankful if I can reach out to a doctor I trust in the U.S. and this is what I'm trying to do. I would so appreciate it if you can take some time to look at her labs and tell me what you think about all this. Struggling with hypothyroidism for so many years has taken a huge toll on her emotional state and at this point she feels hopeless but I told her to never lose hope and that I will do all I can to help her.”  Thank you, Ms. “Eldeeb” (Egypt)


    


 
Dear Ms. “Eldeeb,”
I am humbled that you thought about me as the doctor who could best assist your cousin with her hypothyroidism.  After scanning your cousin’s blood count labs from 2011, 2012, and 2015, her white blood cells are functioning normally; however, as you mentioned, her red blood cell production and counts are low.  Your cousin has anemia.  Furthermore, your cousin’s thyroid panels are extremely consistent with hypothyroidism.  In fact, the thyroid ultrasound scan along with the thyroid gland results definitely shows chronic autoimmune thyroiditis (Hashimotos disease).  Both you and your cousin’s mother are correct in the assumption that she has Hashimoto’s since “her mother claims she has never been exposed to any of the of the other common causes (Treatment for hyperthyroidism, Radiation therapy or Medications such as lithium).”
 
Your cousin’s doctors have been thorough in their examination of your cousin’s anemia and hypothyroid condition; however, one trend, I noticed on the labs between 2011 and 2015 that may have been overlooked, is the need to rule out a blood disorder called thalassemia.  Your cousin’s MCV in 2011 was within the normal range (82.2); however, her MCV in 2015 had a dramatic fall (70).  In addition, the production of red blood cells, from 2011 to 2015, was lower than normal, but those red blood cells that were produced,  if malformed in structure (common in thalassemia), this could lead to sluggishness and fatigue due to decreased oxygen carrying capacity.  When coupling your cousin's symptoms with the data, your cousin should be evaluated for a possible thalassemia, a blood disorder characterized by low MCV levels.  Fatigue and weakness are hallmarks of Thalassemia, which could also lend credence to your cousin’s weight gain due to inactivity.
 
You mentioned your cousin has been taking a drug called "Eltroxin (100 mcg/day)" but this drug, which is called Synthroid in other parts of the world, “has not been helpful.”  Since the medication is not benefitting your cousin’s recovery, this is yet another reason she should be examined for thalassemia.  You asked if “a more natural substitute (natural thyroid replacement) called Armour thyroid” could be substituted for the Eltroxin.  Barring any allergic conditions, I do not foresee any problem with your cousin trying the Armour thyroid medicine in place of the Eltroxin; however, her doctor should initiate, conduct, and monitor all treatment regimens. 
 
As requested, I have included other natural herbal remedies for hypothyroidism, all of which should be taken only with a doctor’s supervision.
1)      HERBALISM:  Bladderwrack, Flaxseed, Bayberry, Brown Seaweed, Gum Guggal, Coleus Forskohlii, Gentian

2)      AROMATHERAPY: Clary Sage

3)      HOMEOTHERAPY: Calcarea

4)      VITAMINS/MINERALS:  Deficiencies in Vitamin A, Zinc, Selenium, and Iron may cause hypothyroidism; thus, eat a healthy diet with plenty of fresh, organic vegetables, seafood, and onions.  Garlic helps regulate thyroid function.

 
I am humbled that you thought about me as the doctor who could best advise and assist your cousin’s hypothyroid condition.  Thank you for your questions and trust.  Please stay in touch as I wish to know the results of a future,  thalassemia evaluation.  God Bless your cousin, God Bless you, and God Bless Egypt.
 
Respectfully,
 
Dr. Roshin








* PHILIPPINE MOTHER SHOCKED SHE HAS CHICKENPOX
“Thank you roshin.. you are really a big help. You are the one who always helps  and youll always there every time.  Roshin please help.you say is this a chicken fox..?? How can i cure this.?  Is there any medicine for this it is spreading in my body?  But im not feeling drowsy.  On my left eye.. I feel it has also inside.  What will i do now.  My god... Is there any medicine can cure this so that it doesn't continue spreading?  Im fine.. I don't have fever.. This rash is only my problem...Is this really like this.. It is itching super.. And also my bones are aching because of this.  Ok.. So many days will i suffer from this.”  Ms. Jipal (Philippines)


                                                                                                                                                                    
Dear Ms. Jipal,
After viewing the dozens of pictures you sent me and after extensively talking with you on Facebook this past week, I feel fairly certain you have chickenpox, a contagious, viral disease transmitted by a virus, called varicella-zoster, causing many of the symptoms you mentioned including “Stiff neck and loss of muscle coordination sometimes And disorientation, rash, itching super, bones are aching, and Headache also.”
 
Your rash started on June 16, 2015; thus, you should expect the total course of this infectious disease to last approximately 10-14 days.  You also mentioned, “But i didnt recognize it was chickenpox because it is only few.  I saw it on my left and right arm only 1...Yes it was spreading now on my face my back and my stomach.”  The pictures you sent me, indicate the sores on your body are in various stages of the chickenpox disease.  Specifically, chickenpox occurs in three phases: 1) pink or red bumps first, 2) followed by the red bumps becoming blisters filled with fluid, and 3) finally, all the blisters will begin to crust or form scabs.  Once the scabs form, the risk of you transmitting chickenpox to other people decreases significantly.  However, at the moment, you should isolate yourself in a room within your house, completely avoiding contact with people, especially your children and elder relatives or friends.  People with weak or immature immune systems have an increased risk of acquiring chickenpox, especially, if no vaccination was ever provided.
 
In various countries around our world, babies are provided a chickenpox immunization, which helps prevent this disease from forming in adulthood.  However, when I asked if you ever had the chickenpox vaccine, you said, “I dont know roshin if i had a vaccination for chickenpox..And yes this is my first time to have a chickenpox.”  Furthermore, since you said your children have never had the chickenpox vaccine, you should avoid contact with your kids; however, the transmission of chickenpox to your children may have already occurred due to the fact that any person can develop chickenpox 10-20 days after exposure to a person who already has chickenpox.  Also, when I asked if you had visited a doctor, you stated, “Not yet.. I have work so i don't have much time to visit a doctor.  I dont want this chickenpox to continue.”  In order to speed recovery from the chickenpox and to prevent spread to your coworkers, you should take time off from work and visit a doctor.   The doctor can prescribe a strong medicine, called Acyclovir, to fight the virus causing the chickenpox.   A doctor could also prescribe antihistamine medications to reduce the “itching super” you are presently experiencing, and the physician will monitor your children making sure they are taken care of in the event they acquire chickenpox.
  
As far as your question, “Is it true that eating egg makes chickenpox plenty in my skin..?” the answer is no.  Eating chickens or eggs does not increase your risk of  getting chickenpox.   However, eating healthy foods (fruits, vegetables, and fish) and hydrating well ( drink water) will speed recovery time from the chickenpox.
 
Thank you for your question and trust.  Please stay in touch, and feel free to keep sending photos of the blisters on your body.  I want to see you fully recovered and smiling, unlike the photos you sent me.  God Bless you and God Bless the Philippines.
 
Respectfully,
 
Dr. Roshin








ENGLAND MAN WITH SHINGLES ASKS QUESTIONS ON DISEASE

 

Hi Roshin cn you help I have the shingles
Yes on my face and back.  Let me send you a pic.  Thanks as you can see it's fairy bad on my face. I went to an eye specialist it isn't in my eye but very painful and now starting on my lip need to stop it Anything I can do to stop it happening agen? again*.  What is the cause of shingles?”  Thnx. Mr. KSmith

    

 
Hi Mr. KSmith,
Shingles is caused by the same virus that causes chicken pox, called the varicella zoster virus.  In fact, after a chicken pox infection, for years, this virus lies dormant in the nervous system before being reactivated due to a stressful situation in the body (such as old age or a weak immune system).  Shingles is a painful, burning rash that often follows dermatomes, areas of skin innervated by a spinal nerve.  Thus, upon reactivation, the virus follows spinal nerves to specific areas on the body, causing a stripe of painful blisters or vesicles.  At the moment, you are contagious; therefore, you should avoid contact with people.   Once the blisters scab over, the risk of transmission from you to another individual diminishes significantly.  After our conversation on Facebook, I was glad to hear that your “Doctor has given me aciclovir and paracetomel.”  Since there is no cure for shingles, Acyclovir is the strongest medicine against the virus.  In addition, a physician may prescribe creams to ease itching, anesthetics, steroid injections, and or anticonvulsants to treat the shingles outbreak or symptoms resulting from shingles.  Once treatment is initiated, the recovery time may take one month to six weeks, and although most people experience a single bout of shingles, recurrence may occur in some people.  In the United States, Zostavax, a varicella zoster vaccine, does exist for people older than fifty years of age who have never had shingles; however, the vaccine does not guarantee that shingles will never occur and does little to reduce severity in active infections.  Patience is needed to allow your body time to heal the exposed blisters.  Thus, reading a good book or catching up on James Bond thrillers might be your immediate plans while recovering.   Thank you for your question and trust.  If I may be of further assistance, please do not hesitate to ask.  God Bless you and God Bless England.

Respectfully,

Dr. Roshin





* PHILIPPINE MAN CONCERNED ABOUT WIFE HEMORRHOID CONDITION

hi friend i have an question for you what do you think is the best home treatment for the hemoroids because my wife is have and he is doing on take a bat the stools is blood but its to not heavy.  [6/4/2015 2:22:41 AM] and if you have medicine what is the name and how many days to drink \ thank you.”   Mr. Aris (Philippines)


Dear Mr. Aris,
Before providing information on hemorrhoids, any blood located in or on the stool, should ALWAYS be examined by a doctor.  In fact, visiting a physician may save a person’s life especially if the blood is due to bleeding in the lower GI tract, due to ulcers of the stomach, inflammation in the colon, or the worst case scenario, a cancer.  The doctor will identify the source of your bleeding and provide the appropriate treatment. 

Since you sent a question on Skype concerning hemorrhoids, the following general information is to help remedy the discomfort and pain associated with this condition.  Hemorrhoids are swollen veins located either in the anus or in the lower rectum.   The vein swelling is often attributed to chronic constipation, straining during a bowel movement, and in your wife’s case, her recent pregnancy.   Thus, the bulging veins cause extreme discomfort, pain, itching, irritation, and traces of blood on toilet paper during wiping of the anal area.  Thus, we doctors, are likely to initially treat hemorrhoids by recommending a sitz bath (warm water bathing the veins), changes in diet (high fiber diet/ drink more water), or medicine (medicated cream, suppository, or ointment), all of which will relieve and decrease pain and irritation.  If these treatments do not remedy the hemorrhoidal condition, the doctor will likely recommend stronger treatments including rubber band ligation (cutting off blood supply to hemorrhoid area), sclerotherapy (injection of medicine to decrease hemorrhoid tissue), and or use of a laser to eliminate the hemorrhoids. 

Your wife should try the initial treatments of a sitz bath, diet changes, and time to decrease hemorrhoidal inflammation.  If possible, a prescription cream (Preparation H, Tucks rectal, Lidocaine topical, Zypram rectal) should also be acquired to decrease the hemorrhoid flare.  If these treatments do not bring relief in the short term (1-2 days), you must take your wife to the doctor immediately.   I will help locate a clinic on your island as needed. 

In the meantime, yes, please feel free to have other people send questions to me by Facebook, Skype, or by email at DoctorAdvice4u@gmail.com.  Thank you for your question and trust.

God Bless you, God Bless your wife, and God Bless the Philippines.

Respectfully,

Dr. Roshin

 





* BURKINA FASO MAN MAY BE DEVELOPING TOOTH ABSCESS


Doctor,
" I lose my tooth 2 weeks gone.  U fixe my tooth but litle hurting 2day.”   William (Burkina Faso)



 
Dear William,

Two weeks ago, I mentioned that your teeth are malaligned likely leading to the lost tooth, a malocclusion, and a possible explanation for your “headet (headache).”  Although the Ibuprofen (200 mg tablets) decreased the pain substantially, in the subsequent days after you came by my apartment asking for help, today’s pain seems directly related to what I had mentioned two weeks ago.  Specifically, when I asked if you had bleeding from the gums, you said “a litle.”  The bleeding gum is likely traced to the lost tooth; however, due to the possibility of an infection developing within the gum tissue, I reiterated the urgency of you seeing a dentist as soon as possible.
Today, I am certain that the sensitivity and tenderness around your tooth and gum line is unmistakably “due I lose my tooth 2 weeks gon.”  The tooth you lost two weeks ago was fractured at the junction of the crown and body of the tooth.  Thus, the top part of your tooth was dislodged (came off); however, the root of the tooth remains in your gum line (see photo).  That portion of the root of the tooth remaining in the gum line is a focal point for an infection or an abscess (periodontal or periapical).  An abscess is a collection of pus that has developed at the bottom of the root (periapical abscess) or in the gum line (periodontal abscess), full of bacteria.  The bacteria arrive in the mouth by way of food, drink, or the environment.  As the bacteria multiple, the infection worsens causing bleeding, pain, and fever.  Upon placing gloves on my hands, when I pressed along the gum line and vestibule on the buccal and lingual surfaces of the upper jaw near the broken tooth, you jumped in pain.  William, you must see a dentist.  After two weeks, the sensitivity you are feeling in the tooth, especially when chewing food, may be a developing abscess, an indication that a bacterial infection is already present.  These abscesses that are in one location can easily spread into the blood and cause severe illness.  The abscess, if present, must be drained, a root canal procedure done, the remaining broken tooth removed, and or the dentist will likely provide antibiotics to kill the bacteria present in your oral (mouth) cavity.
Due to your unfamiliarity with dentists in New Jersey, I made an appointment for you with a dentist.  With urgency, please go to the appointment, ensuring that any infection or any potential infection will be promptly treated.  Thank you for your continued trust.
 
Respectfully,
 
Dr. Roshin







* COULD LOST TOOTH BE CAUSE OF BURKINA FASO MAN'S HEADACHE
Hello Doctor,
“I lose my tooth and I got headet that going now.  What kind of medecine can I take for my headet?  How can I fixe my tooth.”   William (Burkina Faso)

Hello William,   
                                                                                                                                                                   Upon you (and your friend) visiting with me in person, your demeanor and expression readily revealed you were in dire pain.  Thus, after checking your vitals, I proceeded to check your oral cavity, and arrived at the conclusion that your teeth are malaligned likely leading to malocclusion and a possible explanation for your “headet (headache).”   Put simply, this means that the teeth, or in your case, the canine tooth of your upper jaw, is not properly aligned; thus, the growth of the malaligned tooth (the canine), is pushing on adjacent teeth, likely contributing to the loss of your tooth, worsening an improper bite (called malocclusion), causing the acute (recent), onset of your headache.  This condition requires a specialized dentist, called an orthodontist, to help align the teeth properly.  However, the immediate concern is your tooth pain and headache.  
                                                                                                  
You mentioned that you arrived from Burkina Faso several years ago; and, although you are working, presently, you do not have health insurance.   Thus, although I thought about recommending an over-the-counter painkiller from a local drugstore to help subdue the pain, in the short term, an infection or possible nervous system etiology to your headache needs to be ruled out.  Therefore, I took you and a companion to the emergency room, as a means to ensure a thorough medical examination, proper imaging, and appropriate, prescribed medications are offered.    Yet, after several hours, I was surprised that you returned to my apartment, still in pain, mentioning that “they would not see you without paying fifty dollars, so you left.”   Although I insisted that the hospital was your best option, you wanted to try the pain killer first realizing that a dentist would have to be visited after the pain subdues.

Upon my recommendation, you purchased Ibuprofen (200 mg) tablets, and I mentioned to you how to take the medication for the next 24 hours.  After I called you periodically the next few days, both the headache and tooth pain had subsided; however, when I asked if you had bleeding from the gums, you said “a little.”  The bleeding gum is likely traced to the lost tooth;  however, due to the possibility of an infection developing within the gum tissue, I reiterated the urgency of you seeing a dentist as soon as possible.   More importantly, the malalignment of the teeth may contribute to untimely, future headaches, which is yet another reason to visit a dentist.

Nonetheless, after the four days had elapsed, even with slight tooth sensitivity from the exposed tooth socket, you had returned to work, offering a “thank you” for my help and concern.  I accept  this thank you on the condition that you visit a dentist soon.   In the interim, I thank you for your question and trust.  God Bless you, God Bless New Jersey, and God Bless Burkina Faso.

Respectfully,

Dr. Roshin






*MUSLIM WOMAN WITH BEHCET'S SHARES STORY

“Thank you Dr. Rowjee!! 
You saying that means a lot to me.  I would be honored to have my story on your site.  I've been on there many times.  What you're doing with your site is amazing.  I suffer from a rare disease called Behcet.”   Fatoom (Middle East)




Dear Fatoom,
Thank you for taking time out of your schedule to share your story with the world concerning Behcet’s disease.  Personal accounts are the most impactful, empowering people to persevere amidst the disease side effects and difficulties.  Behcet’s is classified as a genetic, environmental, and autoimmune disease, predominantly affecting people from the Middle East (Iran, Iraq, Turkey, Jordan) and Far East (Japan, Taiwan, Japan), specifically causing inflammation of blood vessels.  Inflammation of blood vasculature causes profound effects throughout the body not limited to the following:  genital and mouth sores, joint pain, and eye, brain, and blood vessel inflammation.  Since no test exists to diagnose Behcet’s syndrome, men and women in their 20-30s, must relay their signs/symptoms to their doctors, and upon examination, a physician, can make a clinical diagnosis for this condition.  Let us read your story.
 
“Thank you Dr. Rowjee!  I really appreciate it.  I suffer from a rare disease called Behcet which causes inflammation in the blood vessels throughout the entire body. It also resulted in me getting arthritis. Most of my joints are very painful and stiff. At the moment the most extreme symptoms that I'm suffering with are joint pain and stiffness in my wrists, elbows, ankles, knees and hip joint. Earlier in the semester for a month and a half my spine was inflamed and I couldn't sleep or sit still at all. For a couple of months now the pain in my right knee, left wrist and ribcage is extreme and unbearable. I'm currently taking Colchicine and Hydroxycloroquine twice a day and will start going to physical therapy next week. I also take diclofenac at times when I can't tolerate the pain. When I turned 20, is when I started have pain in every joint and I'm 21 now but starting from the age 14 is when I developed the extreme knee pain that would come every other month and last for 3 weeks then go away. I also developed edema in my lower legs which lasted for a month. My father took me to the emergency and they did blood tests but assumed that I had kidney or liver disease causing the edema in my lower legs but when nothing showed up in the results I left the emergency with no answers or treatment plan. Last summer is when I first went to a Rheumatologist. My ANA test came out positive and they discovered that I had a variation of the HLA-B gene called HLA-B51 which increases the risk of developing Behcet's disease.  It's been very tough on me but I try to stay positive and continue chasing my dreams.
 
Yeah it's common in the Middle East but still characterized to be rare. It's extremely hard for a doctor to diagnose you with it is what I heard. My father discovered at the age 40 what he had been suffering with for 20 years. He was mistakenly diagnosed with gout before in Egypt. My father and uncle both have it as well and my uncle who is a doctor was the one who diagnosed himself and reached out to my dad to let him know and what medications he should be taking. The extreme amount of oral ulcers was the major sign for the disease.
 
Life is beautiful, it just doesn't seem worth it to sit at home and just feel bad for myself but rather look at all the blessings God has blessed me with and thank him for them every day.”
 
Fatoom, your story touches us all, and upon reading, I am sure, all readers will agree that you are truly a source of inspiration.  We all grow from shared experiences with the ultimate goal that we as a world grow together as a people recognizing our similar needs of support, basic necessities in life, and above all, peace.  By sharing your story, we are one step closer to reaching that goal.   God Bless you and God Bless all Middle Eastern countries.
 
Respectfully,
 
Dr. Roshin










*DOES 1 YEAR OLD BOY HAVE MENINGITIS?

“ Roshin do you why my 1yr old boy has fever every night and why he vomit. Ms.” RJ”

 


Dear Ms. “RJ,”

After visiting with you this past week, May 11, 2015, on Facebook, I came to the conclusion that your son likely has a bout of gastroenteritis the past few days due in large part to your comments stating “He dont want any food   He only likes is drinking juices or water”  and “After 2 nights and two days he doesn't dirt.”   Later that day you sent a message stating that “ roshin i forgot to tell you when he has fever last night his Stomach is full of air  He wasn't able to burp.”   Due to your baby’s lack of appetite, little to no bowel movement, fever, and vomiting,  the symptoms suggest a bowel disorder.  Thus, my suggestion was to have your baby evaluated for Norwalk virus, a common intestinal virus in newborns and young infants.  If present, there are medicines against the virus.
 
However, after reading your last, sent comment, I prompted further inquiry on the status of your baby, and you mentioned, ““Yes hes irretable.. He doesn't know what position of sleeping he will b comfortable, fever of 40 c and he also cant sleep, and rash Yes in his forehead and neck To his shoulders.”  Immediately, I became alarmed that your son might be developing meningitis, a toddler medical emergency. However remote the possibility, meningitis must be completely ruled out as a possible disease in your child’s body.  Meningitis symptoms include fever, vomiting, headache, rash (called meningococcemia), and overall feeling ill.  In addition, a tense or bulging spot on the head, irritability when picked up, refusing to feed, and a stiff body or stiff  limbs are common features.  When I asked you if your baby has a stiff  neck or stiff body parts, you replied, “I dont know if any of hes body stiff.”  Thus, with urgency, I asked if you could take your baby to a hospital immediately.  You said, “50km away...But the doctor or the pedia there is not around at this time.. And they not wanted to accept patients at this time if its not emergency.”  Meningitis is a  medical emergency in babies and young toddlers, and if present, the bacteria must be killed before doing serious harm to your child.
 
I am glad to have received a message that that you were able to find someone to take you and your baby to the hospital.  Thank you for the pictures of your baby’s new, onset rash.  As I await your comments on what the doctor(s) diagnosed, my thoughts and prayers are with you and your son.  God Bless you, God Bless your son, and God Bless the Philippines.  Thank you for your question and trust.
 
Respectfully,
 
Dr. Roshin









* DAUGHTER ASKS IF MOTHER'S CHRONIC BRONCHITIS WORSENING

Hello Dr.Roshin,
“I spoke to you on Tuesday about my concerns over the treatment of my mother. She has hypothyroidism, low blood pressure, she's asthmatic and she has chronic bronchitis. I didn't realize just how bad the hypothyroidism had gotten until I went to go pick up her Levothyroxine and realized she wasn't at 60 mg anymore, she reached 112mg, which I realize is pretty bad. She refuses to see an endocrinologist and I fear it has a huge affect on her constantly getting sick. She has had high blood pressure as a child, but now she has pretty low blood pressure that is not being treated by  her doctor (I have asked why and he said she was fine, I do not agree). Anyway my main concern is her Chronic Bronchitis, which is progressively getting worse, she has two inhalers, Qvar (80 Mg) and albuterol sulfate (90mg) but she doesn't take it daily and it's because she is afraid of dependence and the negative side affects. Her asthma is largely controlled for most of the time, but the moment bronchitis hits from seasonal change or stress her asthma strikes. She can only last a day after she feels the initial symptoms of a sore throat and chest tightening before it's full blown bronchitis for her and she is off to get a shot of steroids from her doctor. It worries me because she is becoming very dependent on the shots and the bronchitis is getting more common. I worry about her really low thyroid performance and how it is tied to all of this and how her inhalers aren't working as well as it should anymore. I would really like your opinion on this since I do not believe her primary physician is doing enough.  Thank you for your time.” Ms. Lorena (New York City)



Dear Ms. Lorena,
Thank you for visiting with me by phone concerning your mother’s chronic bronchitis.  After our conversation, I am of the belief that your mom’s chronic bronchitis is not worsening; rather, with lifestyle alterations, her bronchitis symptoms and hypothyroid condition would actually improve, if not reverse altogether.  The reason for this presumption is her medical history is far from that of a person with a serious chronic bronchitis condition.  Specifically, your mother is not a smoker, her heart, kidney, and liver show normal functioning, and her bronchitis flares appear to be seasonal propogated only by a change in temperatures and or seasons.  Furthermore, although she has had a diagnosis of chronic bronchitis for the past five years, her bronchitis flares occur usually 1 night per month and self resolve in 7-10 days.  The Qvar and albuterol inhalers were prescribed to manage her bronchitis flares and steroid shots for emergency conditions if her inhalers did not work.  Her leg edema is likely attributed to incompetent valves from her varicose veins, and her hypothyroidism is likely due to inactivity due to being overweight.  At 5’10” and 202 pounds, your mom is overweight (BMI of 29.0) and closing in on obesity status.  Inactivity has a direct effect on the thyroid gland lowering its basal metabolic rate; thus, less thyroid hormone is secreted from the thyroid gland, which prompted your doctor to increase your mom’s Levothyroxine medication dosing from 60 mg to 112 mg, due to the thyroid gland being underactive.  Bottom-line, with a change in lifestyle habits such as 1) incorporating an exercise regime into her normal daily routine, 2) removing allergens such as the cats and rabbits in her house, and 3) consulting a nutritionist to eat healthier foods low in calories, her weight will decrease, activity level will increase, the thyroid gland will reset the basal metabolic rate higher thus causing more thyroid hormone to be secreted from the thyroid gland, and the net result, is your mom’s Levothyroxine medication dose dependence should decrease, and more importantly, the decreased weight will place less work on the chest cavity during breathing, likely decreasing potential, extreme bronchitis flares and vastly improving symptoms.  Lifestyle changes are well within your mother’s control, and as a family, the goals much easier accomplished.  With that in mind, thank you for your question and trust.  God Bless your mom, God Bless you, and God Bless New York City.

Respectfully,

Dr. Roshin







* ELDERLY BRAZILIAN WOMAN MAY HAVE SJOGRENS SYNDROME

Hello Doctor,
I am a 69 year old Brazilian woman living in New York City.  Since 2000, after my trip to Alaska, I have had “dry eyes and trouble putting lipstick on because of my dry lips.”  I went to a dermatologist three to four times, was referred to a neurologist, who ordered a CAT scan of my head; but, they did not provide an explanation.  The only time I am able to wear lipstick is when I use Laby, a Brazilian cocoa butter formula to keep my lips moist.  I read your articles every week and decided to call to see if you could offer an explanation.  Thank you.  Ms. “TonyaG”

  

Dear Ms. “TonyaG,”
After we visited by phone concerning your main medical concern, I believe you should be examined for a rheumatology disorder called Sjogren syndrome.  Sjogren syndrome, also called Sicca syndrome, is an autoimmune disease with two common symptoms, dry eyes and dry mouth.  Sjogren syndrome typically occurs in females of middle and elderly age.  Sjogren syndrome is often associated with other autoimmune conditions such as rheumatoid arthritis, lupes, primary biliary cirrhosis…etc.  Since you have a history of hypothyroidism, an autoimmune disease of the thyroid, there is likely an increased risk of acquiring other autoimmune disorders, such as Sjogren syndrome.  Sjogren’s causes inflammation of the glands and tissues around the body; thus, inflammation of the tear glands causes dry eyes and inflammation of the salivary glands causes dry mouth.  Furthermore, you mentioned your latest blood results were normal including overall kidney and liver function.  However, you also mentioned not drinking much water due to frequent bathroom use, and since there are limited restrooms along the New York City subway system, you “try to keep your bladder as empty as possible.”  Thus, part of the excessive dry conditions, not limited to your mouth and eyes, may be due to decreased hydration.   

As far as your question “which tests to order,” that should be left to the discretion of the physician however, tests to consider include the Schirmer eye test, slit lamp eye examination, Anti-Ro (SSA)/Anti-La (SSB) blood tests, biopsy of the gland, and or available tests to eliminate keratoconjunctivitis sicca as a possible diagnosis.

You are not crazy.  The neurologist was likely using a sense of humor (ordering a CAT scan of the head) to simply reassure you that your condition is not life threatening or a medical emergency.  Since tear drops have not improved your condition, having your doctor check for Sjogren’s seems the next best step.  At that point, the doctor may prescribe medications to increase tear and saliva production (Salagen and Cevimeline) as well as recommending better hydration techniques.

Thank you for your question and trust.  God Bless you, God Bless Brazil, and God Bless New York City.

Respectfully,


Dr. Roshin











* WHY DOES PHILIPPINE MAN HAVE STEVENS JOHNSON SYNDROME?

Hello Doc Roshin!
“ I was actually taking TRUVADA and NEVIRAPINE before for almost 2 months but sad to say I experienced Hypersensitivity reaction due to Nevirapine. The next ARV drugs iontroduced to me was Lamivudine-Zidovudine combi plus Efavirenz, again I experienced hypersensitivity severe rashes and asphixation. I was refered to the Allergologist, we conducted a drug resistance test or desentisizing and they found out that I am allergic to lamivudine. Then, I stopped taking the medications. They introduced to me another drug which is the tenofovir, abacavir and efavirenz. I took that drugs for several months but unfortunately there is no longer tenofovir available here. Thus, I only have a double therapy instead of the adviced tripple therapy the abacavir and efavirenz excluding the tenofovir. Until such time aluvia is available. Tomorrow Doc I will be starting the aluvia and afavirenz. Aluvia (BID dosage) and Efavirenz (QD dosage). But I am afraid to experience hypersensitivity again. What are the precautionary measures or good things to do prior taking the aluvia? What are the possible side effects of it? I will be observed for 15 days upon taking this aluvia. Thanks a lot Doc for your time and care. :) God bless u. See u soon...”  --- Mr. Pinoy (Philippines)



Dear Mr. Pinoy,
After visiting with you on Skype this past week, I was delighted to hear that your triple antiretroviral therapy treatment has resumed.  The combination Aluvia (lopinavir/ritonavir) + Efavirenz triple therapy will be stronger than the double therapy of abacavir + efavirenz.  In fact, Aluvia is the first and only co-formulated protease inhibitor tablet that does not require refrigeration and can be taken with or without meals, both important factors in delivery and overall effectiveness of HIV medicine in developing nations.  Nonetheless, during our discussions of your hypersensitivity skin reactions, my conclusion was that you likely had Stevens Johnson’s syndrome, a dermatology emergency, in which a rash of the  skin and mucous membranes, causes burning, blistering, shedding of skin causing immense pain.  Serious Stevens-Johnson’s infections may occur on 10-30% of the body’s surface area thus requiring hospitalization for treatment.  A weakened immune system is a risk factor for Stevens Johnson’s syndrome, and since HIV weakens immunity, you are at a significant, increased risk to acquire this skin disorder.  In addition, people who are of Chinese, Southeast Asian, or Indian subcontinent ancestry have a higher prevalence of Stevens-Johnson’s syndrome, especially if an individual carries the HLA-B1502 gene.  As mentioned, treatment requires hospitalization as well as the administration of medications or procedures to control pain and infection from exposed, peeled skin.  After our most recent Skype conversation (April 20, 2015), I was thrilled to hear “so far its my 10th day of trial period of aluvia and thanks god theres no side effects.” Similar to you, I also look forward to hearing your latest CD4 count late week.  With that in mind, I appreciate your continued trust and questions.  You are definitely keeping me on my toes.   God Bless you and God Bless the Philippines. 

Respectfully,



Dr. Roshin




* PHILIPPINE LADY NEEDS JAW TUMOR TREATMENT OPTIONS
“Sir can i ask u sumthng?  Sir wat is posible medecine for tumor in gums,?
and they said dat i need d major operati0n. . i sent u my x-ray”  Ms. “Jhoy” (Philippines)
 

Dear Ms. “Jhoy,”
Without a doubt, the X-ray you sent me confirmed what appears to be a 3 to 5 cm cystic mass located in your lower, right jaw (mandible).  However, the image does not provide information on whether the lesion is cancerous or benign (no cancer); thus, I asked if you could acquire, and then send more information concerning your “tumor.”  Fortunately, eight days later, you wrote back to me one word, “anemablastoma.”   I believe “anemablastoma” is actually spelled ameloblastoma, a noncancerous and rare tumor that develops near the molars of the upper and or lower jaw.  Although benign, the tumor can grow aggressively from the molar teeth into the jawbone causing significant pain and swelling, similar to the symptoms you are presently experiencing.  80% of these tumors occur in the mandible with increased prevalence among Asians, especially Chinese and Malaysians.  Furthermore, two genes (SMO and BRAF) have been identified as the mutations leading to the formation of ameloblastomas.  In fact, SMO mutations are typically found in the upper jaw of patients with ameloblastomas, while BRAF mutations are found in the lower jaw of people with this same tumor.

Nonetheless, although typically benign in nature, there have been recorded instances of ameloblastoma behaving in a malignant fashion complete with recurrences, intracranial extension, and death.  Thus, whether benign or cancerous, your doctor(s) are correct mentioning that a “major operati0n” is necessary to prevent any future, unwanted consequences.  The extent of tumor surgery, which may involve bone removal, is dependent upon the tumor’s size, location, and type, as well as the proximity of the tumor anatomy to surrounding structures. 

However, with regards to your question, “wat is posible medecine for tumor in gums?” researchers have found that the drug, vemurafenib, is toxic to ameloblastoma tumors that have the BRAF mutation.  In addition, other research has suggested a compound, called arsenic trioxide, an approved anti-leukemic drug in the United States (USA) effective against ameloblastoma tumors carrying the SMO gene protein.   These medicines are approved for use in the USA, and the doctors in the Philippines should be able to acquire these medicines upon request.  I have made telephone calls to the lead researchers of this study (Stanford University), and upon a reply, I will ask how doctors in the Philippines could acquire the above, mentioned medications, if not direct communication between both parties.  Realizing you are only twenty-two years of age, major surgery could be disfiguring, and if medicines are able to reduce the tumor size without surgery, this treatment method is definitely worth trying.  However, be aware, that ameloblastomas are renowned for recurrence; thus, in the end, surgery might be the best option to rid your body of any future difficulties with this tumor..

Thank you for your question and trust.  My prayers are with you.  God Bless you and God Bless the Philippines.


Respectfully,

Dr. Roshin  








* MALAWI MAN ASKS CHILI & LEMON HEALTH BENEFITS

“I just want to knw the negative impact of the following things to life of a person: Lemons and chilli”   Thank you. Malawi resident
   

Dear Malawi resident,
I am deeply humbled to make your acquaintance, address your medical question(s), and most importantly, make growing friendships from your and other sub-Saharan African countries.  Although your question asks for the negative impacts of “Lemons and chilli,” this article has been written to address both the benefits and cautions of both food types.

PEPPERS:

BENEFITS:    
1. Cool the body by increasing perspiration.
2. Decrease pain sensitivity by increasing blood supply to effected area.                   
3. Toxin elimination from body
4. Cayenne Peppers:  provides pain relief, tiredness, cold
5. Treatment for varicose veins, asthma, digestive system complaints.
6. Excellent source of Vitamin C, potassium, fiber
7. Vitamin A found in red peppers, paprika, and chili powder
 
CAUTIONS:
1. Skin irritation
2. Painful Inflammation in eyes and open skin wounds.  
3.  Irritation in urinary system during urine excretion

LEMON:

 BENEFITS:
1. Rich in Vitamins B & C, potassium (helps people with heart problems), strengthens immune system
2. Antifungal, antacid, antiseptic, antibacterial (stops infection spread)
3. Boosts immune system (relieves cold/flu symptoms)
4. Treatment of hemorrhoids, kidney stones, varicose veins
5. Aids digestion, stops bleeding from cuts/scrapes, controls bladder infection
6. Cure cold sores, oral cavity ulcers, dissolve gallstones (when mixed with olive oil)
7. Natural insecticide (against mosquitoes, black flies, and house flies)
8. Pain killer on wasp stings, act as a diuretic and laxative, relieves arthritis, dispels depression
9. Improves circulatory system (when adding sliced lemon to food)

CAUTIONS:
1. Irritates sensitive skin
2. Dilute well for massage and bath blends (use not more than a few days at a time)

Thank you for your question and trust.  To answer your follow up question, yes, feel free to have your friends and family write questions as needed.  I am humbled to be in a position to assist neighbors around our world.  God Bless you and God Bless Malawi.

Respectfully,



Dr. Roshin







* NY LADY IN ACCIDENT SEEKS HELP FOR LOW BACK PAIN
hi prof rowjee,
“for the past 10 years, ive endured chronic pains (in my back and legs) and recently was informed my thyroid, pituitary and adrenals do not produce enough hormones - now i understand this exacerbates my pain.  to this very day i do not know what caused these problems aside from a pedestrian accident from when i was much younger.  doctors i've met with do not seem to be equipped to help lessen my pain. I'd really like to talk to you about what is going on, talking to someone that knows about the body - if you have time.” Ms. “Nan”

     

Hi Ms. Nan,
I am glad we were able to visit for consecutive weeks in New York City concerning your various medical questions.  After viewing your MRI images, reading the radiological spinal column impressions, and learning about your past medical history leading up to recent questions, I took the liberty of consulting with a colleague, a physician with forty years of experience, tapping his expertise on spinal cord related pain, post injuries.  A suggestion of you talking with a neurologist specializing in microneurosurgery became the main emphasis of our conversation.  Microneurosurgery is a type of surgery conducted under high magnification with miniaturized instruments on microscopic vessels, nerves, and structures within the nervous system.
 
Your MRI report mentions “disc herniations at the L4-L5 and L5-S1 levels, with evidence of significant spinal canal stenosis.”   Lumbar region spinal stenos can cause neurogenic claudication, a poorly defined pain, tingling sensation, or cramping in one or both legs worse when walking and standing but relieved with sitting or assuming a leaning forward posture.  Neurogenic claudication is caused by compression of nerves within the lumbar spine.  Thus, after conservative measures such as physical therapy and pain medications are exhausted, a surgery called,  decompressive lumbar laminectomy  (open decompression), may be a viable option removing damaged bone, joints, disc, or ligaments that are compressing the nerve causing your pain.
 
Herniated discs, also called a slipped or ruptured disc, results in pain due to the protruding central disc material impinging on a nerve causing pain, numbness, and weakness in that dermatome (skin and or muscle area) supplied by the nerve. Once again, if conservative measures fail, a neuromicrosurgery procedure, referred to as a microdiscectomy, can be completed on an outpatient basis.  Microdiscectomy surgery “involves a small incision over the spine at the location of the herniation. The muscle is separated from the bone to expose the spinal column. A very small amount of bone is then removed to expose the compressed nerve root and herniated disc material. The disc is removed to create enough room for the nerve root to exit comfortably. The incision is then sutured closed.”
 
During our conversations this past month, the entirety of our conversations centered around pain control.  Although you attend regular physical therapy sessions, have a regular chiropractor, and have tried acupuncture, your pain is “relentless at times.”  Thus, microneurosurgery should become a viable treatment option of discussion with your physician, with the ultimate goal allowing you to improve your quality of life as pain free as possible or more realistically, living your life with much, improved pain management.  At age 36, you have your whole life ahead of you, and since the natural remedies and alternative treatments have yet to improve your pain, minimally, invasive microneurosurgery could be the key to a pain free future.  The following link (
http://weillcornellbrainandspine.org/minimally-invasive-neurosurgery) is New York-Presbyterian Hospital/ Weill Cornell Medical Center Department of Neurological Surgery website.  One call to the Weill Cornell Brain and Spinal Center is likely to change your life forever (http://weillcornellbrainandspine.org/contact-us).
 
Thank you for your question and trust.  My prayers are with you as you move forward with your decisions.  I wish you only the best in the outcome(s).  God Bless you and God Bless New York City.
 
Respectfully,
 
Dr. Roshin









* NY WOMAN ENDURING DOMESTIC VIOLENCE ASKS FOR HELP

“ Hi.  I’ve been taking meds for my depression for 2 weeks but not helping.  Could u tel l me if this medicine is any good?  I stopped taking it.  My number is xxx-xxx-xxxx.  Thanks. “   Ms “Kan”

    

Dear Ms. “Kan”
After visiting with you in person, Tuesday March 24, 2015, your symptoms of depression, for the past nineteen years, is medically diagnosed as persistent depressive disorder (PDD).  PDD, formerly called dysthymia, is characterized by a generalized depressed mood that last most of the time during the day and is present most days for at least two years.  The anhedonia, depressed mood, feelings of worthlessness, diminished ability to concentrate, insomnia, and frequent crying spells, you mentioned, are typical features of this mood disorder.  To treat this disorder, doctors will prescribe anti-depressant medications.  Although you could not recollect the name of your medicine, more than likely you were    prescribed a selective serotonin reuptake inhibitor (SSRI), a tricyclic antidepressant (TCA), or monoamine oxidase inhibitor (MAOI).  However, these anti-depressant medications require 4-6 weeks to be therapeutically effective; thus, your discontinuing the medication after two weeks was a premature decision.  You should consult your doctor prior to altering any treatment regimen.
 
Nonetheless, during our conversation, I sensed more to your story than you were divulging (especially since you did not remember the medication name…etc), and I pursued further inquiry.  Finally and shockingly, you said, “ Your marriage has never been a match, and that your husband is emotionally abusive with his words toward you.”    Although you said the physical abuse has ceased, no man, much less human being, has a right to be emotionally or physically abusive to you.  Realizing you are and have been an immigrant in the United States, monetarily, you have been dependent on your husband’s support; however,  no amount of support is worth receiving without peace and self worth intact.  I am glad to hear that you have entered a nursing program as a means to become self sufficient.  In New York state (and New York City), women’s shelters are available for your protection and to make a fresh start from abusive environments.   With heartfelt empathy, call the domestic abuse hotline in New York City at 1-800-621-HOPE(4673), and in New York State, call the domestic abuse hotline at 1-800-942-6906. The United States National domestic abuse hotline is also 1-800-799-7233.  In New Jersey, the domestic abuse hotline is 1-800-572-SAFE(7233).

You are already a very, courageous lady seeking help for dire circumstances.  Now, let others help you to escape from the abuse, keep you protected, and offer a clear, solution to an otherwise unharmonious relationship(s).  Let your faith and God guide your steps into a more tranquil future.  Please do not hesitate to call/write if further assistance is needed.  Thank you for your question and trust.  God Bless you, God Bless your son, and God Bless New York. 

Respectfully,

Dr. Roshin





* MALAWI MAN HAS EYE PAIN FROM PTERYGIUM

“Hie Sir hlp me. My brother, i have sores in my eyes i met doctor gave medicine bt nt change am thinking that i have asnthma see it. I am ready for questions.”  Banda (Malawi)


Greetings Banda,
I am humbled to have made your acquaintance, and I admire your work as a priest uplifting the lives of people in various African villages of Malawi.  Thus, concern about your eye sore is understandable especially since many people look to you for daily life assistance. 

After our visit on Facebook March 14, 2015, your diagnosis is likely a pinguecula that is now leading to the formation of a pterygium in your right eye.  Although a pinguecula and pterygium have very similar characteristics, a pinguecula is a yellowish tissue growth normally on the conjunctiva of the eye (white part of the eye) between the eye lids, while a pterygium is a similar tissue growth that extends onto the eye’s cornea likely effecting vision if left untreated.  The excessive tissue growth, in both a pinguecula and pterygium, is a protective mechanism against the sun’s ultraviolet light on the eye.  The tissue’s growth protects the eye’s surface from sunlight damage.  The reason for this conclusion is that during our conversation, you mentioned that the yellow deposits developed for “a year nw” since “Dec 2013;” however, the yellow deposits have become “Sindithatu koma” or “feel it pain. “   The pain also occurs “any time bt nt everyday.”   You also mentioned “no” bleeding or discharge from the eye and you have never been hit or had trauma to the eye (“i never hit.”)  Furthermore, you mentioned that pain comes “When i have sneezing” and “Whem am reading it affect me for the tears start to drop.” 

You also mentioned Malawi has “Many areas r hot with high temperature sun shine from 6-6 manytimes.”  Furthermore, you spoke of your eyes becoming dry in the heat and sunshine, and that eye drops have helped relieve the pain but “after it end the pain come again.”  When I asked if you wear sunglasses or a hat daily to cover your eyes, you said “No.”  You have no medical history and no allergies; but, your dad suffered from hypertension (“bloods presure for my father are surfer from it.”) 

I believe the recent onset of pain in your right eye is due to the fact that, over the past year, the yellow tissue deposits have grown much larger in coverage infringing on the cornea and causing pain during blinking and sneezing.  The more your eyes are affected by the hot, dry air and abundant sunshine, the more likely that the pinguecula and or pterygium will continue to grow, causing increased irritation in the eye.  Thus, not only should you wear a hat and sunglasses to protect your eyes; but also, locating an ophthalmologist (an eye specialist),  to conduct a complete, eye exam investigating the anterior and posterior eye chambers including the retina, is very important.  Specifically, since bacteria and viruses are invisible to the naked eye, the doctor must rule out “bugs” and trauma within the eye.  Continue to use the lubricating, eye drops to relieve pain; however, if the pain becomes worse, surgery may be needed to remove the tissue from your eyes.  Thus, if not present in Malawi, you might consider checking the neighboring countries of Zambia, Mozambique, and or South Africa for an ophthalmologist.  I wlll help you locate an opthamologist if needed.  Thanks for your question and trust.   God Bless you and God Bless Malawi. 

 

Respectfully,

 

Dr. Roshin






* MY BROTHER HAD 5 SEIZURES OVER NINE HOURS. HELP.

 “ last thursday and the time 9 PM, my brother had 5 seizures until in the morning 6 am.  after the seizure he got mental block he do what ever he wants. he's breaking our appliances. did you see his face he got some wounds on his face he have headaches 2 plz help.”  -- Mr. Arisgado (Philippines)

       

 

Hello Mr. Arisgado,

Thanks  to your sister for helping with information and translation, on Skype, concerning your series of seizures this past Thursday March 5, 2015.  Although you have had a history of seizures over the past twenty years, the unprecedented, sequence of five seizures from 9:00 PM Thursday night to 6:00 AM Friday morning, of over one hour each seizure event, understandably caused much anxiety and worry within your family.  You endured convulsive status epilepticus, a condition characterized as an emergency situation due to prolonged or repeated convulsive seizures lasting 1) longer than 30 minutes per event and 2) moving from one seizure into another without recovering consciousness.   The “mental block he do what ever he wants. he's breaking our appliances” are likely postictal symptoms, a state of altered mental status (drowsiness, confusion) after a seizure, where you were not fully aware of your movements and actions.   Also, the “mental block” is why you did not remember the entire night of seizure after seizure events.
 

Seizures have many causes including and not limited to the following:  stroke, meningitis, abscess formation, trauma, uncontrollable hemorrhage, low levels of blood sodium/calcium/magnesium/sugar, decreased oxygen levels, cancers, and autoimmune etiologies.  The headache your sister mentioned could be a potential cause of your continuous seizures, namely, a possible brain tumor, and or the headache could be due to your head hitting the concrete ground during two seizures.  Thus your sister mentioned “did you see his face he got some wounds on his face” are the marks due to the impact of your head hitting the ground.

 

With extreme urgency, I recommended that your sister take you to a doctor immediately.  The doctor is likely to order a battery of tests including an electroencephalogram (EEG), a CT or MRI of the skull (to rule out a possible brain bleed and a brain tumor), blood levels to check electrolytes and glucose, and a pulmonary test to check oxygen levels in the blood.   After these tests are completed, let us pray, a cause of your seizures is identified and future episodes prevented with medications.  Furthermore, by visiting a doctor, there are medications that can be taken to help prevent the onset of a seizure.  In fact, visiting an epilepsy specialist would be in your best interest to bring these intractable seizures under control.   At age 20, these seizures, can be managed, with adequate monitoring of medication treatment regimens. 

 

Your sister asked if I could help with money for your brother’s visit to the doctor.   At the moment, I am unable to fulfill her request; but, rest assured I am trying to put myself in a position, in the near future, to do more than provide medical advice to people around the world.  For over four years since the onset of my DoctorAdvice4u website, I have had to deflect international requests for monetary assistance for medicines, doctor visits…etc., referring people to clinics in their respective countries.  From the bottom of my heart, I am truly sorry.  I pray these delays, in  achieving my goals and calling, will finally come to an end, and upon entry into public service, medicine and long, unresolved political conflicts will change for the better.  Thanks to Ms. Crisologo for referring you to me.   God Bless you, God Bless your sister, and God Bless the Philippines.

 

Respectfully,

 

Dr. Roshin






* ANTIPHOPHOLIPID SYNDROME: A CAUSE OF FETAL DEMISE

“I just wanna ask y did my baby die after 4mo pregnant?”  – Ms. Crisologo (Philippines)



Dear Ms. Crisologo,
I pray this message finds you healing spiritually, mentally, and physically from the loss of your baby, of four weeks gestation, February 26, 2015.   During our prior Skype conversation, I mentioned that you endured fetal demise, a medical condition defined as the loss of a fetus 20 weeks of gestation or older.  Although the 20+ gestational weeks defines fetal demise from a perinatal perspective, from a medical viewpoint, the death of a fetus 10 weeks of gestation or older is clinically considered fetal demise.

Therefore, I was surprised to hear that you endured a similar experience in 2013 losing a five month old gestational age embryo, spontaneously.   Both unplanned losses including your 5 month old gestational age fetus in 2013 and last week’s loss of your four month old gestational aged fetus constitutes recurrent fetal demise.  Recurrent fetal demise has multiple causes including and not limited to the following:  diabetes mellitus, congenital anomalies, listeriosis, rubella, placenta complications, toxoplasmosis, umbilical cord problems, hypertension, cytomegalovirus, herpes, and antiphospholipid syndrome.  Yet, nearly half the time, an unplanned fetal demise etiology remains unknown.    Whenever the first episode of fetal demise occurs, an autopsy should be performed to identify the cause as a means to prevent future occurrences.  Since an autopsy was not done on your initial fetal demise event, we can only speculate on the potential causes. 

One thought your doctor should investigate further is antiphospholipid syndrome, a condition that causes thrombosis (clot development) in the fetus resulting in decreased or absent blood circulation to the growing embryo resulting in subsequent fetal demise.   Antiphospholipid syndrome mothers develop antibodies (lupus anticoagulant/ anticardiolipin) that work against a successful pregnancy by promoting the formation of both arterial and venous clots (referred to as thromboembolic disease).  In fact, mothers with Lupus have increased susceptibility to the development of antiphospholipid antibodies.   Since you are unsure of your medical history including whether you have diabetes or Lupes…etc., the urgency to identify the cause of the past two miscarriages is obvious.  Without an explanation to the cause of both past fetal demises, you are likely to endure the same heartache and pain you are presently feeling.

With that in mind, please feel free to provide the above information to your doctor as a means to help generate a successful, future pregnancy for your family.  If I can be of any further assistance to you or other villagers, we are a Skype call away from potential resolution.  Thank you for sharing your story and experiences, as I am sure there are many other women around the world encountering similar circumstances.  God Bless you, God Bless your baby, and God Bless the Philippines.

Respectfully,


Dr. Roshin





* PREGNANT LADY OF 4 MONTHS SUFFERS FETAL DEMISE

“i'm sorry to tell you that my baby will never be born i come to see my doctor yesterday and she told me that he's not breathing so i'm going to the hospital now to get the baby out in my tummy.” 
---- Ms. Crisologo, Philippines




Dear Ms. Crisologo,
After receiving a “thank you” from you regarding last week’s article concerning your question on placenta previa, I was anticipating our visit on Skype concerning your follow up pregnancy questions.  Thus, reading news of your baby’s death was distressing for me, and I cannot imagine the pain you must be feeling.  I am sorry for your loss.     Fortunately, we were still able to visit on Skype; yet, I was surprised that after two days, the baby has not been induced for expulsion from your body.  You have endured fetal demise, a medical diagnosis given after the death of a fetus 20 weeks or older, confirmed by ultrasound demonstrating the absence of any fetal heart rate.  I realize that you are going through a grieving process; but, without sounding insensitive to what has occurred in your body, the deceased baby is now dead tissue and a growing source of infection, the longer the remains stay in your body.  You mentioning that a fever has developed over the past two days indicates that an infection is likely already begun, and with urgency, you should return to your doctor with these latest symptoms, for a scheduled, prompt induction of the dead corpse from your body.   Often times, a condition called disseminated intravascular coagulation (DIC), may develop within a month after fetal demise.  DIC is a condition that causes both excessive clotting and bleeding throughout the body, prompting further, unnecessary health problems.  As long as the deceased fetus remains in your body, the risk of DIC is greatly increased; thus, once again, removal of the dead tissue is of absolute benefit for your health and survival.
As to your question regarding why you lost your baby after four months pregnancy, my next article will cover an obstetric condition called antiphospholipid syndrome, an autoimmune disorder marked by repeated, and spontaneous abortions.  Your past history of a similar fetal demise in 2013 after five months pregnancy warrants further investigation as to whether antiphospholipid antibodies are working against your past and potentially, future pregnancies.  
Please know that my heart pains with you.  May your faith bring you peace and comfort at a time where answers to questions do little to console the pain.  I send heartfelt prayers for your full recovery spiritually and physically.  God Bless you, God Bless your baby, and God Bless the Philippines.


Respectfully,








Dr. Roshin




* PREGNANT WOMAN WITH PLACENTA PREVIA WORRIED


“hi friend i just wanna ask i'm pregnant now for 4 months and i think i have a placenta previa can you explain it to me if why do i have to be concern about it? thank you.”  (Ms. Crisologo,  Philippines)

   


Dear Ms. Crisologo,
Congratulations to you and your family on the wonderful news of your second pregnancy!  More than likely, an obstetric ultrasound confirmed that your placenta is covering or partially covering the cervix opening (the lower end of the uterus leading into the vaginal canal), called the cervical os.  Thus, the placenta is covering the opening leading into the vaginal birth canal.  Thus, you can understand the possible complications that may occur during pregnancy.  Why does a placenta previa occur?  Wherever the embryo implants in the uterus, the placenta will encompass the growing fetus providing nutrition to the baby and removing toxic wastes from the baby’s blood.  Your baby’s embryo must have implanted close to the cervical opening and the placenta has grown accordingly.  Thus, you may experience painless, vaginal bleeding, especially during the third trimester of your pregnancy (7th to 9th months), a clear sign that a placenta previa bleed may be occurring, and help must be sought immediately.  Depending on how much the cervical opening is covered will determine the type of placenta previa you have and subsequent treatment options.  For example, a placenta previa is classified as 1) total or complete placenta previa (the placenta completely covers the cervical opening, 2) partial placental previa (the placenta partially covers the cervical opening), or marginal placenta previa (placenta edge is near but does not cover the cervical opening).  Usually, a marginal placenta previa dictates a vaginal delivery.   However, a complete placenta previa, likely will necessitate a C-section delivery, due to an immense blood loss risk during pregnancy.  You should continue to consult your doctor as a placenta previa bleed can occur spontaneously without warning during rest and or activity.  If and when painless, unexpected vaginal bleeding occurs, you MUST seek medical assistance immediately, for both you and your baby’s health.  In the end, majority, if not all, women with placenta previa have successful pregnancies; however, due to the mentioned risks, premature births are frequent; thus, consultation with your physician throughout the pregnancy is mandatory.  My prayers are with you and your baby, and upon delivery, I would love to see a picture of you and your baby as a means to celebrate life long distance.  Enjoy your moment. 

Respectfully,

Dr. Roshin





* WHAT ARE TREATMENTS FOR GRAVES DISEASE?

Hello Roshin,
Could you tell me about Graves disease and treatment options?  “PATH Train Commuter - NYC”

 


Dear Commuter,

After visiting with you on the PATH train, as promised, this week’s article contains general information on a type of hyperthyroidism, called Graves disease.   Specifically, Graves disease is caused by the production of too much thyroid hormone due in large part to antibodies overly stimulating the thyroid gland.  Excess thyroid hormone leads to symptoms not limited to increased sweating, fine tremors  (hand/fingers), nervousness, bulging eyeballs, anxiety, insomnia, chest pain, rapid heartbeat, heat intolerance, unexpected weight loss, high blood pressure, and or muscle weakness.  Nonetheless, several treatment options exist including 1) antithyroid medication, 2) surgery, or 3) radioablation, all of which should be discussed with your doctor.  Surgery and radiation therapy will eliminate hyperthyroidism altogether, while antithyroid medications will place Graves disease into remission.  However, each therapy type has side effects.  For example, the antithyroid medications may cause agranulocytosis, thus your doctor should monitor white blood cell counts, during treatment.  Surgery and radiation therapy may cause permanent hypothyroidism, a condition of an underactive thyroid gland, leading to lifetime medications to stimulate thyroid hormone production.  In addition, the stage of pregnancy eliminates some treatment options and specific medication use.  However, multiple options do exist and should bring your “hell” as you stated to a dramatic end.  Thank you for your question and trust.  God Bless you and God Bless New York City.

Respectfully,

Dr. Roshin









* WHICH HIV MEDICATIONS SHOULD I TAKE, DOC?

Doc
can we have a short videocall pls.  actually i was successful already with my ARV with 8am tenofvir and abacavir and 8pm efavirenz and abacavir but sad to say no available tenofovir now and i stopped the medication for 5 days already.  what can u recommend doc where last time i had a serious allergic reaction to lamivudine. (Mr Pinoy)



Hi Mr. Pinoy,
Back in October 2014, your CD4 count was approaching levels that would cause a pneumonia only found in Human Immunodeficiency Virus (HIV) patients; thus, I had recommended with urgency that your doctors not delay your antiretroviral therapy (ART) any further.  After visiting with you this past week for the first time since last year, I was thrilled to hear that you have been taking ART for the past two months.   You have been receiving “8am tenofvir and abacavir and 8pm efavirenz and abacavir” with  good results; however, tenofovir is no longer available now.  Realizing that your previous use of lamivudine caused unsightly rashes; but, zidovudine remains unavailable, I believe you should suggest and allow your doctors to try the following combination of ART drugs:   tenolam (tenofovir + lamivudiine) with efavirenz combination.   Yes, you will likely have rashes; however, until other ART medication types become readily available, better to be alive with a skin rash than dead without a skin condition.  The Tenolam is a two drug, generic combination of tenofovir with lamivudine (300 mg tablets) used for the treatment of HIV infection in people older than 12 years of age.  Tenolam interferes with HIV ability to replicate itself thus the viral load levels should remain down over the time period the medicine is taken.  However, you might ask your doctors if they have access to Tenolam-E, a three drug regimen combination which already includes efavirenz.  Whether Tenolam or Tenolam-E, these drugs are to be taken once a day, which would definitely help with overall compliance.  Tenolam’s major side effects include possible kidney damage and a blood acidosis; thus, your doctor(s) should monitor both the kidney function and blood pH throughout upcoming, possible treatment.  Thank you for the update.  Since our last visit in 2014, I have said a prayer for your recovery, and that prayer will continue into 2015.  Please feel free to write if you have any other questions.   Also, I am glad to hear that you were inspired by the Pope’s visit to the Philippines.  Stay in touch.  God Bless you and God Bless the Philippines.
 
Respectfully,
 
Dr. Roshin





*WHY DO I WAKE UP FROM SLEEP BUT CAN'T MOVE?


“Thnks.  Y do I sometimes fel lik I wak up from my sleep but cant move but I am sleep b/c I dont tok to my wife.”   (Swimmer from JFK Aquatic Center)

 


Dear Swimmer,
After visiting with you at the aquatic center, you described irregular sleep patterns (falling asleep during the day) along with “wak up from my sleep but cant move.”  More than likely, you have a condition called sleep paralysis, a state of being in which you are conscious (in bed); but, you are unable to move.  Sleep paralysis occurs due to waking up too early from REM (Random Eye Movement) sleep, the sleep cycle where people have dreams.  Every person, who averages eight hours of sleep per night, sleeps through five to six full cycles (100 minutes per cycle) inclusive of two sleep stages, NREM (Non Random Eye Movement) and REM (Random Eye Movement).   Upon completion of NREM and REM stages throughout the night and morning, a person wakes up fully refreshed.  Any interruption in NREM or REM sleep results in daytime sleepiness and irregular sleep patterns.  In sleep paralysis, a person enters and completes NREM sleep , enters REM sleep allowing body relaxation and the beginning of dreams;  but,  the person wakes up before the REM stage is complete; therefore, the person is conscious but unable to move because the bodies muscles are still in a relaxation state.   However, sleep paralysis often resolves simply by establishing regular sleep patterns and reducing life stress (your job as we discussed).  Yet, I do believe you should visit a doctor discussing the possibility of narcolepsy.  Narcolepsy is a chronic brain disorder that results in extreme daytime sleepiness episodes with sleep attacks, an irresistible desire for bouts of immediate sleep.  Sleep paralysis is linked with narcolepsy and since narcolepsy is often treated with medications such as modafinil, amphetamines, and schedule drugs, you have a vested interest in finding solutions to your medical concerns.  After all, although highly unlikely, you would not want to fall asleep in the pool while swimming, would you?   I am simply offering a little humor for an otherwise treatable condition.  Thanks for your question and trust.  God Bless Newark, God Bless New Jersey, and God Bless you. 

Respectfully,


Dr. Roshin    
 





WHY CAN'T I LIFT MY ARM OVER MY HEAD, DOC?

Hi Doc,
“I am having difficulty lifting my hand and arm over my head when working out with weights. On my right side.  Feels weaker over past year esp this past six weeks.  why? “  Coach A



Dear Coach A,
While visiting with you at the gym, the range of motion of your right arm was noticeably limited, specifically, you had difficulty lifting  your arm beyond 45 to 50 degrees  from the original position of your hands being placed vertically along the side of your body.  Furthermore, when you turned your head to the right, you mentioned a “ periodic, sharp pain travelling from your neck to the right hand.”   Without a proper arsenal of medications to properly evaluate your right shoulder and arm, you should be evaluated by a physician for a possible right shoulder cuff tear with cervical radiculopathy.  Placing the barbell on your neck while doing squats may have contributed to the pain radiating from behind your neck to your right hand as well as the rotator cuff tear as your exercise regimen is to perform the squat followed by lifting the barbell with weights over your head.  The precise movements of your exercise likely have contributed to the medical concern you submitted.   With any luck, rotator cuff tendonitis/impingement is present which would require stopping that exercise and an extended period of rest; however, a rotator cuff tear or a frozen shoulder (adhesive capsulitis) would likely require possible surgery.    Consulting a doctor (orthopedist) followed by a physical therapist would be beneficial in the diagnosis and eventual healing process.   Please stay in touch as I pray for resolution of your present symptoms.   Thank you for your question and trust.   God Bless you and God Bless New Jersey.

Respectfully,

Dr. Roshin













* A MESSAGE FOR THE HONORABLE POPE FRANCIS


Dear Honorable Pope Francis,
 
One year after I graduated medical school (December 2007), I founded the DoctorAdvice4u.com, nonprofit website with the intention of being a medium for communication between people living in underdeveloped and developed countries.  The DoctorAdvice4u website was launched in the midst of the global economic meltdown (2007-2009) with one sole purpose:  offer an avenue for people, facing dire economic challenges, to ask questions or request assistance as needed.   Thus, the initial mission of the DoctorAdvice4u website was to provide global medical, humanitarian, and tropical cyclone coverage 24/7;  yet, as time has passed, that mission continues to grow and evolve.   Eighty-seven thousand (87,000+) views later, the traffic on the website has been nothing short of humbling.  

 Thus, I write this week’s column acting as a mediator between the Philippine people and the Honorable Pope Francis.  Realizing that your “Mercy and Compassion” visit to the Philippines extends from January 15-19, 2015, if the developing Tropical Storm Amang alters your itinerary, would you please consider adding a couple of extra days beyond your scheduled departure date, to visit areas that you were originally scheduled to  see in the first place.

Specifically, you were scheduled to visit Tacloban City (along with other areas of Eastern Samar Island), sites of immense death and carnage due to Super Typhoon Haiyan’s wrath November 2013.  Since my website’s inception, annually, I have covered numerous typhoons, of varying strengths, that have pummeled all Philippines islands from Mindanao to the Visayas to Luzon.  Covering the typhoons for the Philippine people is unconditional; yet, under conditions of utter destruction, the graciousness of the Philippine spirit has always reciprocated messages of gratitude along with sentiments and stories of personal loss, both lives and property.  Their stories have impacted me more than I ever could have imagined; therefore, I write on their behalf hoping to translate their pain(s) to you.   Specifically, when people say “I believe my country is cursed,” or  “O M G! !!!!! Exactly those dates is pappal visit here in the philippines....,,,, spare us oh Lord... Bohol is badly hit by typhoon Senyang recently... very devastating,” their words break my heart. 
As much as I try to keep their spirits up, you, Pope Francis, are the light in these people’s lives.  People refer to you as “our pope francis,” and they desire to see your presence in the most desolate, poverty ridden areas of the Philippines as well as the cities devastated by Super Typhoons, past and present. 

The Philippine populace is an incredible people, who arguably, have shown the most resilience, character, and strength, in light of countless natural disasters.   Yet, you not being able to be on the ground with the people would be just as devastating as reliving a Category 5 Super Typhoon.   From the bottom of my heart, I ask, if Tropical Storm Amang alters your present plans to visit certain areas  of both spiritual and tangible need, would you please consider adding additional days to your stay, allowing extra time to visit with the people on the ground, which undeniably, would send a spirit of renewed hope to all corners of the country, as well as lift the perceived “foreboding curse” from their country?  

As much as my website has provided humanitarian and medical assistance through conventional medicine treatments and advice, I am a believer in the power of prayer.  With that in mind, your presence will perpetuate healing of the mind and body beyond any medicine or monetary compensation.  Thus, I pray my written words reach you in a timely manner, to make changes in your agenda as needed, all for the Philippine people.   God Bless and thank you.


Respectfully,



Dr. Roshin










* WHY DO I ALWAYS NEED A PRESCRIPTION DOCTOR?

"Why do I have to get a presciription for my medicines avery time.  Dont make sens. ”  Mr. G (NJ)

Dear Mr. G (NJ)
You asked a fantastic question.  The reason you should “get a presciription for my medicines avery time” is due to your health changing year to year, month  to month, week to week, day to day, hour to hour, and second to second.   Your health is always evolving and having a doctor exam you as routinely as possible works to your advantage to stay healthy.  In other words, having you visit a doctor after your prescription has been completely used, allows you and the physician to see if your treatment plan is working and to discuss any side effects or unwanted allergies from the medication.   Furthermore, a routine visit to your doctor allows the physician to change the diagnosis just in case a new condition has surfaced since your last visit.   Writing a new prescription after your most recent visit ensures that the right medicine and dosing will cure or alleviate your symptoms.   Certain diseases require only specific drug classes and the doctor will base the selection of medicines on your past medical history.  In addition, when medicines are combined, adverse effects such as difficulty breathing, rash, heart arrhythmias, kidney problems…etc. are possible; thus, writing a new prescription may be necessary to prevent any ill effects in your body.  In fact, did you know some medicines cannot be taken with certain foods or liquids; thus, the prescription will list these exceptions on the label as needed.  Finally, being able to buy medicines, such as antibiotics at any store at any time, would likely lead to resistance of the bacteria to that medicine in the community.  Why, you might be wondering?  Overuse of antibiotics or using antibiotics when not necessary, allows the “bug,” causing the illness, to become smarter and avoid being killed by the medicine.  When the bug outsmarts the medicine, epidemics and outbreaks occur. Therefore, I know paying a visit to your doctor may be a bit of a hassle; but, being compliant and taking your medicines as directed, will not only allow you a healthier existence;  but also, taking your medicines on time may lead to stopping the medicine, and therefore the prescriptions, altogether.   Thank you for your question and trust.  God Bless you and God Bless New Jersey.

Respectfully,
 
Dr. Roshin



 








*WHY DO MY FINGERS TURN RED IN THE COLD, DOCTOR?


Dear Dr. Roshin,
“Whenever it’s really cold, my hands get really red. Why is that? Am I dying?”  Sincerely Maria Silva (Portugal)



Dear Maria,
There are many explanations of why fingers/toes turn red in cold weather; yet, most causes seem to revolve around two aspects 1) psychology (emotions, stress) and 2) vascular (blood vessels).  Depending on age, some causes are more likely than others.  For example, a middle age adult or elderly person may have red fingers/toes, due to diseases affecting the blood vessels, preventing an adequate blood supply from reaching a certain area in the body.  The lack of blood reaching an extremity causes the change in skin color.  Examples of these types of blood vessel or autoimmune diseases include the following:  Peripheral Vascular Disease, Buergers (smoking) disease, Cryoglobulinemia, Lupes, Rheumatoid arthritis, plastic industry chemicals, Scleroderma, and a vasculitis.  Often times, spasms of the muscle in the blood vessel wall, cause the blood vessel cavity to narrow in size, reducing blood supply to the fingers/toes, which then  leads to skin discoloration.  Since you are 18 years of age, more than likely your fingers turning red were due to the cold causing spasms in the arteries of your hand, decreasing the blood supply to your fingers, and causing the skin discoloration.  In fact, there is a condition called Raynaud’s disease, a rare blood disorder, where the blood vessels narrow, decreasing blood circulation to the fingers, toes, nose…etc.  In addition, extreme cold conditions (frostbite) have also been known to cause blood vessel muscular spasms leading to reddened fingers/toes.   Whatever the cause, for you, reddening of your fingers is more a nuisance than a serious medical problem.  However for those people where Raynaud’s is debilitating, medications exist to reduce muscular spasms in the blood vessels.  Thus, as you celebrate the New Year tomorrow, possibly in New York City’s Times Square, you should purchase hand and feet warmer packets, place in your gloves, socks, and shoes, while layering clothes to properly combat the cold during New Year’s Eve activities.   Furthermore, visit a doctor to ensure no other serious health condition may be the cause of your symptoms.  But, rest assured, you are definitely not dying.  Thank you for your question and trust.  God Bless you, God Bless Portugal, and Happy 2015 New Year!
 
Respectfully,

Dr. Roshin










* RUSSIAN LADY ASKS WHY SCHIZOPHRENIA APPEARED SO SUDDENLY IN HER FRIEND'S 18 YEAR OLD DAUGHTER?

Hi Dr. Roshin,

“ How person can be normal till 18 years but then have schizophrenia?"  Elina Klimova (Russia)



Dear Elina,

Latest data from the Substance Abuse and Mental Health Services Administration suggests that every year, roughly 42 million American adults (or 18 percent of adults in the USA) suffer from some form of mental illness including bipolar disorder, depression, and schizophrenia.  In fact, mental health conditions cost the country an estimated $444 billion/year, including lost productivity and disability payments.   Since much mental illness arises during adolescence or young adulthood, these mental disorders rob people of decades of good health and life.  One such mental disease is schizophrenia.  Schizophrenia affects 1% of the American population today.   Put simply, people who develop schizophrenia have a difficult time distinguishing between what is real and what is unreal; thus, the ability to think, have relationships, manage emotions, and function normally becomes ever challenging.   Regardless of ethnicity and gender, schizophrenia affects men and women equally; however, men tend to experience symptoms of the disease (hallucinations, delusions…etc) earlier than women, typically between the ages of 16 to 30.   Interestingly, childhood-onset schizophrenia cases appear to be on the rise, presenting another cohort of the population needing future earlier screening and treatment options.

What causes schizophrenia?  Genetics and environment play the most important roles in the eventual development of schizophrenia.  Schizophrenia occurs in 1% of the general population, but the risk increases to 10% if a first degree relative (such as a parent or sibling) has the disorder.  The risk of an identical twin of a person with schizophrenia, developing the disease is an astounding 45-60%, further suggesting a strong genetic link.  In fact, in recent research sponsored by the global Schizophrenia Working Group of the Psychiatric Genomics Consortium, 108 new regions of the genome were identified and linked to the psychiatric disorder.   Bottom line is this research suggests that there are many more genes, than originally thought, causing schizophrenia.  The research also suggests that early intervention of being able to identify those genes that cause schizophrenia will likely lead to better outcomes for that person.
Identifying schizophrenia in the teenage years has proven challenging.  Why, you might be asking?  The first signs of schizophrenia may mirror typical teen growing pains such as changing friends, irritability, insomnia, and poor grades; yet, a combination of factors (including withdrawing from people, isolation, an increase in paranoia and suspicious thoughts, and family genetics) is likely to predict up to 75-80% of those adolescents at risk for schizophrenia.   Thus, to answer your question, the National Institutes of Mental Health suggested the following:  “Studies of brain tissue after death also have revealed differences in the brains of people with schizophrenia. Scientists found small changes in the distribution or characteristics of brain cells that likely occurred before birth. Some experts think problems during brain development before birth may lead to faulty connections. The problem may not show up in a person until puberty. The brain undergoes major changes during puberty, and these changes could trigger psychotic symptoms. Scientists have learned a lot about schizophrenia, but more research is needed to help explain how it develops.”

After you shared your story of a friend’s teenage daughter developing schizophrenia out of the blue, I hope the above information sheds some light on the many questions you had asked of me.  My prayers are sent to your friend’s family.  Thank you for your question and trust.  God Bless you and God Bless Russia.

Respectfully,

Dr. Roshin








*MY SISTER'S KIDNEYS ARE FAILING...WHAT SHOULD SHE DO?
 

Dear Doctor Roshin,
My sister who has had diabetes for over 17 years was recently told that now, her kidneys are failing.  “What do you think she should do?”  We both want to know what happens when the kidneys start to fail.  “I think her doctor said that she has worst anemia than before.”  Thanks for your time.  Anonymous Sisters (USA)



 
Dear Anonymous Sisters,

As you are aware, the kidneys are part of the urinary system, important organs to rid the body of wastes, toxins, and fluids through the urine.  However, when kidney(s) fail, toxins that are normally excreted from the body now build up within the blood.  The net result is, without dialysis, a machine used to remove the toxins from the blood, a patient is on a fast track that likely has a fatal outcome.  Your sister has end stage renal disease (ESRD), more than likely a consequence of prolonged diabetes.  In fact, ESRD is caused not only by diabetes, ESRD is also the result of hypertension and other kidney diseases (such as glomerulonephritis and cystic disease).  More importantly, the complications of kidney failure are very real and life threatening.  These complications include but are not limited to the following:  1) bleeding (due to platelet dysfunction), 2) heart problems (pericarditis, accelerated atherosclerosis, high lipid levels), 3) increased infection risk, 4) bone loss (renal osteodystrophy) and 4) significant variability in electrolyte levels (higher phosphate/magnesium/ potassium levels, and lower calcium levels).  In fact, your sister appears to be already showing signs of renal failure due to her declining anemia.   The kidney makes a hormone called erythropoietin (EPO), which assists in the production of red blood cells.  However, without the kidney functioning properly, EPO is not produced, and the result is your sister’s worsening anemia.  Furthermore, keep in mind that the most common cause of death caused by ESRD is accelerated atherosclerosis; thus, yes, a compatible, kidney transplant may likely be her best and only option.  As for your question, “what should she do?,”  that discussion should be between your sister and her doctor.  However, since finding a kidney match may take time, placing your sister on dialysis is a must to prolong her longevity.  With the holiday season upon us, may your faith and may God provide a kidney match as the New Year begins.   Thank you for your question and trust.  God Bless you and God Bless the USA.

Respectfully,

Dr. Roshin







*  HELP, MY BLOOD PRESSURE IS CONSTANTLY 180/95.


Dear Dr.:
Prior to the year 2009, I never gave my blood pressure much thought. I felt great and I assumed that my blood pressure was normal.  I did not know my numbers, and I must admit that I didn't even know what normal blood pressure numbers were.  One day in February 2010, I didn't feel quite right at work and I went home early to lie down.  My wife came home and after talking for a while she dragged me to the doctor's office.  It was then that I found out that my blood
pressure was very, very high. The readings were 240/100.  The doctor prescribed medicine and advised me to change several things in my diet.  He started me with Amlodipin, Lisinopril, Lovastatin, and Bumetanide.  I took two in the morning and two before bed. Gradually, my blood pressure came down to the neighborhood of 139/87.  This continued until I had to change my doctor in May of 2013.  My new doctor changed my medication by discontinuing Bumetanide and prescribed Benicar.  I continued on this for a year until my prescriptions expired.  For some reason, possibly a mistake somewhere, the doctor did not renew my Amlodipin or Lisinopril.  In retrospect, I should have gone to see the doctor immediately, but I didn't.  I thought that just the Lovastatin would be sufficient to control my pressure.  I was wrong!  My blood pressure numbers kept going higher and higher until in November 2014, my most recent visit to the doctor revealed that my blood pressure was 180/95.
Now, my doctor has changed my medication again.  He wants me to take Amlodipine and Losartan.  I have only been on this medication for a short time and have yet to see any great difference but the doctor said it might take a couple of weeks before my pressure goes down.  He is expecting it to go to about 130/85.  Can you offer any suggestion as to why I have this problem with very high blood pressure?
 
Charlie T.
Belleville, N.J.

 



Hello Charlie,
After extensively visiting with you in person this past week, I was shocked to hear that your latest blood pressure readings repeatedly reveal 180/95 or higher.  A reading above 140/90 places a person in Stage I hypertension and any reading above 160/100 is considered Stage II hypertension.  Once a person is diagnosed with stage II hypertension, and if left untreated for an extended period of time, serious bodily consequences occur, including but not limited to 1) increased risk of stroke, 2) TIA, 3) heart attack, 4) aortic aneurysm, 5) eye retinopathy (blurred vision, scotomas, blindness), and 6) kidney problems which could require dialysis.  When a person reaches stage II hypertension, general guidelines suggest two medications be prescribed to decrease the high blood pressure.   Yet, in the narrative you submitted, you mentioned in the past, you have tried dual medications multiple times with little success.  However, back in 2010 when you were placed on four medications (Amlodipine, Lisinopril, Lovastatin, and Bumetinide), your blood pressure returned to the high, normal range of 139/87.  Thus, I am stunned to learn that your new doctor(s) have not returned you to the four drug regimen, a treatment plan that has been undeniably successful for you in keeping your blood pressure readings in the normal range.
 
In addition, constant high blood pressure readings may be caused secondarily by diseases not limited to 1) Cushings Disease, 2) Conn’s Disease, 3) Renal Artery Stenosis, 4) Aortic Coarctation, and 5) Pheochromocytoma.  These five diseases should be ruled out by your doctor, as potential etiologies to your present, constant, high blood pressure readings.  In other words, if ordered tests confirm the presence of one of the five mentioned diseases, you now have an explanation for the constant high blood pressure.  However, if these five diseases are not the cause of your high blood pressure, the combination of lifestyle modifications (exercise and diet changes) along with medications may be your last resort, outside of being diagnosed with refractory hypertension, a term used to describe hypertension due to prolonged but ceased blood pressure medication use.
 
Nonetheless, if your diastolic reading (bottom number of a blood pressure reading) goes above 120, this scenario is called a hypertensive emergency.  Hypertensive emergencies likely require the use of Nitroprusside and or labetolol.  With your kidney problems, enalaprilat might be a better choice to bring your blood pressure back to normal.
 
Whatever the cause, in the short term, your blood pressure reading is way too high, and with urgency, your doctor must bring your hypertension under control.  Thus, feel free to share my thoughts with your doctor as a means to benefit your quality of life.  God Bless you and God Bless New Jersey.  Thank you for your question and trust.
 
Respectfully,
 
Dr. Roshin







* HELP...I WAS BITTEN BY A STRANGER

Hola Roshin.  Mi pregunta:  Can a dz be got from morder (a bite)?”   “Jalia” (Texas)

 

Dear Jalia,
Whether an animal or human bite, all bites must be thoroughly examined by a doctor, cleaned, and treatment offered to prevent infection.  Due to the copious amounts of bacteria in the mouth, human bites have a very high risk of infection.  One of the most common bacteria found in the oral cavity, that requires antibiotic treatment, is Eikenella Corrodens.  In fact, once an infection forms, without effective treatment to kill both anaerobic and aerobic bacteria, rapid spread to other areas of the body including joints, nerves, skin, and/or organs is likely. 

Your story that a stranger bit you at an outdoor event one month ago should have been already examined by medical personnel.  An examination is needed to determine if the wound was clean or dirty which will determine what medicines to prescribe, and more importantly, since HIV, Syphilis, and Hepatitis B/C can be transmitted rarely by human bites, the appropriate prophylaxis treatments should be offered.  In addition, a tetanus shot or booster will be offered as added protection against certain bacteria that affect your motor nerves. 

Although several weeks have transpired since your bite, I strongly urge you to seek assistance with your bite wound.  Any bite wound that had pus, pain, warmth, swelling, loss of sensation, loss of motor coordination, and or blood should be examined promptly.  Your washing the wound with soap and water along with placing hydrogen peroxide was a good first step;  however, even without health insurance, do visit a doctor or a hospital emergency room for further follow up as antibiotics (Amoxicillin-Clavulanic Acid)  and or booster shots are likely needed.  

Thank you for your question.  God Bless you and God Bless Texas.

Respectfully,


Dr. Roshin







* MY AIDS TREATMENT IS NOT WORKING...NOW WHAT?

Hi Doc. Are you available to chat online? I was rushed again in the hospital d oder day due to shortness of breathing by taking lamivudine… I am already okay of taking tenofovir and efavirenz, what will be the substitute for the lamivudine?” Mr. Pinoy

Hello Mr. Pinoy,
Since May 2014 when you were diagnosed with the HIV virus, you have tried several anti-retroviral triple therapy regimens; however, you have had to discontinue many medications due to serious, allergic side effects.  For example, in May 2014, you took Truvada and Nevirapine, only to have to stop the Nevirapine due to a severe hypersensitivity reaction.  Then, in July 2014, you began taking Zidovudine, Lamivudine, and Efavirenz only to have severe allergic reactions, such as respiratory distress, with Lamivudine in combination or when taken independently.  Thus, you have not been able to maintain an anti-retroviral treatment regimen for an extended period of time which likely has resulted in your CD4 count dropping from 385 one year ago to 284 May 2014.  What does this mean to you?  Without treatment, you are becoming sicker and sicker.  When the CD4 count drops below 200, you will have an increased risk of AIDS Associated Diseases not limited to Pneumocystis Jirovecii (pneumonia), profound dementia (significant mental impairment), and widespread fungal infections in the body.  As the CD4 count drops below 100, you have an increased susceptibility not limited to widespread Herpes, Toxoplasmosis, Cryptosporidiosis, Cytomegalovirus, and Cryptococcus. 

If you remain untreated, the CD4 count will drop 55-110 ul/year.  Therefore, the urgency to be placed on long term triple anti-HIV therapy becomes absolutely important for your survival.  With treatment, the CD4 count can be elevated or maintained.  Some studies have shown that a person placed on long term anti-retroviral therapy can reverse potential complications to that of an HIV negative person.  Therefore, future therapy should be a combination of three drugs from one of the following three drug classes: nucleoside reverse transcriptase inhibitor (NRTI) , non-nucleoside reverse transcriptase inhibitor (NNRTI), and protease inhibitor (PI).  Routine combinations include a) 2 NRTI + PI or b) 2 NRTI + Efavirenz or c) 2 NRTI + Ritonavir.  Usually, initial drug regimens begin with Emtricitabine, Tenofovir, and Efavirenz. 

On 11/12/14, you mentioned on our online chat that you may be placed on Abacavir, Tenofovir, and Efavirenz in a matter of days.  This is very good news; however, common side effects of these medications include the following:  1) Abacavir – Hypersensitivity reactions, 2) Tenofovir – Kidney problems, and 3) Efavirenz- Somnolence & Psychiatric issues).  Nonetheless, the urgency of beginning these medications as soon as possible goes without explanation.  Furthermore, since your CD4>200, you should consult with your doctor(s) about taking the following vaccines:  pneumococcal, influenza (injected, not live form), Hepatitis B, and varicella as soon as possible.

Since our initial, online contact early 2014, I have recommended with urgency that you begin HIV antiviral therapy as soon as possible; however, the lack of taking medication consistently has resulted in one fact:  Slowly but surely, you are dying.  Thus, please obtain the anti-AIDS medicines from your doctors and take as directed.  Upon fulfilling this request, your viral load will instantaneously begin decrease allowing the chance of increased longevity.  At age 23, you have everything to gain!

Respectfully,

Dr. Roshin 


PS:
* Inform your doctors that there are viral sensitivity tests (latest research/development) that can be run to determine which drug(s) are sensitive versus resistant, to the HIV virus in YOUR body. 







*PHILIPPINE LADY ASKS ABOUT DAUGHTER'S SKIN INFECTION

Hi  Dr. Roshin may i ask what would be the best topical medicine for aczema? My daughter has it on her toe. Hoping for your response.  Hello Dr. Roshin Im really overwhelm and thankful that you replied My daugther had skin allergy, she is drinking desloratadine Aerious and citirizine when her allergies occurs. She is also allergy from can goods and some preservatives even in some medicine like amoxicilin, co-amoxiclav, ampicilin.  she is 17 years old now.  Regarding your blog you can name me eve.. thank you Thank you very much.   God Bless and more poower..”

 

Dear Eve,
Thank you for sending pictures of your daughter’s skin infection, which you referenced in your question, as eczema.  Eve, did your daughter’s doctor diagnose eczema?  The reason for this question is that the “nizoral cream,” you mentioned  placing on your daughter’s foot, has ingredients of an antifungal medication.  Thus, one thought that came to mind, was the constant scratching leading to the dark patches on your daughter’s foot, might be due to tinea pedis, a fungal infection of the feet.  If a fungus is present, the topical antifungal “nizoral cream” is not likely strong enough to ease the scratching, much less kill the fungus.  Thus, her doctor should prescribe an oral medication to kill a potential fungal infection in the blood and throughout the body.  Once the fungus is killed, the itching should be eliminated. 

However, if the infection is eczema, an incurable skin condition, different, treatment options revolve around management of this dermatological disease.  Eczema, also called atopic dermatitis, is an inflammatory, immune modulated rash causing bouts of intense scratching (during flare ups) to relieve the itching.  A patient’s constant scratching results in thickened, darkened , scaly, cracked skin patches (similar to your sent photos), called lichenification.  Although managing mild, moderate, and severe eczema can be challenging for both the patient and family members, overall, implementing the following guidelines, inclusive of topical medications, will noticeably reduce eczema symptoms, especially the scratching.  Thus, treatment options in your control include the following:  1)  take warm (not hot) baths/showers with immediate application of a moisturizer, vaseline, or calamine lotion after bathing to keep the skin moist, 2) wear cotton clothing, 3) pat, do not rub, your skin with a towel after bathing, 4) use a humidifier in cold, dry air, 5) expose eczematous areas to controlled amounts of sunlight, and 6) reduce daily stress as much as possible. 

Topical medications in the form of creams, lotions, or ointments have proven beneficial to reduce inflammation and itching during eczema flare-ups.   In fact, topical medications that contain steroids (hydrocortisone) have proven most beneficial to combat eczema symptoms.  In addition, antihistamines (diphenhydramine) are often prescribed to treat daytime and nighttime eczema itchiness.   Almost all medications containing steroids cause serious side effects thus consulting a doctor is highly urged prior to using any over-the-counter (drugstore purchased) steroid topical medication.  Fortunately, there are topical medications available that do not contain steroids (called calcineurin inhibitors) that are also highly effective at treating eczema.   The two most effective calcineurin inhibitors used to treat eczema are 1) Protopic (Tacrolimus) and 2) Elidel (Pimecrolimus), both of which must be prescribed by a doctor.  Finally, prescription strength moisturizers including  Hylatopic Plus and Mimyx, could be prescribed by a doctor, as added protection against eczema itching.  

Since your daughter has an extensive allergy history, always consult her doctor prior to trying, ingesting, or applying any medication drug to her body.  Eve, I am deeply humbled by your question, comments, and trust.  Thank you.  May the above suggestions bring quick relief to your daughter’s ongoing symptoms.  God Bless you, God Bless your daughter, and God Bless the Philippines.

Respectfully,

 

Dr. Roshin


-------------------------

Friday November 7, 2014 @ 6:26am

Hello Dr. Roshin, thank you very much for giving so much time and concern answering my question.. I have read you blog..God Bless you ,. Eve

 







*IS TAKING ASPIRIN DURING PREGNANCY OK?

Hello Roshin.  I have another ?.  Last time you wrote me about diabetes. What can I take for my head ache.   Asprin is ok right.”  Susan (New Jersey)

Hello Susan,
Anytime a woman becomes pregnant or is thinking about becoming  pregnant, one conversation a doctor will always have with the expectant new mother is medication use, current or future.  A woman’s medical and allergy history plays a significant role on which medicines are recommended or are to be avoided before and during pregnancy.  Your question about aspirin use for an unexpected headache are common; however, aspirin use is NOT recommended during pregnancy.   Why you might be asking?   Aspirin carries an increased risk of bleeding and depending on the trimester (the number of weeks of carrying a pregnancy), different consequences will occur.  For example, taking aspirin near delivery could lead to an abnormal amount of blood loss during labor.  In addition, in the 26-40th week of gestation, aspirin has been known to cause blood pressure complications, while in general, aspirin promotes an increased risk of miscarriage right after conception.   Furthermore, turning to medications such as Excedrin, Motrin, Advil, Ibuprofen, Aleve, or Cold Formulas (that contain pseudo-ephedra) to relieve a headache is also NOT recommended during various stages of pregnancy.  What can you take for a headache during pregnancy?  Tylenol (Acetominophen) is recommended for pain relief of a headache during pregnancy;  however, consult your doctor on appropriate dosing and frequency of use as latest research has shown an increased risk of asthma and attention deficit disorder with use of Tylenol more than three times/month during pregnancy.   Finally, one concern that must be mentioned is headaches are often one symptom of a condition called preeclampsia;  thus, your doctor must monitor for development of this condition especially as the latter stages of pregnancy are approached  (after 26 week).   Glad to hear you are enjoying your pregnancy, and although you made an innocent mistake taking aspirin for your headache, always consult your doctor, phone a hospital emergency room ,  or call 1-800-626-6847 (in English/Spanish) for direction on any medication ingested during pregnancy.  God Bless you, and God Bless New Jersey.

Respectfully,

Dr. Roshin







PHILIPPINE LADY ASKS IF OVERSEAS AD SAFE FOR HER EMPLOYMENT

hello how are you.. roshin.. if you read this message pls answer.. i have something to ask..
i have..employer in portland oregon.. he will get me here in the philippines to work ther as a nanny..
can i have a favor roshin..?  can you check his name..
he introduce himself as GENELLA CORNELIA he told me that he is a us army.. i want to know that he tells me the truth and i want to make sure that im safe in his hands...”  Plz use Eunice not my rel name.

 

Dear Ms. “Eunice,”
Your desire to improve your quality of life is not unlike many people who must place their trust in communication by social media outlets rather than face to face encounters.  Whether Facebook, Twitter, or emails, a person can only hope that what is being advertised or communicated on the internet is legitimate without sinister intent.  Thus, due to your request, I have taken the liberty of using my DoctorAdvice4u website as a format to verify if the man you have been in contact with is genuine in his request or a fraud.  My decision to post your request is due to the fact that my attempts through phone calls and emails have not been returned by him. 

Specifically, you sent me the following information:  “ i got his telephone no. here..+15413940852 and this is his adress: 16400NE LAS BRISAS PORTLAND OREGON zip code is 97230. this is his e.mail
genelav@gmail.com

Over the past two weeks, I have placed calls and sent emails, and upon doing a little research, I came across the following post at http://www.targro.com/classified/JOB-OFFER/367519 .  The link has a similar ad as the one you have discussed with me except he apparently lived in Scotland at that time.  The advertisement is as follows:

“My name is Genella Cornelia from the US Army but currently in Scotland for a course sponsored by the US Govt. I really need a Nanny for my daughter Kim back in the US..... Will like to know if you are interested as i will be helping you with all your papers. Kindly forward your RESUME to my email
gencorn@outlook.com Await your response +447 087642745.”

Thus, Eunice, my instincts are telling me, unfortunately, I believe this man is a fraud.  He is scamming you for money especially when he asks for you to send money to him as a means to prepare your United States Visa paperwork.  The proper way to apply for a visa in the Philippines is at the following US State Department link:
http://travel.state.gov/content/visas/english/immigrate/immigrant-process/approved/contact.html .

I know many men and women who have served in various branches of the United States military, all of whom are honorable people and serve our country with distinction.  In the past, all my US military friends provided their US military  email addresses; thus, this is another reason for my skepticism of this man’s claim. 
Since you mentioned other Filipino young ladies also making inquiries to similar advertisements in developed countries, I have provided a list of international crisis hotline numbers for the United States, Canada, Australia, and the United Kingdom.  If anyone who travelled overseas finds herself in trouble, these numbers are avenues to seek help while living in those countries.  The crisis hotlines are listed below:

1) United States:  
http://removingchains.org/resources/32-usa-crisis-hotlines
2) Canada    
http://removingchains.org/welcome/42-canada-crisis-hotlines
3) United Kingdom  http://removingchains.org/welcome/43-united-kingdom-crisis-hotlines
4) Australia  
http://removingchains.org/welcome/44-australia-crisis-hotlines
5) International Trafficking Hotline: 
http://www.state.gov/j/tip/rls/other/2011/168859.htm

Please know that your motivation to improve your standard of living is very captivating, and with patience and completing paperwork  through proper US government avenues, your wishes will turn into reality.  I offer prayers for a safe journey.  Kindly share this article with your friends as a means to keep them safe on their journey also.  God Bless you and God Bless the Philippines.

Respectfully,


Dr. Roshin











* ELDERLY TEXAN WANTS TO KNOW WHY TOOTH REMOVED?

Hello Dr. Roshin,

“I was wondering if you could visit with me about why my tooth was removed when it did not hurt and after spending a lot of money doing a root canal.”  Thanks “ElderlyTexan”





Hi Ms. “ElderlyTexan,”

After visiting with you extensively this past weekend, you expressed overall satisfaction with previous different dental visits; however, I am of the belief that your present dentist committed malpractice.   I do recall our conversation one year ago, a talk in which we determined you had developed an abscess in a tooth requiring a root canal procedure to be done emergently to control the pain and spread of any infection.   Before your root canal procedure, I recall you mentioning that your tooth was excruciatingly painful and sensitive to liquids; however, after the procedure was completed, not only had the pain disappeared, you were grateful to still have an intact, viable tooth for “eating” purposes.  Thus, I am stunned to hear that your new dentist removed the very tooth you had the root canal procedure done back in January 2014.

His claims that a black shadow at the root of the tooth, represented an active infection, is his reason for removing the tooth does not coincide clinically with your presenting symptoms.  You had an asymptomatic tooth, which means you did not have symptoms representative of an active infection.   You did not have a persistent fever, fluctuance (pus), bleeding and or pain while brushing your teeth, bleeding gums upon palpation or instrumentation, or an inability to chew food without pain; thus, there was no infection.  In addition, when I asked you if your dentist looked at an X-ray from last year for comparison purposes, you mentioned that he did not.  This dentist’s failure to locate and retrieve an old dental x-ray is startling, as I am definitively positive the tooth x-ray from last year would have looked identical to this year’s x-ray, with one exception, specifically, this year’s x-ray would have the root canal packing material in the center of the tooth.  The black shadow from last year’s x-ray would still be on this year’s x-ray; however, last year you had an active infection causing symptoms, this year, you did not have infection and no symptoms.  Had an active abscess indeed existed, antibiotics and drainage, dependent on the situation, are usually ordered.  Thus, there was no need to remove your tooth.

Although you wish not to pursue any litigation, as a health care professional, I find the judgment of this dentist questionable.  Thus, although you wish not to pursue this issue further than our conversation, in my opinion, the Texas Board of Dental Examiners should be notified, as this dentist may be performing other similar type procedures on similar trusting, unsuspecting elderly patients and others.  Considering the fact that you already have a limited number of teeth in your mouth, every viable tooth becomes a precious commodity.  I respect your wishes; however, if ever a person wanted to voice a complaint against a dentist in the state of Texas, one can 1) click the Texas Board of Dental Examiners Link and follow listed directions: http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=54&Itemid=65 , 2) Call 512-475-1996 for more information, or 3) email the board using the complaints@tsbde.state.tx.us address.

I am sorry for the loss of your tooth that you were clearly happy to still retain after the root canal procedure.  Furthermore, I appreciate you having the courage to share your story and grievances.  May peace continue to guide your decisions.  Thank you for your question and trust.

Respectfully,

Dr. Roshin












* STUDENT ASKS HOW EBOLA IS CONTAINED IN THE USA


Dear Professor,
"I came from west afrika.  how the govement trac the virs here in us?”  --“Will” (not gud spel)



Hello “Will,”
Presently, West Africa, specifically, the countries of Liberia, Sierra Leone, and Guinea, have an ongoing Ebola virus epidemic, with close to 3500 deaths reported in that region of the world.   On September 30, 2014, United States officials reported the first case of the Ebola virus after Mr. Thomas Eric Duncan, travelled from Liberia to Dallas, Texas.  Although Mr. Duncan went to Texas Health Presbyterian Hospital in Dallas, Texas presenting with Ebola like symptoms and revealing his overseas travels, the hospital released him on antibiotics, only to have Mr. Duncan return  in a much more serious state.   Upon the second visit to that same hospital, samples were collected and sent to a laboratory to diagnose the possibility of Ebola virus, and one week later, the Texas Health Department confirmed that Mr. Duncan did indeed have the Ebola virus. 
The revelation that Mr. Duncan had Ebola virus within his body set in motion actions to determine his travel and contact history.  Symptoms of Ebola, not limited to fever ( >101.5F), diarrhea, vomiting, stomach and or muscle pain, severe headache, sudden appearance of bruise marks, and unexplained bleeding , can only be spread to other people if the patient is already sick with symptoms.  Mr. Duncan presented with symptoms after landing in Texas, not on the planes travelling to the USA.   Since symptoms can last up to three weeks, anyone in contact with Mr. Duncan, since his arrival in the USA, has been identified and is being followed for the development of Ebola symptoms.  The Ebola virus can spread from the sick patient to other people through open sores (a cut in the skin), blood, urine, sweat, feces, vomit, saliva, semen, breast milk, sharing of needles and syringes from someone who is infected, and infected animals (due to blood exposure while butchering animals).  In fact beyond humans, apes, bats, rodents, antelope, chimpanzees, and monkeys are commonly infected by the Ebola virus.
As of today, October 8, 2014, the state of Texas is still monitoring 48 total people from the initial 100 people identified in the days after Mr. Duncan was confirmed with Ebola virus.  Every day and for the subsequent three weeks, Texas Department of Health officials, along with appropriate government entities, communicate with all of the people that were potentially exposed to the Ebola virus upon contact with Mr. Duncan, asking each individual every day how he/she feels and checking to see if Ebola symptoms have appeared.   If new symptoms do appear in a person, that individual will be quarantined to prevent further spread of the virus, and treated accordingly.
Mr. Duncan’s condition remains critical, prompting a new experimental drug, called brincidofovir, to be provided with the goal of reversing his dire condition.  Worldwide, prayers have been sent for Mr. Duncan’s full recovery.
On a personal note, the State of Texas should hold hearings to determine where failure in communication occurred after Mr. Duncan’s initial visit.  Mistakes were made, and these errors must be identified, determined, and rectified with utmost priority.  Thank you for your question.


Respectfully,



Dr. Roshin










* HOW DO I KNOW IF I HAVE DIABETES DURING PREGNANCY?

Hello Roshin,
"How do I know if I have diabetes during pregnancy?"  Susan (New Jersey)

Hi Susan,
Diabetes is a disease that results when blood sugar levels are unable to be controlled by the body's inherent (natural) mechanisms.  Thus, the body uses the hormone, insulin, to regulate and keep sugar levels to a specific level in the blood.  Uncontrolled blood sugar levels, called hyperglycemia, has many adverse (bad) consequences on a person's health, and seeking assistance, by consulting a doctor, is important to reverse and or prevent all bad effects, within the body, due to the high sugar levels.  Genetics, diet, lack of exercise, race, autoimmune diseases, hypertension, and obesity are some of the major risk factors for diabetes, most of which are controllable with personal lifestyle changes and prescription medicines.

In a nonpregnant individual, one method diabetes mellitus is diagnosed is if blood sugar levels, after fasting, are >125 mg/dL on two, separate occasions.  In a pregnant woman, diabetes is diagnosed by doing a screening test between the 24-28 week of gestation.  Specifically, around the 28th week of carrying her baby, all women are checked for the possibility of having diabetes.   If a pregnant woman has high blood sugar, she has gestational diabetes, a term used to indicate diabetes during pregnancy.  If the nonfasting, screening test is positive for diabetes, the woman will have a blood sugar level >140 mg/dl.  However, the screening test must be further confirmed, by your doctor, by performing a 3-hour oral glucose tolerance test.  Based on her blood sugar levels, the 3 hour oral glucose test, completed after fasting, positively identifies if the pregnant mother has impaired sugar tolerance or gestational diabetes.

As mentioned earlier, many risk factors are manageable with lifestyle changes of diet and exercise; thus, whether pregnant or nonpregnant, male or female, and regardless of race, take time to visit with your doctor discussing ways to maintain or reduce blood sugar as needed.  Thank you for your question and trust.

Respectfully,

Dr. Roshin








 


* WOMAN ASKS IF ACCUTANE IS SAFE FOR HER USE

Hello Roshin,
“Since you know me, is taking accutane dangerous for me?”



Dear “Kim,”
Accutane, also called Isotretinoin, is used to treat severe forms of acne.  Very often, doctors will prescribe Accutane only if other medications have been unsuccessful in eliminating acne.  Acne is caused by bacteria that enter clogged hair follicles producing excess oil (sebum) allowing bacteria to live and multiply underneath the skin.  When enough bacteria accumulate, inflammation of the pore occurs, and this red, inflamed pore appears as a pimple.  However, acne may also manifest as blackheads, papules, whiteheads, cysts, and pustules on the skin.  Although Accutane is a very effective medicine for severe and most types of acne, many serious side effects exist, and consultation with your doctor is absolutely necessary to avoid harmful effects within your body.  Typical side effects of Accutane include dry skin, itching, nosebleeds, and cracks at the corners of the mouth; however, if a woman is pregnant, Accutane must never be used during pregnancy.  In medicine,  Accutane is considered a Category X drug, an indication that this drug will cause harmful effects to the fetus including and not limited possible congenital heart defects, nervous system defects, deafness, and small ears.  In addition, depression, skin sensitivity to light, tingling sensations of the skin, and aggressive behavior have been documented requiring further immediate, medical consultation. Since you are 24 years of age and sexually active, proceed with Accutane use only after your past medical history, allergies, and gynecology history have been discussed with your doctor.  Bottom-line is that Accutane must be used with extreme caution.  Thanks for your question and trust.  God Bless you and God Bless New Jersey.

Respectfully,

Dr. Roshin






* WOMAN ASKS IF WEIGHT GAIN DUE TO DIABETES MELLITUS

 

Doctor
“I am 61, had gestational diabetes and large babies. I lost 75 lbs about 18 months ago, and then my weight loss stopped and now even though I continue to try everything to lose weight I have started gaining. Could this be a symptom of diabetes. I know typically it is weight loss, but I thought if my blood sugars were out of whack maybe that could be the reason for this unexplained weight gain.”




Dear Madam,
Losing weight typically improves diabetes by decreasing insulin resistance with tight glycemic  control.  However, you mentioned that your “blood sugars were out of whack” thus, out of control blood sugars worsen diabetes potentially leading to weight gain.   However, due to your medical history of hypothyroidism, a thyroid panel should be ordered to check the activity level of your thyroid gland.  An underactive thyroid gland would also contribute to weight gain, and your doctor could provide medicine to boost the gland’s activity level.  The thyroid medication, if needed, along with lifestyle changes (modified diet and tolerable exercise regimen) should help maintain weight loss.   Consult your doctor on reducing glucose levels and an exercise program  and visit a nutritionist to assist maintenance on a diabetic diet. Thank you for your question and trust.

Respectfully,
 
Dr. Roshin
 


 



*MOTHER ASKS IF ENTEROVIRUS D68 IS HEADED TO NEW JERSEY?

Yes, hi doc, is that flu we see on the TV comin here/ (NJ)



Hi Madam/Sir,
Your question, concerning the virus effecting a dozen plus states across the USA, arrives at a time when many parents have voiced similar concerns.  Specifically, the rare respiratory virus, called Enterovirus-D68, has sickened many teenagers and school children alike, with severe cold to flu like symptoms.  Dozens, if not hundreds of Enterovirus D68 cases, have been reported in Colorado, Kentucky, Michigan, North Carolina, Georgia, Illinois, Missouri, Iowa, Ohio, Kansas, and Oklahoma.   Is the Enterovirus-D68 headed to New Jersey and surrounding Northeast states?  Although, I obviously have no control of where and when the virus will spread, with the onset of the new school year, coupled with fall like cooler outdoor temperatures, environmental conditions seem to be favoring similar cases to eventually be reported here in the northeast USA in due time.   Thus, we should all become better informed about Enterovirus-D68 and how to prevent the spread of this virus.  Enterovirus D68 is infecting newborns, infants, school age children, and adolescents due to this population having an immature immune system.  In particular, Enterovirus D68 has targeted a large number of kids who have asthma and or other breathing related diseases.  Thus, this virus may initially present with typical cold symptoms such as coughing, runny eyes/nose, fatigue, or sneezing; however, every parent should pay particularly close attention to the development of the following serious symptoms not limited to fever, rash, conjunctivitis, muscle aches, chills, night sweats, and most importantly, breathing difficulties.  Since many of the mentioned symptoms are very similar to symptoms of a regular cold or flu, the likelihood of eventually finding Enterovirus D68 cases intermixed among cases of the Influenza virus is very likely.  An infected person carrying Enterovirus D68 will expose the virus to close contacts through bodily secretions (saliva, nose mucus, sputum, spit, blister fluid, stool).  Furthermore, the act of touching or shaking hands with an infected person, inhaling respiratory droplets from a cough/sneeze, changing diapers, drinking water, breast feeding, and touching your eyes/nose/mouth prior to washing your hands are avenues the virus can spread from person to person.  Thus, if your child displays any of the serious symptoms listed above (especially difficulty breathing, skin turning bluish in color), you should call 911, go to your child’s doctor, or visit a hospital immediately.  In addition, since there exists no cure, vaccine, or definitive treatment for Enterovirus D68, methods, in your control, to help prevent viral spread include frequent washing of hands with soap and water, constantly disinfecting surfaces/appliances, isolating the sick individual in a room away from other family members, avoiding crowds/gatherings, and covering your mouth/nose when coughing/sneezing.  Whether in school, public facilities, or at home, being vigilant is key to combating this sudden viral outbreak.  Hopefully, speculation that Enterovirus D68 will affect us here in New Jersey, will be incorrect; however, in the end, keeping  informed allows to stay safe rather than sorry.  If you have any other questions regarding the Enterovirus D68, please feel free to write or call as needed.  Thank you for your question and trust.  God Bless you and God Bless New Jersey.

Respectfully,

Dr. Roshin

* TEXAS ELDER WOMAN NERVOUS ABOUT SKIN BOIL APPOINTMENT

 

Hi Doctor Roshin,

“On the front part of my shoulder under the armpit, I think I have a boil and it is very painful.  I have an appointment this afternoon at 1:30PM CST August 28, 2014.  I called to ask what is going to happen?  I am a little nervous.”  Thanks Sheila (Texas)



 
Hello Sheila,
After conferring with you by telephone, your self diagnosis of a boil seems accurate.  A boil is a pus filled, painful bump that forms due to bacteria (usually Staphylococcus aureus) infiltrating the skin, especially hair follicles.  Thus, this bacterium, commonly found in the environment, managed to gain access to hair follicles along your anterior chest within the armpit. Your telephone call was timely, as you mentioned the boil becoming excruciatingly painful and larger in size from just twenty-four hours prior.  In essence, the pus, which is the multiplying bacteria, is causing a cellulitis under the skin, and your doctor must remove the pus (the bacteria), to rid your body of the pain.  Thus, the doctor will place anesthetic along the margins of the boil, make a small incision in the boil, squeeze and drain the pus from the boil, and pack the cavity with antibiotic or iodine laced gauze.  Daily changes of the gauze are necessary ensuring that any remaining bacteria is effectively removed from the armpit area.  Furthermore, an antibiotic will likely be prescribed to kill the bacteria that might have entered the blood stream.  Without killing the bacteria in the blood, boils could easily form in other parts of the body. Realizing you are in your seventies, I understand your health concern and nervousness about this condition; however, rest assured, this procedure is routinely performed by family medicine doctors.   Thus, in mere hours, your pain will be markedly reduced, and within a week, new tissue will fill the cavity, and this boil will be a distant memory.   In the interim, do eat healthy foods high in vitamin C to help speed the healing process.  Look forward to hearing your recovery thoughts.  Thank you for your question and trust.  God Bless you and God Bless Texas.

Respectfully,

Dr. Roshin






 

* TEXAS MAN WITH SHOULDER PAIN ASKS FOR NATURAL ARTHRITIS JOINT REMEDIES

Hi Roshin,
“ For several months, whenever I sleep, I have right shoulder pain. The pain is deep inside the joint but occurs mostly when  I lay down to sleep.   I bought Arthri-D3 for the pain and it has helped, but I want to treat my pain with natural remedies.  Can you provide some suggestions?”  Thanks.  Mr. AM (Texas)




Dear Mr. AM (Texas),                                                                                                                                                              
After consulting with you by phone, your agility at 70 years of age is remarkable; yet, as we all grow older, ailments are to be expected.  However, with healthy eating, a tolerable exercise program, activities keeping the mind and body stimulated, working, and volunteering,  a good quality of life well into your golden years is a given.  Yet, often times, there are health issues that develop beyond one’s control.   One such issue is arthritis (joint pain).  Arthritis is an inflammation of a joint’s surrounding tissues causing pain, swelling, and stiffness.  Whether osteoarthritis (thinning of cartilage due to life’s normal wear and tear of joints) or rheumatoid arthritis (autoimmune joint disease where the body attacks its own joint lining), people learn to adjust to the joint disease ensuring a full quality of life.

You mentioning rubber band use during exercise, aquatic therapy, along with continued yoga and meditation, all serve well in overcoming arthritic symptoms.  Furthermore, your mentioning that you prefer to “stay away” from medicines resorting to natural remedies is reasonable, achievable choices.  Eastern philosophy medicine is teeming with alternative remedies that have proven effecting in coping and dealing with different types of arthritis.  The following is a list of arthritis natural treatments, which should be used after consultation with both your regular doctor and alternative therapy specialists. 

1) AYURVEDA MEDICINE:  Ginger, Coriander, Aloe vera, Angelica, Basil, Barberry (tea), Calamus Oil, Camphor

2) CHINESE HERBAL MEDICINE:  
A) For rheumatoid arthritis: Cinnamon Twigs, Aconite Root, Angelica Root, Wild Ginger, Gentian Root, Cork Bark Tree, Pupleuri Root, Licorice, Chinese Skullcap
B) For osteoarthritis: Cinnamon Twigs, Tinospora stem, Angelica, Ledebouriella Root

3) AROMATHERAPY:  Juniper Oil, Petitgrain, Lemon Oil, Cypress Oil, Chamomile, Lavender, Rosemary, Black Pepper, Eucalyptus, Marjoram, Benzoin

4) HOMEOPATHY:  Bryonia, Colchicum (joint pain in warm weather), Rhododendron (joint pain in cold weather), Rhus tox

5) VITAMINS/ MINERALS:  Vitamin A/C/E, Selenium, Magnesium, Cod Liver Oil, Evening Primrose Oil, Copper

6) HERBALISM:  Slipper Elm with Cayenee, Feverfew, Meadowsweet, Celery Seed, White Willow, Bladderwrack, Comfrey with Black Pepper Essential Oil, Dandelion Root, Horsetail, Devil’s Claw, Siberian Ginseng

7) HOME REMEDIES:  Nettles, Vinegar with honey, Apple cider baths, Ginger Root baths, Apples

The information provided is representative of present remedies beneficial to improving arthritic symptoms.  I pray these suggestions bring eventual relief to your present joint pain(s).  You are correct that “the body is our temple, and we must always work to keep the mind and body healthy.”   Thank you for your advice.  God Bless you and God Bless Texas.

Respectfully,




Dr. Roshin





* JERSEY WOMAN ASKS FOR ALTERNATIVE TREATMENTS FOR DEPRESSION

Hello Doctor,
                                                                                                                                                        
“ My question is about depression.  I recently broke up w my boyfriend of 5 years and I work in the entertainment business/ so its major physical manual labor to going home sleeping – totally black & white up & down.  I am wondering if there are any foods that will help make me feel better in my down time.  I don’t eat any red meat or pork –“  Thanks Ms JAM (New Jersey)




Dear Ms JAM
After visiting with you in person, I empathize with your present situation, namely work and personal related circumstances that have contributed to your depressed mood this past year.  Arguably, your depression may be transient if only due to the fact, that as circumstances improve, the despondency you presently feel will likely retreat.  However, during our conversation, you seem to have alternating episodes of both mania and depression, requiring bipolar disorder to be further investigated.   Furthermore,   the fact that you mentioned contemplating, not implementing “a plan to take your life,” definitely is a signal for you to visit a psychiatrist or a psychologist discussing your feelings and avenues for resolution.   Talking, sharing, and receiving perspectives on ongoing challenges is solid therapy to combat clinical depression.
  
Your conscious awareness that “life is dragging you down” is a good starting point in beginning the process of reversing present anguish.  Part of that progression is eating healthy, exercising, and performing activities that lift your spirits and provide a sense of inner peace.  Life presents challenges that are often times beyond your control;  however, maintaining composure during the difficult times will place you that much further ahead once fully recovered.  You will recover.  Thus, as you have requested, I have provided a list of alternative therapies that have proven helpful in reversing depressive mood.   However, my recommendation is for you to incorporate the following alternative treatment suggestions as well as to schedule routine visits to a doctor who will further assist your recovery efforts. 

1) CHINESE MEDICINE:  Angelica, Peony root, licorice, thorowax root
2) HERBS: Balm, Borage, Limeflower, Oats, Rosemary, Vervaub, St John’s Wort
3) AROMATHERAPY: Neroli, Jasmine, Geranium, Melissa, Rose, Ylang ylang, lavender, clary sage, chamomile
4) HOMEOPATHY: Aurum, Pulsatilla (for bursting into tears), Arsenicum, Ignatia
5) FLOWER ESSENCE: Cherry Plum, Agrimony, Gorse, Gentian, Mustard, Sweet Chestnut
6) VITAMINS/MINERALS:  Tryptophan, Vitamin C, B6, B12, zinc
7) YOUR SOCIAL HABITS: Stop smoking!

I have contacted a psychologist in your locale that has extended an open invitation for you to visit and talk with her.  I will provide her name, location, and number in an email to you, and she stated that you, not having health insurance is not a problem, and she will work with you on an affordable fee(s).  My prayers are with you during this difficult time in your life.  Thank you for your trust and question(s).  God bless you and God bless New Jersey.

Respectfully,





Dr. Roshin






* NIGERIAN MAN HAS RECURRENT DIARRHEA & LOOSING WEIGHT.  EBOLA?

Doctor,
“Having loose stool after meal most often
Twice or three times a year
Resulting in weight loss
Needs advice on what to do
Your respond will be highly appreciated.” - Mr. “Lan” (Nigerian in New Jersey)




Dear Mr. “Lan,”
After visiting with you several times by telephone, I feel fairly certain you have had relapsing bouts of acute gastroenteritis this past year before, during, and after Ramadan.  Gastroenteritis is an inflammation of the gastrointestinal tract that has caused the diarrhea symptoms you mentioned during each episode.  Fortunately, your diarrhea, without fever, bloody stool, cramping, nausea, or vomiting, lasted less than two weeks and resolved spontaneously each time.  Had the diarrhea persisted for greater than 2-4 weeks, the gastroenteritis induced diarrhea would be classified as chronic rather than acute.  Chronic diarrhea can be further subclassified into infectious or noninfectious types. 

Both infectious chronic diarrhea and acute gastroenteritis may result from the similar microorganisms not limited to parasites (Entamoeba, Giardia, Cyclospora, Cryptosporidium), bacteria (Shigella, Salmonella, E Coli), and or viruses (Rotovirus, Norovirus).   Since acute bacterial gastroenteritis often has bloody diarrhea with fever, while viral gastroenteritis has a nonbloody, watery diarrhea causing subsequent dehydration with loss of essential salts, vitamins, and minerals, and the fact that you mentioned, upon cessation of the diarrhea, you gained back the lost body weight, more than likely you had acute viral gastroenteritis.  How could you have acquired the viral gastroenteritis?  Eating food or drinking liquids contaminated with the virus (norovirus), touching surfaces with the virus and putting your fingers in your mouth without washing your hands, or sharing utensils or food with someone infected with norovirus are all ways the virus is transmitted from person to person.  Realizing you do not have health insurance, to confirm a virus may possibly exist in the digestive tract, a rapid stool test should be done by medical personnel.    In addition, measures such as proper hand washing , using antiseptics to wipe counters, and washing linen are methods in your control to prevent the spread of the virus.

As requested, I have listed alternative therapies to help prevent future acute gastroenteritis episodes.  Remember to always consult an alternative or homeopathic practitioner prior to ingesting suggested remedies.
1) Home Remedies: Yogurt, Honey in warm water, Bananas (past ripe)
2) Herbs: Comfrey root with Meadowsweet, Arrowroot, Slippery Elm Tea
3) Aromatherapy: Chamomile and Geranium Oil
4) Homeopathy:  Arsenicum, Pulsatilla, Baptisia, Phosphorus, Sulfur, Mercurius

After our discussion, the other certainty is that you do not have the Ebola virus.   With the ongoing epidemic in West Africa, those questions are indeed relevant.   Nonetheless, thank you for your question and trust.  If further questions come to mind, please feel free to contact me.  God Bless Nigeria, God Bless New Jersey, and God bless you.

Respectfully,



Dr. Roshin

 

 


 










* ALTERNATIVE REMEDIES FOR RADIATION OVERDOSE

Dear Mr. Roshin,

 “Ho are you?  I have a very dear friend that has been exposed to severe nuclear radioactivity and is ill.
I am determined to help her cure herself. Please tell me if you know any natural material which has very string effect on absorving radioactivity and spilling it out through evacuation like aste, or even, a natural product which may simply eliminate the radioactivity that is inside the body of the person, or even transforming it into good nutrients.  If you have any information on this, please tell so i can help my ill friend. I have heard that clay absorves radioactivity, but... Do you know something stronger, more efficient?  Warmest regards!  May God Bless you!”     “Mr JLA”


 
Hello Mr. JLA,
I was hoping you would reply my return email to your question as a means to communicate further concerning your friend’s radiation exposure.  Specifically, I needed to know information not limited to your friend’s age and medical  history, how your friend was “exposed to severe nuclear radioactivity,” how many grays of radiation were detected in her body, the type of radiation your friend was exposed to, whether she is pregnant or not, and her allergy history.  Since you did not reply my follow up questions, I must emphasize that any suggested alternative therapies listed below must be discussed with your friend’s doctor, a nutritionist, a homeopathic doctor, a Chinese medicine specialist, and a herbalist.  Alternative therapies are not part of traditional Western medicine training; thus, please consult individuals who specialize in these types of treatments.  The following are a list of nutrients, foods, and remedies that have assisted people to recover from radiation exposure:
 
1)     Mushrooms (Kombucha Tea, Reishi) – chemoprotective and radioprotective
2)     Blue Green Algaes/ Marine Phytoplanktons (Spirulina, Chlorella)
3)     Topical Treatments:Calendula Extract (Heels sores/burns from radiation exposure)
4)     Baking soda-  Cleanses body cells of radiation
5)     Cadmium Sulphuratum: Relieves vomiting
6)     Phosphorus: Often first remedy needed after exposure to radiation.
7)     Potassium Iodide: often offered several hours before radiation exposure
8)     Ginkgo Biloba: Protects cells from radiation
9)     Astragalus: Chinese herb that boosts immune system depressed by radiation exposure.
10)  Bentonite Clay: Carries toxic products from radiation exposure out of the body.
11)  Dimethylsulfoxide (DMSO):  Detoxifies & protects body from harmful radiation
12)  Zeolites: Removes nuclear waste at the cellular level
13)  Charcoal: Neutralizes radiation
14)  Papain: Papaya fruit derivative known to reduce effects of radiation toxic biproducts.
15)  Beets: Reduces effects of radioactive cesium-137
16)  Bee Pollen: Known to reduce the negative side effects of radiation exposure
17)  Potassium Orotate: Best form of potassium to use for radiation exposure.
18)  Oils (Coconut, Extra Virgin, Sesame):  Pull radiation out of body.
19)  Fish Oil: Boosts responsiveness of cancer cells to chemotherapy/ radiation.
20)  Silibinin: Milk Thistle Extract that makes cancer cells less aggressive.
21)  Glutamine: protects digestive system cells from radiation/chemotherapy exposure
22)  Vitamin D: Since radiation increases risk of cancers, vitamin D known to decrease cancer risk.
23)  Iodine
24)  Garlic
25)  Citrus Pectin- Block ability for cancer cells to attach to blood vessel walls preventing  metastasis.
 
The listing above is a small sample of alternative therapies known to alleviate the effects of radiation exposure.  As mentioned, since excessive radiation increases the risk of most types of cancer, a healthy diet and a supportive, positive persona will help boost the immune system to combat cancer and the “negative energy” as described by a homeopathic doctor, in those people with radiation exposure.  My prayers are with your friend in her recovery efforts.  Thank you for your question and trust.  God Bless.
 
Respectfully,
 
Dr. Roshin
 




* PHILIPPINE WOMAN ASKS ABOUT DAUGHTER'S RED/SWOLLEN EYES


Doc.
“my daughter has an irretation in her eyes what can I do about that.  both eyes for 2 weeks.  everytime that my daughter playing outside.  No she has no fever.  Yeah  swelling 2.  are you bz can we talk cam to cam.  heres my skype id.  this is my baby that i told you. i am going to turn the camera on my baby's eyes.  w8.  and behind her eyes it turning color red. is it ok if i apply a medicine like terramicin” ( Jhen, Philippines)



Dear Jhen,
Although nothing replaces an appointment to a doctor’s office, social media, such as Skype,  for some cases, proves invaluable in making a diagnosis.  Having seen your “2” year old daughter’s “behind her eyes it is turning red,”  “swelling,” and a scar “on the side of both her eyes,” “for 2 weeks” your daughter likely has viral conjunctivitis of her eyes coupled with environmental irritation due to her playground area.  Since the whites of your daughter’s eyes are a pinkish to red color, without pus exuding (coming out) from either eye, nor a fever,  the diagnosis favors a viral origin, not a bacterial cause.  Furthermore, the scars you mentioned, formed in the past two weeks, due to your daughter’s excessive scratching of her eyes, is likely due to itchiness, a symptom very common in viral conjunctivitis.  Therefore, the “terramicin” your “ mother in law” gave to you since she “used that to my husband before when he was a child,” is an antibiotic used for bacterial eye “irritation,“  not viral “irritation” and will likely not be effective.  By the way, never use antibiotics or medicine that are expired.   Viral conjunctivitis resolves (goes away) on its own in one to two weeks; however, since viral conjunctivitis spreads by touch;  you should take extra precautions wiping down all furniture, door handles, toys, and appliances with antiseptic as a means to prevent viral spread from person to person.  Furthermore, the virus can also spread by linen; thus, in the short term, separate your daughter’s towels and sheets from the rest of your family.  As for your daughter’s playground area, since “it has a house but now it is demolished so now itis abandoned place or lot” with “alot of dust” and “we have a pet like a dog and cat,” change the play area to indoors away from the “abandoned lot” as inside your home  is cleaner without dust and pet dandruff (as you mentioned).  If possible to purchase, normal saline eye drops (.9% NaCl) may be beneficial for environmental condition, even though you mentioned your daughter's eyes are wet, not dry.  To say I am humbled to have made your acquaintance is an understatement; and yes, your neighbors in the village can contact me by Skype for medical advice as needed; however, please remember, that seeking the advice of a physician in the Philippines is more efficient and better, especially if an emergency situation develops.  Either way, thank you for your question and trust.   God bless you, God bless your daughter, and God bless the Philippines.

Respectfully,

Dr. Roshin








* HONDURAN WOMAN ASKS ABOUT HER LARYNGITIS


Puedo preguntarte hacerca Ok Sobre enfermedades de laringuitis.  Si y enferma del oido y laryngitis Desde siempre.  Yo estoy enferma desde mucho tiempo   Y siento mucho dolor de oido. Tu me entiendes ok     gracias ----  Ms. “Duva”  (Honduras)

I can ask question. Ok.  About diseases laringuitis   Historically, I'm sick for a long time And I feel much ear pain.  You understand me ok.-----   Ms. DEva (Honduras)

 

Dear Ms. “Duva” (Honduras),
I am glad we were able to chat on Facebook allowing me to understand and better appreciate your medical concerns .  Your question centers around why laryngitis has lingered well after taking antibiotics for an ear infection.  You took “De penicilina Y LICOCIN” for the ear infection and “amigdalitis.”  After visiting with you, I believe the “amigdalitis” is not tonsillitis, but rather swollen lymph nodes due to pharyngitis (a sore throat).   You also mentioned, “Primero Amigdalitis, luego el oido, Y la fiebre” translated as you had tonsillitis first, then an ear ache,  and fever.   Since the throat is connected to the ear, any infection in the throat would easily travel  to the ear; that is why you were sick for a long time (Yo estoy enferma desde mucho tiempo) without the medications.  However, after taking  “De penicilina Y LICOCIN, the sore throat disappeared but ” your “laringuitis” remained.   More than likely the” laringuitis”  (laryngitis) has remained due to a cause not related to an infection.  For example, smoking, drinking too much alcohol, a job requiring excessive use of your voice, or always having to talk over load noises,  may result in inflammation of the vocal cords and subsequent laryngitis.  However, during our conversation,  you mentioned a past acid reflux condition you had many years ago.  Gastroesophageal Reflux Disease (GERD) is a potential cause of laryngitis due to the stomach acid regurgitated onto the vocal cords causing loss of voice.  Furthermore, GERD can cause a certain type of cancer of the esophagus, and esophageal  cancer could be causing the lingering laryngitis.  Thus, I urge you to visit an ear, nose, and throat (ENT) doctor  as soon as possible.  The ENT physician can use a special camera to look at your esophagus and vocal cords making sure a cancer has not developed.  I know spicy Hispanic food is very delicious; however, you may have to modify your diet, as spicy foods often contribute to acid reflux.   The suggestions listed  above should be discussed with your doctor in Honduras, and hopefully, these thoughts will bring remedy to your concerns.  Thank you for your question and trust.  God Bless you and God Bless Honduras.

 

Respectfully,

 

Dr. Roshin








* MAN WITH HIV+ SHARES HIS STORY/FEARS

hello
i am the brother of the sister whom refereed to you.
  Doc about my health conditions as of the moment.  hope we could have an interactive chat so I can really share to you about my health conditions.  I am very disappointed of the services here in my country. I am an HIV+ i REALLY NEED HELP FROM THE GOVERNMENT THEN especially for the laboratory and other tests especially the CD4 count but we are asked to pay for it and its very costly.  it really stresses me.  they will not start my ARV if I will not have my cd4 count first. they will not valid my CD4 count from Australia.  i really hate it coz i am a teacher and lots of students know me and so i need to be discreet then.”  Mr. Anonymous (Pacific Island)


                                      
 
Dear Mr. Anonymous,
I am glad we were able to communicate by social media this past weekend to discuss your diagnosis of HIV (Human Immunodeficiency Virus).  The HIV virus is a retrovirus that takes over a person’s immune system, disabling the ability of the body to fight off infections.  HIV infects CD4 cells, the good cells in the body that attack any foreign agents in our blood.  Your CD4 test done this past May 2014 in Australia registered a count of 285 with a viral load of “HIV RNA Copies x10^3/ml 32.50.”  These results indicate a serious case of HIV, which if left untreated, would easily progress to AIDS (Acquired Immunodeficiency Disease).  In fact, a CD4 count of 200 or less will be diagnosed as Pneumocystis Jiroveci, a respiratory pneumonia only found in HIV/AIDS patients.  Normally, when a person acquires HIV, the CD4 count will drop roughly 50-100 cells/ul per year from a normal level of 600-1000 cells/ul.  As the CD4 count drops further and further, more symptoms will occur along with a much higher risk of contracting opportunistic infections when the CD4 count drops below 50-55 cells/ul.  For most people, depletion from normal CD4 levels takes 5-10 years; thus, the urgency of starting antiretroviral therapy (ARV) becomes all the more important.  I realize you were started on “neviraphine and truvada;” but due to allergies, the nevirapine was discontinued while “the doc said to continue the truvada.”  Truvada is the latest breakthrough drug in HIV therapy, and this medication will, undoubtedly, reduce the spread of the virus; however, initial antiretroviral therapy often involves a mixture (called a cocktail) of two to three drugs from three different antiretroviral classes.  The three drug classes from which a cocktail is derived include nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTI), and Protease Inhibitors (PI). Based on your past medical and allergy history, a cocktail can be formulated to combat the HIV virus.  The goal of an antiretroviral therapy is to drive down the viral load count in the blood allowing the body to naturally raise the CD4 count.  Thus, you mentioned that the your country’s “hub” requires a new CD4 test to be done before beginning any ARV therapy; yet, the cost of “3k” is preventing you from having the test done as soon as possible.  The contact names and numbers I provided are for various Directors of Medical Field programs designed to assist the population in your country with multiple medical illnesses and treatments.  I pray this will be an avenue for you to begin ARV therapy immediately.  Any delay in ARV therapy will likely produce future dire consequences.  Furthermore, your engaging in sex with eight different male partners, with and without protection this past year, is the direct cause of your present HIV infection.  Thus, prevention of the spread of the virus involves total abstinence from sex until your doctor suggests otherwise, at which point, protection should always be used.  You must inform any future partners of your diagnosis.  My thoughts and prayers are with you.   Please stay in touch, as your story is very real for many people around the world.  God Bless you and God Bless the Pacific Islands.  Thank you for your trust and question.
 
Respectfully,
 
Dr. Roshin  
 





* SISTER OVERWHELMED BROTHER IS HIV+


 “dr can I ask?
a confedencial case

wat is a hiv 1?
cause my brother was diagnose that case
thats become me sad
is that dangeros dr>>
 thank you dr” --Ms. Anonymous (West Pacific)



Dear Ms. Anonymous,

Prior to beginning our discussion, you should know that our conversation and online contact is confidential.  I am sorry to hear news that, one month ago, your brother was diagnosed with HIV.  HIV, referred to as the  Human Immunodeficiency Virus, is the virus that causes AIDs, also called Acquired Immunodeficiency Syndrome.  HIV is arguably the most sinister of viruses due to the fact that once a person acquires this virus, he/she has the virus for life.  In essence, the HIV virus takes over a person’s body by taking control of their immune function, the system that fights off  infections.  Thus, HIV takes control of  the very cells that are helpful to your body, namely CD4 Helper T-cells.  This is why a low CD4 count and a high virus count usually result in a bad future prognosis, especially when the disease is left untreated.  However,  the revelation that your brother is homosexual answers many questions pertaining to overall risk and  most  importantly, how he contracted the virus.  Worldwide, homosexual males, engaging in sexual intercourse, have some of the highest percentages of HIV infection.  Furthermore, the higher the viral load, the greater the risk of spreading the virus to other people.  HIV is spread through bodily fluid secretions including blood, semen, cum, breast milk, vaginal fluids, and the sharing of needles during drug  use.  Thus, survival is dependent on preventative measures and taking antiretroviral medication as directed. The “trovada”  (correctly spelled truvada), you mentioned, is the latest HIV/AIDs drug used to treat HIV infected patients by decreasing the amount of virus circulating in a person’s blood.  Truvada has also been shown to protect uninfected, high risk individuals from acquiring the virus, which undoubtedly is a big step forward in controlling the spread of HIV.  Your brother’s partner should also be informed of the HIV diagnosis, tested often for HIV, and any future sexual activity should require the use of condoms.  I look forward to viewing your brother’s HIV test results and offering a cocktail of medication suggestions to aid in his treatment.  My prayers are with your family. God Bless you and your brother, and God Bless the West Pacific basin.  Thank you for your question and trust.

Respectfully,

Dr. Roshin

* BURKINA FASO MAN ASKS ABOUT MALARIA

Bonjour Mr Roshin, “Je vous pose la question à Savoir un peux plus sur le paludisme car ma manma au Burkina Faso en soufrais rien que la semaine passé . Merci”  (WKab (Burkina Faso)

Hello Mr Roshin, "I ask you to write a malaria more because my mamma in Burkina Faso is sick for more than the three weeks. thank you " WKab (Burkina Faso)



Dear Mr. WKab,

I am deeply humbled to have made my first and, at the moment, only acquaintance and friend from Burkina Faso, the tiny West African nation whose name means “you are welcome here at home with us.”  With that in mind, my thoughts and prayers are with your mother as she recovers from her malaria infection.  Malaria is a disease transmitted by a mosquito bite, in which a parasite the mosquito acquired, infects human blood.  The parasite transforms into multiple stages, invading red blood cells in the merozoites stage,  releasing harmful  chemicals which commonly lead to symptoms of  uncomplicated malaria not limited to fever, headache, chills, body aches, nausea, and vomiting.   However, in complicated malaria, symptoms may present as cerebral malaria (seizure, coma, loss of consciousness), respiratory distress, severe anemia due to red blood cell rupture,  and organ failure (kidneys).  In fact, hyperparasitemia may occur infecting more than 5% of all red blood cells in a person’s body, and some of these parasites may assume the hypnozoites stage hiding in the liver for years before reappearing.  Thus, taking medications to combat the parasites becomes all the more important. 
According to the latest estimates released in a December 2013  World Health Organization report, 207 million cases of malaria were reported worldwide in 2012 along with 627,000 deaths.  Malaria is caused by the Plasmodium parasites (falciparum, vivax, ovale, malariae) and is transmitted to humans by 20 different species of the Anopheles mosquito.  In Africa, the Anopheles mosquito is particularly aggressive contributing to 90% of the worldwide deaths attributed to malaria. 
 
Diagnosis of malaria is made definitively by identification of the parasite type using microscopy.  Once the malarial parasitic type is identified, medications, not limited to Chloroquine, Mefloquine, Atovaquone with Proguanil, and artemisinin-based combination therapy for P. falciparum, often  remedy malarial  symptoms as well as combat the parasite itself.  With regards to if a vaccine exists, “One research vaccine against P. falciparum, known as RTS,S/AS01, is most advanced. This vaccine is currently being evaluated in a large clinical trial in 7 countries in Africa.”

The key to preventing malaria is vector control of the Anopheles mosquito.  Insecticide treated nets, improved surveillance, insecticide sprays, antimalarial medications to suppress various blood stages, and covering skin with long sleeve clothing and sprays will all help prevent and contain the spread of malaria.
Thus, I do hope this information has brought you a better understanding of the infectious disease your “mamma” contracted.  Malaria usually runs a course of one to four weeks; thus, the medicines your mother is presently taking should be adequate for her full recovery.  In the meantime, your community should gain access to the “Roll Back Malaria” government and international programs implemented to reduce malaria mortality rates in many African countries.  I will forward contact information for various programs in Burkina Faso and surrounding countries.  Thank you for your question and trust.  God Bless you and God Bless Burkina Faso.

Respectfully,



Dr. Roshin



* PHILIPPINE MAN ASKS IF VITAMIN C PREVENTS CANCER?

 

“friend,  I just want to ask something it ok? is vitamin c is good for cancer patience? direct injection? thank u again for your kindness. DCastro (Philippines)


Dear Mr. DCastro,

• Vitamin C, also called ascorbic acid, is an antioxidant nutrient humans obtain through eating certain foods, such as citrus fruits (oranges, papaya, lemons, grapefruit, guava, strawberries) and green, leafy vegetables (kale, peppers, broccoli, peas, potatoes).  Vitamin C keeps our tissues healthy improving healing time as needed.  The antioxidant properties of this nutrient prompted speculation that vitamin C enhances our health by boosting our immune system and blocking cells that cause bodily harm.  Thus, vitamin C was thought to prevent many cancers including cancer of the pancreas, lung, breast, oral cavity, prostate, bladder, cervix, stomach, bladder, esophagus, and intestines, as well as prevent blood cancers such as leukemias and lymphomas.   Does Vitamin C prevent cancer?  Put simply, depending on the organization asked, the answer to this question is “all over the map.” 

• Studies in the 1970s linked a distinct correlation between taking high doses of Vitamin C and the subsequent decrease in cancer rates.  However, decades later, these 1970’s findings were dismissed due to study design flaws.  Today, the American Cancer Society cites that “many of these studies show people who eat foods to get a high level of vitamin C have about half as much cancer as those who have a low intake of these foods.”   In 2007, research conducted from sixty eight “various clinical studies of antioxidant vitamin supplements concluded that taking vitamin C supplements had no detectable effect on lifespan.”   Furthermore, the “ 2000 National Academy of Sciences report stated that there is not enough evidence to support claims that taking high doses of antioxidants (such as vitamins C and E, selenium, and beta carotene) can prevent chronic diseases.”  Yet, the National Cancer Institute, a branch of the National Institutes of Health (NIH), has concluded more promising findings of Vitamin C’s effect on certain cancers. For example, the NIH study found that, in the laboratory,  “treatment with high-dose vitamin C slowed the growth and spread of prostate, pancreatic, liver, colon, malignant mesothelioma, neuroblastoma, and other types of cancer cells.”  In addition, the NIH findings also concluded that adding high dose vitamin C to chemotherapy medication regimens proved more effective in killing cells that cause ovarian, lung, and pancreatic cancers.  NIH also found adding high dose vitamin C to radiation treatments for aggressive brain cancer also proved effective in killing cancer cells.   Finally, multiple NIH studies, involving animals, have also shown promising results, in which high dose vitamin C prevents tumor growth in and of the pancreas, liver, prostate, breast, lung, and ovary. 

• Thus, among various laboratory and animal research studies, high dose vitamin C preventing the progression of cancer seems apparent; however, at the moment, there is no large scale clinical trial research studies that offer evidence of the benefits of high doses of vitamin C preventing cancer.  In fact, the United States Food and Drug Administration (FDA), has not granted its stamp of approval for using vitamin C as a treatment for cancer, much less other diseases.  Bottom-line is that there remains no evidence that vitamin C cures cancer. 

• High dose vitamin C involves administration of the vitamin through the veins, not taking pills by mouth; however, due to serious side effects, including toxic effects and organ failure, ALWAYS CONSULT YOUR DOCTOR, prior to attempting any treatment regimen.  Eastern philosophy medicine advocates vitamin C as a means to prevent cancer; thus, this notion should be considered as a possible therapy alternative.  Rather, individually, talk with your doctor about the best treatment options for your cancer/illness. Thank you for your question and trust.  God Bless you and God Bless the Philippines.


Respectfully,

Dr. Roshin




* KENYA PASTOR ASKS IF TUBERCULOSIS CURE EXISTS?

Hi Doctor Roshin,
“hw do we cure tuberclosis?” Pastor Kennedy (Kenya)



 
Dear Pastor Kennedy,
According to the Kenyan Ministry of Health - National Tuberculosis, Leprosy, and Lung Disease Unit, “tuberculosis (Tb) remains a major cause of morbidity and mortality in Kenya.”  In fact, although poverty, the lack of health care services, and congested prisons are factors contributing to tuberculosis burgeoning numbers, the main cause of tuberculosis in Kenya is the HIV epidemic.  Thus, the Kenyan government has implemented the Millennium Development Goals with a vision of “comprehensive, affordable and accessible packages of TB, Leprosy and Lung disease interventions to all Kenyans irrespective of age, gender, race, social economic status and geographical location in order to achieve a significant reduction of morbidity and mortality from the said diseases to the extent that they no longer pose a public health threat in Kenya.”  Yet, to answer your question, there is not a cure for tuberculosis; however, tuberculosis can be treated.  Tuberculosis exists in two forms, a latent infection and active disease.  Persons with Tb latent infection do not feel sick and do not have any symptoms; thus, these people are not contagious and are therefore unable to transmit the infection to other people.  On the other hand, active tuberculosis disease is the worse of the two existing forms, and these people are considered infectious, will spread the disease to other people, and typically have symptoms including night sweats, weight loss, fever, fatigue, chills, and coughing up blood.  Whether a person has the latent form or active disease, there are international protocols of medicines offered for both conditions.  The medicines must be taken as prescribed, as failure to complete the medication regimen may result in the Tb bacteria remaining active and or becoming resistant.  Remember, all people with suspected tuberculosis should be quarantined (isolated) to prevent spread to other people in immediate contact with that individual.  With sustained efforts, Kenya hopes to halt and begin to reverse the incidence and mortality due to tuberculosis, as early as 2015.  If you would like the names of the  specific medications used for either Tb type, please feel free to contact me at your convenience.  Thank you for your question and trust.  God Bless you and God Bless Kenya.

Respectfully,

Dr. Roshin

* UNITED KINGDOM MAN ASKS ABOUT SKIN RASH

Hi Dr. Roshin,
“I have a rash that began around 3 weeks ago (Arms. Upper legs. Parts of abdomen and lower torso).  Can you tell me if  it is serious or not?  I will send photos. “ Thanks   Mr. Kasim Smith (United Kingdom)

   
 
Dear Mr. Smith,
After visiting with you on Facebook and viewing sent pictures, you may have a condition called allergic contact dermatitis.  Contact dermatitis is a normal physiologic response, often not allergic, that occurs when skin comes in direct contact with an irritant.  However, your medical history is one of multiple allergies including “allergies to strawberry and flavours, in food, insect bites;” thus,  since the rash began “3/4 weeks ago” after “recently handling pesticides and garden fertilizers,” contact dermatitis along with a possible allergic (contact dermatitis) reaction may be the cause of your “ red, burning” rash.  Furthermore, you mentioned working in “grass, near trees” in an “allotment type of environment.”  Once again, the combination of exposing your skin to a new environment (“plot of land for growing vegetables or flowers,” coupled with working with hazardous chemicals, would easily lead to your rash symptoms including “redness and itchiness often” along with occasional swelling and blisters. Your other symptoms of “nausea and light headedness” are likely directly related to working with fertilizers and chemicals.  In addition, “not usually” bathing immediately after work does not remove the chemicals directly on your skin; thus, the chemicals remain on your skin leading to the rash.  With urgency, you should  consult a physician in your location, and ask the doctor to prepare an extensive allergy test for all types of allergens including grass and tree pollens.  In addition, although you said your rash does not look like any of the pictures I sent you, your rash should be evaluated for possible poison ivy.  Most importantly, the best treatment is to avoid the skin irritants all together (fertilizers and pesticides). Thus, in the long term, I am glad you mentioned that you will begin searching for new employment; however, in the short term, wearing clean work clothes daily, bathing immediately after work, and wearing fresh clothes at home after work, should help remedy the rash symptoms.  Lastly, wearing gloves and a mask will also help reduce exposure to toxic chemical ingredients.  I hope our discussion provides a guideline as to your next step(s).  Your rash symptoms can be eliminated with prescriptions and lifestyle changes altogether.  Thank you for your question and trust.  God Bless you and God Bless the United Kingdom.
 
Respectfully,
 
Dr. Roshin 





* TURKISH RESIDENT ASKS WHAT IS BEHCET'S DISEASE?

 

Hi.  Everyone speak abut the MERS but why not the Behets?  write plz.  Anonymous (Turke



 
Greetings Anonymous (Turkey),
Behcet’s Disease is an autoimmune disease, typical of the Middle East and Far East countries, in which the body attacks and harms its own tissues, especially, the blood vessels, both arteries and veins.  Thus, since blood vessels supply blood to all organs, Behcet’s has impacts all over the body including the eyes, skin, digestive system, mouth, lungs, joints, genitals, and nervous system.  From sores in the mouth and on the genitals to joint arthritis to brain inflammation (called meningitis) to lung aneurysms, arguably, the most serious complication occurs in the eyes potentially causing blindness.  Although there is no specific test for Behcet’s Disease; internationally, doctors have developed a set of guidelines to classify that a person has Behcets as long as two of the clinical symptoms, mentioned above, are present, along with a positive needle pathergy test within 24-48 hours of testing.  A pathergy test involves a small red bump that develops within two days of a needle prick on the patient’s forearm; yet, only 50% of Behcet’s patients show this skin hypersensitivity.  Although no cure exists for Behcet’s disease, depending on the patient’s symptoms, treatment involves multiple medications, including steroids, along with life style modifications in diet and exercise.  With proper management of medications and treatment goals, people are able to maintain a quality lifestyle; thus, if your question was personal or for general information, please feel free to contact
DoctorAdvice4u@gmail.com with further inquiries.  God Bless Turkey and thank you for your question.

Respectfully,

Dr. Roshin 

* NEW JERSEY MOM STUNNED BY MY DIAGNOSIS: PARVOVIRUS B19

 

 

"Hello Dr. Roshin,
I have a question related skin rash. My 11 year old son started with a very high fever near 106F accompanied with headache in the beginning of the month and it last for about 3 days. I took him to his Dr. and he ran a strep throat test which came out negative. Since the fever was so high he prescribed antibiotics. The fever subsided two days after. Two weeks later on a 
Friday afternoon the fever was back but not as high, was around 101F and did last for another 2 days. Sunday the fever was gone. Monday night after he took a shower he asked me what was all those rashes on his arms and legs? It looked like some type of allergy from something he ate, but I knew it was not because was taking too long to heal. The rashes were not bumpy or itchy. It was very superficial to the skin. I decided to take him to a clinic near my house since his Dr. was on vacation. The Dr. from the clinic said it was seasonal urticaria and prescribed some allergy medication. I gave him the medication for 2 days and the rash was still there. I never found out exactly what was wrong with him, so my question is, is there any type of skin disease brake out going on that you are aware of in our area?
I thank you in advance.” Ms. SL (East Orange, New Jersey)

     

 

Dear Ms. SL (East Orange, New Jersey),

After reading your narrative and viewing the pictures you sent, your son has Parvovirus B19, also called Fifth Disease or erythema infectiosum.  The sequence of symptoms you mentioned reads like a textbook as to how to diagnose Parvovirus B19.  This condition typically begins with non-alarming symptoms such as headache, eye redness, runny nose, and possible fever (although your son’s 106F fever is a medical emergency), followed by a rash that seems inconsequential.  However, when an elementary school child starts to complain about joint pains, and a "lacy" appearing rash is visible on both cheeks as well as many parts of the body (arms, legs, chest, neck, back), a parent should suspect Parvovirus as the culprit.  More than likely, other children in your son’s school have Fifth Disease as this condition is very contagious, easily transmitted by sneezes, cough, and secretions (saliva).  In fact, the picture of your son’s red cheeks is classic for Parvovirus B19’s “slapped cheek” appearance profile.  All symptoms should disappear in one to three weeks; however, in the short term, joint pain can be relieved with Acetaminophen (Tylenol) to be administered only after consulting with your son’s pediatrician.  One additional noteworthy fact is that Parvovirus B19 tends to cause an anemia crisis in people with weakened or immature immune symptoms; thus, recognizing the symptoms becomes all the more important.  Thank you for sharing your story as other parents in New Jersey may be encountering similar symptoms with their children.  God Bless you and God Bless New Jersey.


Respectfully,



Dr. Roshin      

 

 

* HUNGARIAN WOMAN ASKS ABOUT CHEST PAINS

“ Hello! Please add me to your Contact list. what type of sickness in that haert u treat.  i dont no it but when i tell how i feel in my heart u will no the name of that heart disease.  am from hungry but am not living there now. am living at wst Africa.  i feel pain in my heart when i am doing some hard like work and i some times heard that my heart is runing much.  u can help me.”  Ms. FA (Hungary)

 
Dear Ms. FA (Hungary),
I am glad we were able to connect on Skype to discuss your heart condition.  After our discussion, your “pain in my heart when i am doing some hard like work” is likely stable angina while  your “heart is runing much”  is referred to as heart palpitations.  Angina (also called angina pectoris) is chest pains, and the fact that your chest pains disappear upon rest indicates that your condition, at the moment, is stable.  However, a doctor must identify the cause of your chest pains as soon as possible to prevent the stable angina from becoming unstable angina, a life threatening condition.  Angina results from reduced blood flow to the heart (called ischemia) often due to fatty deposits clogging the blood vessels leading to the heart (referred to as coronary heart disease).   The shortness of breath, pain in your chest, and fatigue you mentioned are common symptoms of angina along with nausea, sweating, dizziness, and pain travelling to the jaw , neckline, back, and arms.   Furthermore, angina pain is often linked to stress, smoking, a diet high in fats, lack of exercise, obesity, diabetes, high cholesterol levels, and chronic high blood pressure.  Upon visiting a doctor, the physician should run tests ranging from blood tests (heart enzymes) to imaging tests (Echo, Coronary Angiography) to most importantly, stress tests (treadmill with EKG leads).  The stress test is done to confirm ischemia (decreased blood flow to heart tissues), and   once validated,  treatment options ranging from multiple medication types to opening up blocked vessels (angioplasty with stent or bypass surgery), is offered.  Yet, you do have control over many risk factors that lead to angina such as creating a modified, exercise regimen (consult your doctor), stop smoking permanently, decrease stress in your life, and maintain a diet high in fruits and vegetables.  Lifestyle changes will make a significant dent in the symptoms you are presently experiencing.  As I write this article, please know that I am praying for you and you finding professional, medical assistance to reverse a possible future heart attack as soon as possible.  God Bless you and God Bless Hungary.

Respectfully,
 
Dr. Roshin

* NEW JERSEY MOTHER ASKS ABOUT SON'S IMPETIGO

Good morning Doctor
My son 15 days ago, squeezed a pimple on the nose by 2 times, and got infected, last week began to feel pain in the body, then two lumps ear came next, then fever started then came into her right cheek redness one with small dots, took him to the doctor, it was diagnosed as impetigo and prescribed Bactraban 2%.  Is this correct and how my son get this? I send pictures to you.  Ms. PC from  New Jersey

        
 
 
Dear Ms. PC,
Providing your son’s diagnosis, impetigo, takes the fun and hard work out of answering sent questions.  I am joking.  Most importantly, after our conversation, hearing that your son is feeling much better with improvement of his skin condition is all that matters.  Impetigo is a skin infection that is easily transmitted from person to person, as contact is made with either a person who already has this condition or touching objects already infected with impetigo bacteria (laundry, soccer balls, toys, towels, sheets).   Impetigo begins as red sores (picture of son’s cheek), rupturing of sores, oozing of bacteria from the sores, and golden crust formation (picture of son’s nose).  Judging by the pictures you sent, your son’s impetigo infection began on his nose and migrated to his cheek.  Thus, the doctor prescribed 2% Bactroban, a topical antibiotic placed on the affected skin areas that will kill the impetigo bacteria preventing spread to other regions of the body.  More than likely, your son’s contact with his friends/people at school and or on his soccer team was the source of the impetigo infection.  In fact, the sharing of towels during soccer matches could spread impetigo; therefore, in the short term, this innocent behavior should be halted.  Often, impetigo will clear up in two to three weeks without medication; thus, your son should consider returning to playing soccer games after his infection has totally cleared, as to avoid the unintentional spread of impetigo to his teammates.   Since the medication already appears to be clearing up his infection, he should be back on the field well before the playoffs begin.  Thank you for your question and trust.  God Bless you and God Bless New Jersey.
 
Respectfully,
 
Dr. Roshin








 
* PHILIPPPINE MOTHER ASKS ABOUT SON'S EAR ABSCESS?

Hi Doc,
“ya remember my daugthers el\/.  my son supper now need to operation too.  like wat my daugther ears he has also sys to his left ear .4 mnonths  He tak antibiotic cefalixen”  Ms. CSU (Philippines)

Dear Ms. CSU,
After you posted a picture on my Facebook account and after visiting with you in private, I believe your son has an abscess, not a boil.  Abscesses can be caused by the bacteria, Staphylococcus aereus; thus, taking the “cefalixen” antibiotic is beneficial to try to keep the infection from spreading into other regions of your son’s body.  “Cefalixen” is also good against other types of bacteria that cause abscesses.  Staphylococcus is an opportunistic germ that targets a child’s immature immune system, and this is why your son had a similar infection on his right ear two years ago.  No pus oozing from the site and no steady fever, are good signs the medicine is working until the best treatment is completed, the “operation” you mentioned.  The operation is likely a procedure called an incision and drainage where your son’s left ear abscess will be cut open and drained of pus, containing the Staphylococcus bacteria.  Then a medicine similar to hydrogen peroxide (you are familiar with), called Betadine may be used daily to keep the infection site as clean as possible.  Once the “operation” is completed, the “ear ache only somethimes” you mentioned will go away.  Since your son’s ear infection has been present for “4 mnoths”, the doctor should also examine the pus to make sure the Staphylococcus bug has not become resistant to antibiotics such as “Cefalixen.”  If the bacteria has learned to avoid being killed by the “Cefalixen,” a different, stronger medicine, called Vancomyocin should be used.  As for your other request, I will locate, then contact a medical clinic in the Philippines in an attempt to assist you with costs of medicine and the operation.   In the meantime, please know that my prayers are sent to you and your son.  God Bless you and God Bless the Philippines. 

Respectfully,

Dr. Roshin  

 




* WHAT IS LEUCORRHEA?

Sir,

Leucoreya --- Dr. DP(“west Bengol,” India)

 

Dear DP (“west Bengol,” India )

Leucorrhea is a vaginal discharge normally encountered during a woman’s reproductive cycle between a woman’s periods.  Although the discharge is typically thick and white in color, leucorrhea may also present as a greenish-yellow color.  Yet, regardless of color, leucorrhea becomes more concerning when the presence of itching, a foul smell, swelling, and or redness is found.  Once these ominous symptoms occur, the doctor will conduct an exam to determine if the leucorrhea is 1) physiologic or 2) inflammatory.  Physiologic leucorrhea occurs when estrogen levels rise, causing a discharge that helps to maintain the appropriate chemical balance in the vagina and vaginal canal.  Inflammatory leucorrhea is the worse of the two types characterized by swelling and or a foul smell and is often linked to sexually transmitted diseases (STD) or a discharge after pregnancy.  In addition, anemia, diabetes, and hormonal imbalance all cause leucorrhea.  Treatment options range from self resolution (do nothing) to the use of drugs such as metronidazole and tetracycline (absolutely avoid in pregnant women).  If a woman has a sexually transmitted disease, the appropriate medication is prescribed to combat the STD.  Whatever the reasons for your inquiry, I hope the information has provided answers to your concerns.  Please feel free to contact me at DoctorAdvice4u@gmail.comif further assistance is needed.  God Bless “west Bengol," India.


Respectfully,


Dr. Roshin

* ELDERLY WOMAN HAS "STAGE 2-3" COLON CANCER?

 Hi Doc,
“Brother is it okey to ask some question regarding health like cancer?  My mother has a stage 2-3 cancer in a colon..what is the best thing to do. Is spirulina can help her  At her age..is it possible she can recover if operated or the cancer will spread more fast.”   DC (Philippines)


 
Hi DC,
I am very sorry to hear of your mother’s colon cancer diagnosis.  The colon, located in the abdomen, is the largest organ of the digestive system that has two main functions 1) retain water from digested food and 2) pass stool from the body.  The colon is made up of four layers and is surrounded by lymph nodes and organs.  Thus, the staging of colon cancer is dependent on how far the cancer invades.  In other words, if the colon cancer remains within the colon’s four layers, the patient likely has stage 1 or 2 cancer.  However, once the cancer spreads beyond the colon’s layers to the lymph nodes, the patient now has stage 3 cancer, and when the cancer spreads throughout the body, this is stage 4 cancer.  In general terms, stage 1 is the least aggressive cancer while stage 4 is the most aggressive cancer.  Thus, although all stages have treatment options, the best survival prognosis is with stage 1 cancer (90% survival) while stage 4 cancers have the worst survival prognosis.  Nonetheless, for all stages of cancer (1, 2, and 3), surgery is the treatment of choice, while stage 4 cancers require chemotherapy.  Your mother (age 72) has stage  “2-3 cancer in the colon,” and she will likely undergo surgery to remove the cancerous part of the colon as well as the lymph nodes, followed by either sewing the colon back together if enough colon exists or performing a colostomy procedure where the colon excretes the stool through an opening in the abdomen rather than the anus.  Therefore, yes, your mother can recover after an operation living a quality life even if she has to utilize a colostomy bag for the remainder of her life.  Spirulina is a blue-green algae recognized for its strong anti-oxidant properties and touted to protect against the development of cancers.  Based on your mother’s past medical and allergic history, her doctor will offer the best advice as to whether Spirulina is the best medication for her to use after surgery.  If you have any other questions, please send and we will chat further on Facebook.  In the meantime, I send my love, thoughts, and prayers to your mom, your sister, you, and your family.  God Bless your mother and God Bless the Philippines.
 
Respectfully,

Dr. Roshin


* ST LUCIA MOTHER ASKS ABOUT PROPER POSITION FOR BABY TO SLEEP

 

Hi Roshin,
“Hope u r well.  I had my baby 5weeks ago. I here that babys die b/c they sleep not rite.  What is gud way for my baby to sleep? ”  Ms. SP (St. Lucia)

     
 
Dear Ms. SP,
I am thrilled to hear your wonderful news of the newest member to your family.  May God protect and guide your baby.  Yet, one of the most traumatic events to occur in any mother’s life is to experience the death of an otherwise healthy baby.  When a baby dies during sleep, a common cause may be sudden infant death syndrome (SIDS). Although sudden infant death syndrome usually occurs at any point during the first year of life, there is an increased prevalence during  the fifth and sixth months of life.  Sudden infant death syndrome has no known exact cause; however, the positioning of how a baby sleeps has been linked to an increased risk of SIDS.  Realizing that you, like every mother, wants to protect their child at all costs, the following are recommendations as to how to place your baby during sleep time and naps.  Mothers should place their babies on their backs during sleep.  Statistically, this position (a baby sleeping on their back) correlates with a thirty-five to forty percent decrease in SIDS deaths.  Of course, your infant will obviously not sleep in the same position all night; however, studies have shown that the baby sleeping on his/her back or on either side (left or right) is much better than the baby sleeping on his /her stomach. A baby sleeping on his/her stomach may increase the risk of breathing stoppage (called apnea) for seconds or minutes at a time.  Also, placing your baby on a firm bedding surface while keeping the sleep area free of clutter such as stuffed animals, blankets, and toys, will also help decrease the risk of SIDS deaths.  With that in mind, please know I send prayers and blessings to you and your baby.  God Bless St. Lucia.

Respectfully,

Dr. Roshin  


* MAN ON DISABILITY ASKS HOW TO GET NEW HEPATITIS C DRUG TREATMENT

Dr. Roshin,
“what can B done to obtain new drug for Hep C while retired & on Ssi Disibilty?” Mr. BA (Georgia)

Dear Mr. BA,
Any individual can apply and qualify for Social Security disability benefits (SSDI) as long as two criteria are met: 1) Your employment was covered by Social Security and 2) your diagnosed medical condition meets the Social Security administration’s definition of disability.  Furthermore, Social Security Disability Insurance is based on the amount of earned income prior to the disability, and after screening criteria are met, monthly cash benefits are payed to those people who are unable to work due to a disability.  Since you are already retired, your disability benefits convert automatically to retirement benefits.

Before qualifying for Social Security disability benefits, a doctor must first diagnose a patient with Hepatitis C and chronic liver disease (for at least six months).  However, a diagnosis of Hepatitis C alone will not qualify you for SSDI benefits.  In addition, to meet the requirements for a chronic liver disease diagnosis, one of the following complications must be present: fluid in the abdominal cavity (ascites), fluid in the lung cavity, spontaneous bacterial peritonitis, hepatorenal syndrome, esophageal or gastrointestinal hemorrhage, hepatopulmonary syndrome,or hepatic encephalopathy.  
 
If you do not have insurance and SSDI is your only income, you should call Gilead company at 855-769-7284 or click
http://www.mysupportpath.com/HCP/access-and-reimbursement-resources#support-path-intake, download the PDF patient assistant program form, complete the form, and fax to Gilead company. If approved, Gilead may be able to provide the latest Hepatitis C drug treatments at no additional cost to you.

I pray the information provided above will bring you peace of mind and better health.

God Bless Georgia.

Respectfully,

Dr. Roshin




* MARIJUANA SIDE EFFECTS & IS LEGALIZATION "A GOOD THING?"



Hi Doc,

What are the effects of marijuana use, like bad things that could occur?  Is makin legal a good thing.  Gymfreak 


 

Dear Gymfreak,
Marijuana, also called cannabis, is the most commonly used illegal substance worldwide.  In fact, recent statistics indicate that as much as three to four percent of the world’s population has used or tried cannabis at least one time in the year being studied.   The widespread use of marijuana prompted the psychiatric specialty of medicine to create a new diagnosis, cannabis-use disorder, that would blend abuse and dependence into one heading.   Cannabis use disorder abuse results in intoxication side effects which include and are not limited to impaired motor coordination (lose of balance), diminished thinking ability, slowed sense of time, increased risk of heart attacks, social withdrawal, increased appetite,  hallucinations, and withdrawal symptoms (such as irritability and anxiety).  More importantly, research has shown that marijuana use leads to a higher risk of acquiring lung cancer due to the fact that marijuana smoke containing fifty to sixty percent more cancer causing chemicals than regular tobacco smoke.   Bottom-line is smoking or ingesting marijuana has significant behavioral and psychological effects; thus, abstinence from this substance is your safest and best option.  As for your question on legalizing marijuana, I would prefer to write a separate column on that issue; however, briefly, I am not a proponent of legalizing recreational use of marijuana; especially, since I do not comprehend how this increases global and or national competitiveness.  However, my thoughts remain open to discussion.  As for medicinal use of marijuana, my stance on that issue is also evolving. Thank you for your question and trust.  God Bless.

Respectfully,

Dr. Roshin




*PHILIPPINE MOTHER ASKS ABOUT BABY DIARRHEA

 

 

Hi Doc,

 

 

“Can I ask you about medication?  my baby have diarrehea what medicine can I give?  She did not eat she dont like eat rice.  doctor hard to find.  Need help.”  Ms IU (Philippines)

 

Dear Ms. IU,

I am glad we were able to establish an account, then chat on Facebook.  After our discussion, your “1 year 5 month” old baby hints of gastroenteritis, an infectious diarrhea.   Diarrhea in infants and babies is usually acquired by eating or drinking contaminated food items; but also, diarrhea in babies may be due to a food or medicine allergic reaction or drinking too much fruit juice.  Thus, keeping your baby’s hands, as well as your hands, clean, with frequent washings, will help prevent and eliminate future diarrhea episodes.  Your baby has had diarrhea for two days, no fever, no appetite, a little fussy, no blood in the stool, but “sleeps so so.”  The major concern for her is dehydration, the lose of salt and water (called electrolytes) from her body,   After two to three days, dehydration in a baby, can be life threatening, especially if the water and salts are not replaced in her body.  Thus, since you are recently separated from your husband and a “doctor hard to find,” I will make a suggestion with the promise that you ask someone in your village to take you and your baby to a doctor as soon as possbile.  Your baby’s life depends on having a doctor examine and treat her symptoms.  In the meantime, you can make a liter of rehydration solution by mixing 1 liter of clean water (or boiled then cooled water), adding six teaspoons of sugar, and a half leveled teaspoon of salt.  Mix the solution until the salt and sugar dissolve and give to your baby three to four times per day.  This rehydration solution is to be used only as a temporary substitute until someone in your village can take you and your baby to a doctor.  Upon arrival, the physician can order tests to determine the cause of the diarrhea, and prescribe medication if needed.  Thanks for letting me know that a neighbor would take you and your baby to a doctor in two days time.  Until your travels, let us stay in touch daily as a means to ensure your baby’s survival.  Remember, with urgency, your baby must be seen by medical personnel.  God Bless you and the Philippines.

 

Respectfully,

 

Dr. Roshin









* TEXAS WOMAN ASKS HOW TO MANAGE CHRON'S DISEASE?

 

Dear Doctor Roshin,

“What are good lifestyle and long-term diet practices to help manage Crohn's Disease?” Ms. HS (Texas)

 

 



 

Dear Ms. HS,
Chron’s disease is an inflammatory bowel disease affecting the digestive tract often resulting in abdominal pain, diarrhea, bloody stool, anemia, weight loss, and symptoms in other parts of the body such as the eyes, mouth, joints, skin, bones, kidney, and liver.  Since Chron’s disease may affect the digestive tract from the mouth to the anus, normal intestinal tract functions are disrupted, and malabsorption of digested food becomes a primary problem.  Therefore, depending on the location of the Chron’s disease within the digestive tract along with the intensity of the disease, different treatment plans are offered to individual patients.  Besides medications, exercise, stress relief, or eventual surgery, coordinating with a doctor and a nutritionist, is a good first step to help manage your present symptoms; however, in the interim, since malabsorption is a key complaint, you should keep a food diary recognizing what foods inflame the condition.  Those foods that worsen the conditions (such as dairy products, fiber, spices, caffeine, fruits/vegetables) should be avoided.  Malabsorption syndromes cause vitamins and minerals to be lost in the stool; thus, consider supplementing with vitamins 
(with physician supervision) making sure your diet has adequate calories and nutrients to manage the profound diarrhea symptoms and potential weight loss.  Additional information pertaining to maintaining a good diet in people with Chron’s disease can be found by clicking
http://www.ccfa.org/assets/pdfs/diet.pdf.  I wish to emphasize that those patients with malabsorption syndromes, such as Chron’s disease, are managed on an individual basis; thus, a trial and error period may be necessary to acquire the best lifestyle changes and diet to for quality living.  Thank you for your question and trust.  God Bless Texas. 

Respectfully,


Dr. Roshin 






* TEXAS WOMAN ASKS WHY HER LYMPH NODES ARE HARD AS ROCK?
 

Dear Doc,
What would cause enlarged nodes that feel as  hard as rock?  Anonymous Texan



 
Dear Anonymous Texan,
The lymphatic system is a system of vessels and organs (spleen, tonsils, lymph nodes…etc.) that plays a role in the immunity of your body.  In other words, the lymphatic system keeps your body healthy by acting as an extensive filter to catch bacteria, viruses, and cancers.  If an infection enters the body, lymph nodes will typically enlarge and be painful to the touch.  However, in your case, “hard as rock,” nontender, enlarged lymph nodes, coupled with ongoing, drenching night sweats may indicate a more serious condition, specifically, you may have a blood cancer called a lymphoma.  Lymphomas are blood cancers; thus,   although you mentioned that a CT scan of the head and neck area did not reveal any notable findings, you should inquire from your doctor about 1) having an excisional biopsy of the rock hard lymph node done and 2) having a bone marrow biopsy done.  The excisional biopsy is a procedure ensuring both the margin and the actual lymph node tissue is sectioned for examination.  This is a necessary step to determine if a lymphoma is present, and if found, the biopsy will further establish the type of  lymphoma in your body, specifically, a Hodgkins  versus a Non-Hodgkins lymphoma.  If the excisional biopsy confirms that a lymphoma is present, a bone marrow biopsy should then be done to stage the blood cancer.  The staging of the lymphoma determines what type of treatment will be offered.  Specifically, local disease/cancer usually requires radiation with or without chemotherapy, while widespread disease/cancer routinely requires an extensive regimen of chemotherapy based on the type of lymphoma that is present.  Either way, you have had these medical complaints for several years without resolution, and I do believe that based on your symptoms and past medical history, a lymphoma possibility should be actively investigated.  In fact, after our discussion, I do not believe tuberculosis is the etiology of your symptoms.  I hope that my explanation offers some clarity to your question; however, if further questions warrant, please feel free to contact me at your convenience.  Thank you for your trust as I do wish to see your medical concerns vanquished  once and for all.  God Bless Texas.

Respectfully,

Dr. Roshin













* WHY IS THE PSA TEST NOT CONSIDERED A GOOD TEST ANYMORE?


“I am confused doctor.  Why is the PSA test not considered a good test anymore?”     No name (Ohio)


 

Dear Anonymous,


In the past, the prostate specific antigen test, also called  the PSA test, was encouraged as a routine screening test to all men age 50 and older.  However, today, the PSA screening test is a very controversial subject due in large part to unnecessary treatments and the resulting complications due to overdiagnosis.  Although an elevated PSA score may indicate benign prostatic hyperplasia (BPH) or prostatitis, generally, the higher the PSA score, the greater the risk for cancer.  Yet, there is NO substantiating evidence that PSA testing lowers an individual’s mortaiity risk when used as a screening test.  Often times, small tumors are found that may grow so slowly, a man’s life span is never really threatened.  Yet, due to overdiagnosis, that same patient may opt to have surgery or radiation treatments completed, resulting in complications and serious side effects, including but not limited, to the inability to control urination or bowel movements, and or male erectile dysfunction.  At other times, PSA scores are low; but, the patient actually has cancer. 


Research,  called the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, revealed that men who underwent annual prostate cancer screening were more likely to detect prostate cancer than men who did not have the PSA test; but, the death rate was the same, regardless, of whether a man did or did not take the screen test.  If you are not confused enough, a normal PSA does not exclude the possibility of prostate cancer.  What should you do?  Talk to your doctor to better understand the risks and rewards associated with the PSA blood test specific for you.  Thanks for your question.  God Bless Ohio. 


Respectfully,

Dr. Roshin




 
* WHY ARE MY EYES SHIFTING TO THE RIGHT AND BACK?


Hi Doc,
“Why does my brain/vision sometimes feel like its losing focus and shifting to the right and slowing moving back to place?”  Anonymous


 

Dear Anonymous,

 

Please go to the website, DoctorAdvice4u.com, click the “Submit Your Question” link, and place your contact information in the portal for me to contact you.  Writing random symptoms without understanding your past medical history leading up to the present question is not good medicine. 


At face value, you may have acquired horizontal nystagmus.  Furthermore, the features of “losing focus” which could be optic neuritis coupled with your eyes “shifting to the right and slowing moving back to place,” which as mentioned, could be horizontal nystagmus, may be an indication of a more serious disease, multiple sclerosis.  However, certain medications can cause an acquired horizontal nystagumus, or if you have a history of migraines, the clinical presentation of vestibular symptoms, including migraine associated vertigo, should be further investigated.


Since your symptoms appear to be neurological in origin; paying a visit to a neurologist might be your next best step; but, once again, I can make a better determination after we visit in person or by phone. 


God Bless.


Respectfully,


Dr. Roshin 









* ALABAMA MAN ASKS DOES VIAGRA FIX PREMATURE EJACULATION?

Doctor,

" I have a problem of primature ejaculation.  Will Viagra fix. " Anonymous (Alabama)

 

 
Dear Anonymous,
Erectile and ejaculatory disorders are the most prevalent sexual disorders in men.   Premature ejaculation (PE), common in men of all ages, is defined as the inability to delay ejaculation before or as intercourse begins.  In medicine literature, premature ejaculation is divided into a primary or secondary disorder.  If the PE is due to a neurological cause (such as penile hypersensitivity, hyper-responsive ejaculatory reflex, or excess nervous system hormones such as serotonin), the patient has a primary disorder.  If the PE is due to a behavioral cause (such as emotions, stress, anxiety), the patient has a secondary disorder.  Regardless of whether a patient is diagnosed with a primary or secondary disorder, there are readily available treatments, many of which have proven successful.  Behavioral disorder remedies include the stop/start technique (impeding arousal), squeeze technique (at peak arousal, squeeze penis), and or wearing a condom lubricated with an anesthetic to desensitize the penile shaft.  Neurological disorders are often treated pharmacologically with drugs called Selective Reuptake Inhibitors (SSRIs), Tricycle Antidepressants (TCAs), and or topical preparations that contain anesthetics (lidocaine cream).  Viagra is meant for erectile dysfunction, the inability to maintain an erection, NOT premature ejaculation.  Your next step should be to visit a doctor in your location to help identify the cause of your premature ejaculation.  Once identified, the doctor may prescribe appropriate medications or include other medical personnel in your treatment plan.  Most men become depressed, if not frustrated, due to premature ejaculation; but, kindly take heart, that PE is not a determinant of overall success in a relationship.  Thanks for your question and God Bless Alabama.

 

Respectfully,


Dr. Roshin

 

 

* HOW DO I KNOW I HAVE TRICHOMONIASIS, DOC?

Doc,

Trichomonas. plz.

    

Dear Anonymous,
Although no formal question was sent, I am assuming your one word email, “Trichomonas,” is a request for an informational column on the sexually transmitted disease, Trichomoniasis.   Trichomoniasis is caused by the protozoa, Trichomonas vaginalis, a parasite that is transmitted from an infected partner to unaffected partner(s) during sexual intercourse.  Although vaginal discharge is a normal occurrence in women, any discharge accompanied by burning, pain, bleeding, a foul odor, itching, or change in color needs further examination.  Women infected with the Trichomonas bug experience a frothy, odor filled yellowish-green discharge with itching and or pain on urination and during sex.  In men, Trichomoniasis symptoms include penile irritation, discharge, and or burning during urination.  Either way, the discharge is collected and sent for analysis.  If Trichomoniasis is diagnosed, to avoid further transmission to other people, both men and women and all partners must be treated.  Fortunately, Trichomoniasis is the most curable sexually transmitted disease in sexually active people.  Treatment includes abstaining from sex and a week long course of an antibiotic called Metronidazole.  If the sender of this question, who requested information, suspects Trichomoniasis, you should go to a doctor or visit a hospital for further guidance, immediately.  These bugs can ascend the female reproductive and urinary tracts, thus treatment is recommended with urgency.  If you have any additional questions, please feel free to write or call me at your convenience as all discussions are kept strictly confidential.  God Bless.
 
Respectfully,
 
Dr. Roshin



* COLD CAUSED BY VIRUS...WHAT SHOULD I DO DOC?

 

Dear Doctor,

I have a cold for the weeks past.  I go to hospital and doctor give me paper to show blood numbers.  What is meaning?  Obrigado “Sophie”



Dear “Sophie”,

After visiting with you this past weekend, your symptoms of a cough with phlegm, chest congestion, body aches, runny nose, and low grade fever (100.8F) all reflect the common cold or possibly an upper respiratory infection.  Undoubtedly, the frigid temperatures and extreme cold weather the past seven  weeks here in New Jersey has contributed to your symptoms, and the eventual treatment is solely based on whether the source is bacterial or viral in origin.  Your blood results indicate a high lymphocyte count with relatively normal cell counts (including the red and white blood cell counts); thus, the origin of your cold is likely a virus.  Although there exist hundreds of viruses that can cause common colds, this year, the rhinovirus and certain strains of the influenza virus may be the culprits.  There are no antibiotics for viral infections; however, after first consulting with a health care professional,  over the counter cough syrup, pain relievers, and or decongestants might be suggested to help reduce your present symptoms.  Always check with a doctor or medical personnel as your past medical history including liver disease plays a role in how much medicine a person can ingest.   Furthermore,  by taking time to sanitize utensils, appliances, and rooms, along with keeping yourself in a separate room away from healthy people in your home,  these steps will go far in eventually eliminating the viral infection from your residence all together.   Keep your body warm as another major winter storm is expected Thursday February 13, 2014.  I know you “feel like crap” but try to have a Happy Valentines Day. 


Respectfully,


Dr. Roshin  









* CODE OF ETHICS VIOLATED AFTER TEXAN'S HEALTH INQUIRY


"Bom dia Dr., tenho lido suas colunas e aprecio muito seu trabalho, li a matéria do  link  http://abcnews.go.com/Health/weird-reasons-gaining-weight/story?id=22351889   e gostaria de obter sua opinião a respeito, realmente esses fatores  na saúde  nos dificultam na perda de peso?"

 

Thank you Mrs. LP

"Good morning Doctor, I've read your columns and highly appreciate your work, read the link http://abcnews.go.com/Health/weird-reasons-gaining-weight/story?id=22351889 the matter and would get your opinion about it, actually these factors on health hinder us in losing weight? "

Thank you Mrs. LP



 

 

Dear Mrs. LP (Texas),

I chose your question for this week’s column due to a common trend noticeable among media outlets, syndicated or otherwise.  Specifically, companies, will repackage old information and republish as breaking news, touting its relevance as the most recent clinical findings or latest research breakthrough.  The link you included in your question indicates recent, new medical findings important enough for a February 4. 2014 publication; however, the link is actually an exact copy of an article that was published  November 2011 (http://www.prevention.com/weight-loss/weight-loss-tips/health-problems-make-you-gain-weight/your-bodys-missing-certain-nutrients).  Furthermore, the author of the article is not credentialed as a medical doctor even though, the contributing writer cited physicians throughout the editorial.  People without clinical experience and or those persons not attending medical or a health related professional school, should not be writing articles to the general population touting their expertise in the field.  In addition, to all companies and in this instance ABC News, spare us doctors the indignity of hiring uncredentialed writers to write health columns,  turning our honorable profession, with capable writers, into tabloid trash.  Moreover, shame on the Texas Medical Board for not issuing a cease and desist order barring Ms. Bari Nan Cohen for disseminating health information within the state of Texas; after all,  the writer is practicing medicine without a license.  The double standards are glaring and evident. As for the link’s information on weight gain, the information is ridiculously  simplistic and fails to expand on diabetes, genetic diseases, stress, underactive thyroid conditions, menopause, various cancers (ovarian), heart failure, lack of sleep, and many other potential causes of unexplained weight gain.  Let us visit on your specific weight gain question, and I shall publish on a different week.  Thank you for your question and trust. 


Respectfully,



Dr. Roshin

 

 

 

 

* WHAT ARE THE HEALTH BENEFITS OF MUSTARD?

Hey dr. roshin,


“So we was in the grocere store and my sista says that ketsup is beter for u than musterd.   Yea Maybe. .but we wus want 2 know y eat mustard in the 1place.”  Francene and Genovene 





Hi Francene & Genovene,


I must admit that your inquiry as to how mustard benefits a person’s health is a great question.  In fact, the only sure fact I know about mustard is that this condiment tastes great on hot dogs and burgers.  I actually had to research the benefits of mustard, and astonishingly, mustard is a very healthy ingredient to have in your diet!  Did you know mustard has antiseptic properties including being an excellent antibacterial and antiviral agent?  In addition, mustard relieves bowel distension preventing gas buildup, and mustard also functions as a bowel laxative and vomiting agent when needed.   These properties allow mustard to be used to treat conditions such as chest colds, constipation, cough, loss of hair, backache, joint pain, hiccups, upset stomach, and muscle stiffness.  Since mustard promotes blood flow to the surface of the skin; this spice has proved successful in the treatment of rheumatism, sciatica, peritonitis, asthma, and neuralgia.  Lord knows, due to your question, most readers of this article, will now think twice about discarding little packets of mustard after lunch or while watching this week’s Superbowl.  Thus, thanks for your question and God Bless New Jersey.


Respectfully,



Dr. Roshin







* WOMAN ASKS ABOUT SKIN TEAR IN GENITAL AREA?

Hello Dr. Roshin!

"My name is Toish. I would like your opinion on my problem. I always read your articles in the newspaper and Brazilian Press like how you respond to questions from readers, so I also decided to formulate my question, although it is a little embarrassing:
I have a tiny crack (cut) in the anus for years and that does not disappear at all. Although small, it bothers me a lot because I scratch and itch so I sometimes bleeds. A dermatologist can not give me a treatment that solves my problem: the same've done several tests as pin worm, done up biopsy to see if it was cancer, it was negative. Hydrocortisone Valerate ointment'm using 0.2% with econazole Nitrate 1%, which no longer makes effect. I once saw on TV that there is a doctor who specializes in this area: proctologist. The problem is I have no health insurance. What is this problem? Eagerly await your reply and I thank you."



Dear Toish,
After visiting with you and viewing your sent picture of the anal tear, your symptoms of chronic itch with occasional bleeding mimic an anal fissure, not an anal fistula. An anal fistula usually results from an untreated abscess resulting in a channel forming from the bowel to in or near the anus; however, the lack of a fever, coupled with bleeding due to scratching, favors a medical diagnosis of an anal fissure.  Anal fissures are tears in the skin near the anal opening, due to large stool passage through the anus, chronic constipation, repeat bouts of diarrhea, childbirth, inflammatory bowel disease, or excess pressure built up in the anal sphincters. The skin tears in the lower rectum and is often accompanied by pain, itching, and bleeding; but, typically, these tears will heal in a matter of weeks.  However, if healing is prolonged greater than six to eight weeks, the anal fissure is considered chronic.  Thus, conservative treatment involves an assortment of medicines including Botox, calcium channel blockers (nifedipine), nitroglycerin cream (which lowers pressure in the anal sphincter promoting healing), adding stool softeners to your diet, sitting in a warm sitz bath, and or using topical anesthetics (lidocaine) to numb the anal region prior to a bowel movement.  The 0.2% Hydrocortisone Valerate and 1% Econazole Nitrate medicines you were prescribed decrease itching but do little to eliminate the anal fissure all together.  If the suggested medicines do not work, your last resort would be to have surgery, namely, a medical procedure called a partial lateral internal sphincterotomy, which is considered the best available choice of treatment for  an anal fissure.   Realizing there may be medical terminology in this column that you are not familiar with, please feel free to contact me for further explanations.  Thank you for your question and trust.  God Bless New York.
 
Respectfully,
 
 
Dr. Roshin

 









* WHAT IS CAUSING MY LEFT HAND FINGER PAIN, DOCTOR?


Hi Doctor Roshin,

“I’ve been concerned about this pain on my middle finger that’s being lingering for about 2 months now.  Sometimes the pain goes away.  I can see and feel  a bump on the joint.  Any advice?”  Silvera (Jersey)






Dear Silvera,
After examining your left hand, the bump on your middle finger is a mirror image of a bony projection on your right middle finger; thus, since there is no family history of autoimmune disease disorders much less an arthritic history, a newly appearing nodule seems unlikely.  People with newly, developed nodules that form on their fingers are often afflicted with rheumatoid arthritis, lupes, osteoarthritis, or other joint conditions.   What was found was extreme pain upon palpation of the left middle and little finger.  What is causing your pain?  More than likely, the pain is directly attributed to your 1997 auto vehicle accident.  You mentioned that your head impacted the windshield so violently, that the front car window shattered and you were diagnosed with two herniated neck vertebrae (C3/C7).  The nerves that innervate your hand stem from your neck region; thus, any stress, inflammation, or pressure placed on the nerves in the rear of your neck will cause pain, tingling, numbness, prickling, and other sensations in your fingers.  The medical terminology for your condition is called cervical radiculopathy.  More specifically, the ulnar nerve and a portion of the median nerve may be the cause of your pain; thus, visiting a doctor should be your next best  step.  The doctor will be able to run blood tests to rule out arthritic disease, order X-rays of the hand checking for tumors or new bone growth, request a CT or MRI of the neck to check for new vertebral herniations, and the physician will be able to offer  steroid injections, medicine, and or surgery to help decrease pain in the short term with the ultimate goal of alleviating the chronic pain all together.  Thanks for your question and hope this column provided answers to your questions.  Stay Jersey strong!

Respectfully,  


Dr. Roshin 





* NEW JERSEY MAN ASKS WHAT TESTS EVALUATE DIZZINESS?

Good morning Dr.
Some days before, I felt some dizziness, and vomit. I did exams and the doctor told me all was ok. I dont know, why this happened?
My question is: Are there any test that can do to know if I have some problem with Labyrinthitis, nervous, ears?  Thank you for the support,
 
Mr. PLC (New Jersey)



Dear Mr. PLC,
 
Whenever a patient experiences dizziness, the doctor will always have the patient clarify what he or she means by being dizzy.  For many people, dizziness is the inability to walk, while for others fainting, light headedness, or the room spinning is their definition.  In addition, the patient may complain of ringing in the ears, loss of hearing, nausea, vomiting, and or a complete lack of balance.  After a cardiovascular cause is ruled out, doctors will target the brain, the ear, and the eyes as the most probable causes of the perceived dizziness.  These three organs provide the necessary input to the nervous system allowing us to maintain our balance.  However, if problems arise in any one of the mentioned organs, “dizziness” can result.  A combination of tests must be ordered to accurately identify dizziness causes; thus, CT scans, MRIs, head maneuvers, ear and eye exams, and a thorough check of medication side effects will be assessed.  The Rhomberg test is a neurological test that tests the three sensory systems by asking the patient to stand with their feet together and eyes closed.  If the patient sways, this a positive Rhomberg test which may indicate a brain cause but does not necessarily rule out an eye or ear cause.  As you can tell, assessing dizziness is an involved process and the eventual treatment is based on the identified etiology.  Thus, to have your doctor indicate “all was ok,” this is very good news; however, if these dizzy spells were to reoccur, make note of your daily routine, food, medication use, and any ongoing infections and report these findings immediately to your doctor.  Dizziness disrupts daily routines; thus, locating the cause and correcting is essential to maintaining a good quality of life.  Thank you for your question and God Bless New Jersey.
 
Respectfully,
 
Dr. Roshin











* TEXAS WOMAN ASKS FOR GASTROENTERITIS ALTERNATIVES/ HERBALS


Dear Doctor Roshin,


I have abdominal pains and nausea for over a week, and doctor said I had a virus in my stomach.  She said I had gastroenteris.  I want you to tellme what foods can I eat,and the herbs to take to help this.  Thxxxxxxxxxx.  Dee (Texas)




Dear Dee,


Gastroenteritis is caused by an inflammatory process in the digestive tract; thus, depending on the source of the inflammation, such as food, bacteria, viruses…etc., various treatments are offered accordingly.  The information provided below should always be coordinated with your doctor and or a specialist in alternative treatments.  The nausea, vomiting, diarrhea, bloating, and subsequent fatigue may be remedied with  the following suggestions; however, before any ingestion, let your doctor verify that no bad allergic reactions will occur based on your past medical history.  Thank you.

1)      NATURAL REMEDIES:  Very ripe bananas ease nausea.  Yogurt restores healthy bacteria in stomach causing less gastroenteritis.  Honey is a natural antibiotic and anti-inflammatory.

2)      HERBAL REMEDIES:  Comfrey Root and Meadowsweet to treat infection and relieve symptoms.  Arrowroot or slippery elm tea can be sipped to ease worse symptoms.

3)      AROMATHERAPY:  Chamomile and Geranium Oils are rubbed into abdomen to bring relief from pain and discomfort.

4)      HOMEOPATHY:  Arsenicum (for burning abdominal pain), Pulsatilla, Baptisia (if salmonella bacteria is the cause of the gastroenteritis), Mercurius (for bloody diarrhea), Phosphorus (for vomiting and burning sensation when stools are passed), Sulfur (for burning diarrhea).

Your question is timely since many people are eating and drinking an assortment of foods and drinks this holiday season.  Thus, these are helpful suggestions to keep all people’s  intestinal tract healthy enough to enjoy the end of 2013 and ringing in 2014.  Happy New Year!


Respectfully,


 

Dr. Roshin











* NEW 2014 HYPERTENSION GUIDELINES

Dear Reader,

 

The latest 2014 hypertension guidelines for doctors were released in the December 18, 2013 issue of the Journal of the American Medical Association.   Uncontrolled and untreated high blood pressure can cause heart attacks, strokes, kidney failure, and death.  After randomized control clinical trial results were studied, guidelines were formulated with the net goal in mind of providing the physician the best management options of dealing with a patient’s high blood pressure.  The guidelines are as follows: 



 
1)      In the general population, any patient 60 years of age or older has the goal of reducing blood pressure to below 150/90.

2)      For all other age groups less than 60 years of age, a general consensus of reducing blood pressure to less than 140/90 remains the goal.

3)      In patients age 18 and older with diabetes or chronic kidney disease, the hypertension goal is to bring blood pressure below 140/90.

4)      In the nonblack population cohort, physicians can begin treatment with one of four anti hypertensive drugs:  Angiotensin Converting Enzyme Inhibitor (ACE-Inhibitors), Angiotensin Receptor Blocker (ARBs), Calcium Channel Blockers (CCB), or Thiazide Diuretics.

5)      In the general black population, treatment is to begin with a CCB or Thiazide Diuretic.

6)      All patients 18 years of age or older with chronic kidney disease should be placed on an ACE or ARBs.

The article mentions that hypertension remains “one of the most important preventable contributors to disease and death.”  Thus, by following these guidelines along with lifestyle modifications of exercise and a healthy diet, each of us has the power to live a quality life free of high blood pressure.  During this holiday season, these are points worth remembering.  Merry Christmas to all.

Respectfully,

 

Dr. Roshin

 







* NIGERIAN WOMAN LIVING IN NEW JERSEY ASKS ABOUT FROSTBITE.

Hi Doctor,

Kind of a dumb question, but what do you do when your feet are freezing fro snow?  Thx. (AnOke)

Dear AnOke,

Actually, your question is very relevant to all people who live in areas prone to winter extremes such as heavy snowstorms, blizzards, or extremely cold temperatures.   Frostbite is the result of exposing unprotected, skin areas, for too long in the cold, leading to tissue damage.   The severity of frostbite ranges from mild first degree frostbite to severe third degree frostbite.  Thus, treatment of frostbite is entirely dependent on the degree of severity.   Most first degree frostbite may present with a burning sensation, pale or red skin, and or slight numbness and is easily reversible by removing oneself from the cold and gradually warming the area with warm water (103F water for 15-30 minutes).   Second degree frostbite burns are more severe with skin turning white to yellowish, a deeper stinging, prickly sensation, and firmer skin.  Extreme prolonged, cold exposure can freeze the tissues, blood vessels, nerves, muscles, and bone resulting in life threatening third degree frostbite with skin appearing waxy, blisters filled with blood, and skin tissue hard, blackened, and possibly already damaged or dead.  Second and third degree burns require emergency medical assistance, especially if upon rewarming of skin exposed areas, blisters form or skin sensation does not return.   Remember, if you are caught out in the cold, the armpits are a good area to try to keep your hands warm, and in general, avoid rubbing frost bitten skin areas, get out of the cold, remove wet clothes, gradually warm the frost bite areas without directly placing on heat sources such as fires, hot stoves, very hot water, heating pads…etc due to the danger of heat burns or scalding of the skin, and always avoid walking on frostbitten feet, as further tissue damage could occur.  Your question is timely, especially since a winter storm is headed to the northeast USA, and the official beginning of winter is December 20, 2013.   Thus, keep these winter safety tips in mind and enjoy the winter season.  God Bless New Jersey and Nigeria.

 

Respectfully,

 

Dr. Roshin   










* BRAZILIAN WIFE ASKS ABOUT HUSBAND'S BELLY PAIN - ULCER FORMS.

Dear Roshin,
You have the doctor’s papers for my husband tests.  Please explain Is serious?  Ms. MaM (Brazil)



 
Dear Ms. MaM (Brazil),
Your husband’s recent complaints of “belly pain” accompanied by occasional nausea and vomiting along with a burning in his throat, prompted the doctor to order an endoscopy procedure.  An endoscope is a medical device with a camera placed on the end of a tube, and this tube is placed inside the patient’s mouth, guided down the digestive tract, and the doctor looks for disease or disorders within the gastrointestinal tract.  According to the radiology report you provided for my viewing, the doctor diagnosed a serious condition, specifically, an ulcer was found in the duodenum, the first segment of the small intestine.  Your husband has a duodenal ulcer, and you mentioning that his belly pain goes away after eating food adds to the diagnosis.  In the interim, your husband has been placed on medicines to rid the digestive system of the bacteria that caused the ulcer.  This therapy will help; however, the ulcer that has developed must be treated promptly.  If the ulcer perforates the wall of the small intestine, internal bleeding could occur and this bleeding, if not stopped immediately, could prove fatal.  The fact that your husband has not encountered significant weight loss is a good sign; but, as mentioned, an untreated ulcer could lead to major problems later; thus, with urgency, the ulcer must be treated as an emergency.  I am glad your husband sought medical assistance soon after his symptoms began, and his fast action will be beneficial for healing and resumption of his normal daily routine. I look forward to hearing back from you with a good resolution. Thank you for your question and God Bless Brazil.

Respectfully,

Dr. Roshin

* SOUTH AFRICAN MOM ASKS ABOUT ECZEMA SKIN MARKS ON YOUNG CHILD

 

 

 

Hello Doctor,

 “I write from South Africa.  I want to ask about a problem my son has on his skin. He has eczema and we have got creams etc. for him, but the boy has scratched himself all over his legs and arms. Today if you look at him you can see black marks all over his legs and arms.  How do I stop this?”  Thank you sir.  PMk

 

Dear PMk,

Eczema, also called atopic dermatitis, is a skin condition that may appear as patches, scales, or bumps, itch, ooze fluid, and or become thickened crusts due to repeated itching.  The constant itching has resulted in your son’s “black marks all over his legs and arms.”  There is no known exact cause of eczema; however, a depressed immune system allowing Staphylococcus bacteria to flourish on the skin, genetics, stress, and allergic disorders (asthma, hay fever) have been linked to this skin condition.  Treatments also vary widely based on the severity of the skin eczema condition; thus, a doctor may prescribe steroids, antibiotics (to kill Staphylococcus bacteria), antihistamines, or immunomodulator medicines.  What is in your control is to identify and avoid triggers that precipitate the itching such as avoiding wearing wool or polyester clothing (do wear cotton clothing), harsh soaps, heated bubble baths, excessive sweating, certain foods, low humidity especially in winter months (use humidifier), cigarette smoke, extremely dry skin, sand, and or detergents.  A warm bath with a moisturizing soap, followed by placing a greasy cream, Vaseline, or Calamine lotion on the skin immediately after bathing, should trap moisture in the skin, reducing skin irritation and the subsequent itching.  With regards to bleach baths, when used sparingly, bleach baths have shown success ridding the skin of bacteria as well as reducing itching; however, always check with a pediatrician prior to attempting this treatment alternative, as the correct portions of bleach and water must be mixed to prevent skin burns.  Most children’s eczema disappear as they grow older; thus, by containing the eczema flares and teaching your son the benefits of not scratching, this should translate to disappearance of the black marks presently on his skin.  Thank you for your question, and God Bless South Africa.

 

Respectfully,



Dr. Roshin 


* PHILIPPINE MOTHER ASKS ABOUT "MOUTH SORES" IN 2 YEAR OLD CHILD

Hi friend how are you i just wanna ask if what is the best medicine for mouth sores for my daughter  she us 2 years old now.  friend what is the medicine for mouth sores.  i hope you can help us

Ms. RIN (Philippines)


 

Dear Ms. RIN,

Hard to believe that we made an initial acquaintance two years ago just prior to your pregnancy; thus, hearing that your daughter is already two years of age emphasizes the cliché “how time flies.”   Yet, I am happy to hear that your daughter is healthy and thriving.  The mouth sores you mentioned and identified in photos appear to be canker sores.  Your daughter’s four tongue lesions are painful; and understandably, at the moment, she prefers liquids over solid foods.  However, what is concerning is your mentioning that a low grade fever has developed in the last twenty-four hours.  Canker sores are not contagious and should disappear in one to two weeks.  Thus, in the short term, buy an anesthetic medicine, a teething gel, or mix 1 part hydrogen peroxide with 2 parts water, and apply on the sores with a q tip, a cotton ball, or your finger with the ultimate goal of numbing the pain long enough for your daughter to resume eating solid foods.  Ice popsicles and ice cubes should help reduce the pain along with avoiding spicy, hot, and citrus foods.  Furthermore, Pedialyte is a good short term solution to ensure some nutritional content is ingested in your daughter’s body while her mouth sores continue to heal.  I realize access to a doctor is difficult for you; however, if your daughter’s temperature rises further in the next day or two or if your daughter loses a significant amount of weight (more than 1-2 kg), with urgency, you must travel to the city for medical counsel.  Fevers are usually indicative of an infection; thus, proper treatment must be administered as soon as possible.  Please write daily as to the pain remedy you tried, update on the fever, and if any new symptoms have developed.  Take care, and God Bless the Philippines.

Respectfully,

 

Dr. Roshin 














* NEW JERSEY WOMAN ASKS IF MEDICINE EXISTS TO CLEAR CATARACTS?


Hello Roshin,

My grandfather had cataract surgery seven years ago; but, I think a cataract has returned in his left eye.   Is there a medicine he can take to get rid of the cataract.  I enjoy reading your columns.   Velma (use my name if you wish).



 

Dear Velma (New Jersey),

A cataract is an eye condition caused by clouding of the lens.  The lens is that portion of the eye, located behind the iris (the colored part of the eye), that helps to focus light rays, so we can see.  Thus, lens clouding prevents good vision.  The clouding of the lens occurs due to eye tissue breakdown with subsequent clumping, and these clumps become visible as the cloudiness on the lens.  Most people express symptoms of blurred vision, sunlight glare, night vision problems, sensitivity to light, and faded vision due to a constant haze in the field of sight.  Unfortunately, outside of surgery to remove the cloudy lens, no medications exist to reverse a cataract condition.  Thus, most people will tolerate a cataract until their quality of life is greatly hindered due to poor vision.  People with cataracts often light their homes with brighter lights, limit night driving, and will wear sunglasses to reduce sunlight glare.  Modern day technological advancements in medicine now make cataract surgery very routine.  Specifically, cataract surgery is often completed in an outpatient setting, requires minimal anesthesia, takes less than an hour, and is low risk.  Since you mentioned your grandfather wears eyeglasses, he might consider a bifocal lens to replace the cloudy, cataract lens.  Either way, your grandfather’s quality of life will vastly improve post surgery making his upcoming 92nd birthday that much more special.  Thanks for your question and God Bless New Jersey.

 

Respectfully,

 

Dr. Roshin 

* TEXAS MAN ASKS ABOUT 4.6 PSA SCORE

Dear Doctor Roshin,

Last year in 2012, my PSA test score was 2.3 but two weeks ago, my PSA score was 4.6.   My doctor scheduled an appointment with an urologist 11/13.  What does this score mean?  Thanks Mr AbR

Dear Mr. AbR,


Protein specific antigen, also called PSA, is a protein produced by the prostate gland.  When men have a PSA test done, the blood exam measures levels of this protein.   Although there is no absolute value for PSA, by convention, the medical profession has used a PSA score of 4 or higher as an indication that an abnormality in the prostate gland may be ongoing.  However, plenty of men have had PSA scores over 4 with no disastrous consequences while other men have reported PSA scores under 4 resulting in life changing events.  Typically, a PSA score of 4 or higher is an indication of both cancerous and non-cancerous possibilities.  Specifically, an elevated PSA of 4+ could indicate prostate cancer, inflammation of the prostate (called prostatitis), or an enlarged prostate gland [termed benign prostatic hyperplasia (BPH)].  The fact that your PSA score is elevated is not as important as the fact that your PSA score doubled in one year.  The doubling of the PSA score is an indication that your prostate gland needs to be examined.   The urologist will perform a digital rectal exam (DRE), order urinary tract infection tests, and may order other imaging such as a cystoscopy, ultrasound, or X-rays.  During the digital rectal exam, a gloved finger touches the prostate gland checking for lumps, bumps, or inflammation and swelling.   If a lump is found, a prostate biopsy may be ordered to rule out prostate cancer.   Treatments are based on the diagnosis.  If prostatitis or BPH is suspected, medicines are available to treat the condition.  If a cancer is diagnosed, surgery and radiation treatment are options with the goal of limiting possible side effects including bowel movement problems, inability to control urine flow, or an inability to obtain an erection.  However, let us not jump to conclusions.  First, visit the urologist and determine what if anything is occurring in the prostate, and at that point, discuss with your doctor, treatment options as necessary.  In the meantime, do know that my thoughts and prayers are extended to you and your family.  Stay in touch. 

 




* DR. ROSHIN, WHAT IS YOUR VIEW ON ABORTION? 



Dear Roshin,

“I am sure you heard about the abortion debate in Austin (Texas).  I was wondering what your opinion about abortion?"  LP (East Texas)

               


Dear LP,

Before offering an abortion perspective, I would like to mention that my opinion continues to evolve.  After all, the only constant in life is change.  I wish to begin by mentioning that this past year, after unsuccessful attempts, a nineteen year old lady contacted my website, DoctorAdvice4u.com, requesting methods to abort her five month old fetus using overdoses of medications, wanting advice on the dangers of back alley abortions, and requesting information as to the costs and techniques used for typical abortions.  This nineteen year old teenager mentioned that her decision to abort her baby revolved around lack of family support much less resources to raise her baby.  Always the pragmatic, I visited with her over a span of a week, contacting a clinic that would not only provide free prenatal care for her and the baby; but, the agency  would also leave the option of adoption available if she still desired not to keep her baby.  Nine months later, this young lady has not only given birth to her baby, she married, has the support from both her spouse’s and her own family, has a job, and cannot believe “she was so confused before.”  In a synopsis, she said  I would have torn my baby limb for limb within my own body, and that seemed logical at the time; but, right now, my baby is the most precious gift I have ever been given. “I was confused, and I thank you doc for taking time to visit with me.”   This lady is from the Philippines; yet, regardless of country of origin or religion, abortion is a decision that places a heavy burden on what we as a society wish to value.  Should we place greater value on freedoms of choice or the preservation of life?   Personally and professionally, I believe life should always be the standard.  Yet, having mentioned this fact, I would not impose my value system on any women regarding her body; however, here in the USA, one of the most developed countries in the world, we have many forms of available contraceptive types, and in the end, decisions to engage in intercourse are a personal choice with consequences.   Recently, a federal judicial ruling will now make the Plan B- Step One emergency contraceptive pill readily available to women of all ages without adult or physician consent; thus, with so many means of contraceptive methods available, I ask should we even be discussing abortions in the second trimester of pregnancy?  At five months, there is a living entity in a woman’s body, nearing the ability to hear sounds and feel pain; thus, any abortion this late in a pregnancy, in my opinion, constitutes murder, or in the least, the loss of innocence.   Abortion is not a black and white issue, and as in life, exceptions do exist; but, placing a late term abortion safety net for the lack of foresight with respect to personal choices regarding sexual behavior, leaves one to wonder whether society is becoming weaker in accountability, responsibility, and judgment.  As mentioned in previous opinions, I have always been of the belief that the home, institutions of education, religious organizations, and the community should be consistent with messages to children.   Setting an example to the youngest generation, that humanity places the value of each life as the standard, will have far reaching consequences beyond abortion, specifically, less poverty, war, and famine along with better prospects for lasting peace.  Let us hope Texas recognizes that a democracy is only as strong as recognition of minority opinion; thus, a balance should be struck between preserving life as the standard but not denying access, inclusive of transportation to hospitals if clinics are closed, for women who choose to have an abortion.  Thank you. 

Respectfully,




Dr. Roshin










* MY GRANDFATHER HAS PROSTATE CANCER BUT NO TREATMENT, WHY? 


Hey Doc,

My grandfather has prostate cancer but they are doing nothing to treat him.  Why?  “Tank”



Dear "Tank,"

Although prostate cancer is the leading malignancy among elderly men in the Western hemisphere, overall, due in large part to improved screening and diagnosis, the incidence of deaths from prostate cancer has decreased over the last decade.  Yet, more men are being diagnosed with prostate cancer due to their increase in life expectancy as well as implementation of the Prostate Specific Antigen (PSA) blood test.  Most men request a  PSA test to check for prostate cancer; however, a PSA score > 4+ may not solely indicate prostate cancer; but also, a high PSA score may suggest inflammation of the prostate (called prostatitis), benign prostatic hypertrophy (BPH), or a side effect of certain medications.   Yet, recent health task force recommendations have created controversies as to when or if a man actually requires PSA testing.   Generally, a PSA test is encouraged for men between the ages of 40-75.  However, beyond age 75, a PSA test may not be necessary.  Bottom line is that whether to have a PSA test ordered or not, is a discussion every man should have with his doctor.  As for an elderly man diagnosed with prostate cancer, treatment guidelines are complicated, some of which revolve around expected life expectancy.  In other words, conservative measures, such as observation, may be implemented in elderly patients with localized prostate cancer, patients with limited life spans who are anticipated to die from diseases other than prostate cancer, and those men who are expected to live less than ten years.  Patients who have metastatic prostate cancer (cancer that has spread throughout body) or patients with at least 10 years of expected life expectancy have more aggressive treatment options; thus, your grandfather (age 87) may not be receiving further treatment due to the previous explanations or the fact that surgery may increase his mortality risk.  Whatever the reason, ask for consent to visit with your grandfather’s doctor and inquire as to an explanation for the chosen treatment plan.   I hope my answer clarified your question, and please know my prayers are with you and your family during this difficult time.  God Bless.

Respectfully,

Dr. Roshin  

PS: Prostate Cancer Treatement Link:  http://www.prostate-cancer.com/index.html





 
* HOW MUCH IS TOO MUCH VITAMIN A?

Dear Doctor,
“I love carrots.  Can I eat this every day without getting sick or must I limit the amount?” Thanks Martha
(New Jersey)



Dear Martha:
Vitamin A is a fat soluble vitamin that comes in two forms: 1) retinol and 2) beta-carotene.  Both forms promote the beneficial effects of vitamin A which includes growth, boosting the immune system, improving vision at night, providing nourishment for healthy skin, eyes, hair, teeth, and gums, and acting as an antioxidant to help fight cancer.  The retinol form of vitamin A is found in cod liver oil, liver, eggs, and dairy produce, while the beta carotene form of vitamin A is found in carrots, spinach, broccoli, cantaloupe, apricots, sweet potatoes, mangos, and tomatoes.  Yet, in adults, too much vitamin A, also called hypervitaminosis A, will result in symptoms not limited to the following:  alopecia (hair loss), nausea, vomiting, yellowish-orange colored skin, dizziness, blurry vision, skin peeling, brain swelling, anorexia, osteoporosis, headache, and psychiatric disorders.   How much vitamin A should a person take daily?  The amount of Vitamin A ingestion is variable but often dependent on a person’s age, pregnancy status, allergies, and past medical history; thus, consultation with your physician is vital to avoiding both vitamin A toxicity and deficiency.  While eating your carrots, please view  the 2013 National Institutes of Health Table of Recommended Dietary Daily Allowances of Vitamin A for men and women.  Thank you for your question.      

Respectfully,

Dr. Roshin


Table 1: Recommended Dietary Allowances (RDAs) for Vitamin A 
Age Male Female Pregnancy Lactation
0–6 months* 400 mcg RAE 400 mcg RAE    
7–12 months* 500 mcg RAE 500 mcg RAE    
1–3 years 300 mcg RAE 300 mcg RAE    
4–8 years 400 mcg RAE 400 mcg RAE    
9–13 years 600 mcg RAE 600 mcg RAE    
14–18 years 900 mcg RAE 700 mcg RAE 750 mcg RAE 1,200 mcg RAE
19–50 years 900 mcg RAE 700 mcg RAE 770 mcg RAE 1,300 mcg RAE
51+ years 900 mcg RAE 700 mcg RAE



Food mcg RAE per
serving
IU per
serving
Percent
DV*
Sweet potato, baked in skin, 1 whole 1,403 28,058 561
Beef liver, pan fried, 3 ounces 6,582 22,175 444
Spinach, frozen, boiled, ½ cup 573 11,458 229
Carrots, raw, ½ cup 459 9,189 184
Pumpkin pie, commercially prepared, 1 piece 488 3,743 249
Cantaloupe, raw, ½ cup 135 2,706 54
Peppers, sweet, red, raw, ½ cup 117 2,332 47
Mangos, raw, 1 whole 112 2,240 45
Black-eyed peas (cowpeas), boiled, 1 cup 66 1,305 26
Apricots, dried, sulfured, 10 halves 63 1,261 25
Broccoli, boiled, ½ cup 60 1,208 24
Ice cream, French vanilla, soft serve, 1 cup 278 1,014 20
Cheese, ricotta, part skim, 1 cup 263 945 19
Tomato juice, canned, ¾ cup 42 821 16
Herring, Atlantic, pickled, 3 ounces 219 731 15
Ready-to-eat cereal, fortified with 10% of the DV for vitamin A, ¾–1 cup (more heavily fortified cereals might provide more of the DV) 127–149 500 10
Milk, fat-free or skim, with added vitamin A and vitamin D, 1 cup 149 500 10
Baked beans, canned, plain or vegetarian, 1 cup 13 274 5
Egg, hard boiled, 1 large 75 260 5
Summer squash, all varieties, boiled, ½ cup 10 191 4
Salmon, sockeye, cooked, 3 ounces 59 176 4
Yogurt, plain, low fat, 1 cup 32 116 2
Pistachio nuts, dry roasted, 1 ounce 4 73 1
Tuna, light, canned in oil, drained solids, 3 ounces 20 65 1
Chicken, breast meat and skin, roasted, ½ breast 5






* WOMAN FINDS BREAST LUMP...NOW WHAT?

Hello Doctor,

I noticed a lump in my right breast, and I am scared I have the cancer in the breast like Angelina Jolie.  Please advice 4 me.  Ms. “Lupe”

 

Dear “Lupe,”

After unexpectedly finding a lump in your breast, I understand your fears.  Due to genetics, many women have an extensive family history of breast cancer.  Thus, these women, similar to Angelina Jolie, must make decisions to surgically remove their breasts in exchange for living life longer.  Untreated breast cancer easily spreads to bone and other areas of the body; thus, once a lump is discovered, a woman must have both mammogram and biopsy procedures done as soon as possible.  A mammogram will locate possible cancer in both breasts, while the biopsy will sample the actual tissue in the lump(s) you found as well as what was located on the mammogram.  Once an exact diagnosis is made, the doctor and you will discuss the best available treatment options based on the cancer type and aggressiveness for spread throughout the body.  Radiation, chemotherapy, observation, removal of only the lump(s), and or removal of the entire breast(s) as well as lymph nodes are all possible treatment options.  Although you do not have medical insurance, you should travel to a county clinic or hospital emergency room, explain your breast findings, receive initial medical services, and complete the forms for Medicaid.  A small copay may be necessary for the services; but, this minor fee in exchange for life is worth paying.  My prayers are with you.  God Bless.

Respectfully,


Dr. Roshin












* ABDOMINAL AORTIC ANEURYSM COMPLICATIONS

Hi Roshin:
I need your advice for the following:  Recently, about 3 months ago, I had surgery for "Abdominal Aortic Aneurysm".  I get pain in my left leg from hip to ankle when I walk more than 200 yards.  Pain goes away when sit or lay down.  How long normally this pain will be with me, and, are there any side effects to this fact? After two months, I had another Cat Scan for my doctor, which I will now the fact on June 19th.  I may not see you in the gym. Will be happy if you would reply my e-mail.  Regards.

 

Dear Mr. AA,
I have been wondering why you have been absent from the gym for the past three months.  Now, I understand.  An abdominal aortic aneurysm is a life-threatening condition, and I am glad to hear that prompt surgery was performed.  However, even after surgery, serious complications not limited to intense pain, shortness of breath, low blood pressure, dizziness, or loss of consciousness, often develops.  The symptoms you described of “pain in my left leg from hip to ankle when I walk more than 200 yards,” and “pain goes away when sit or lay down” sounds like a medical condition called claudication. Claudication is a condition of intense, cramping pain in the legs induced by the obstruction of arteries during exercise.  Claudication is often caused by blood clots or deep venous thrombosis, both possible complications after your surgery.  With urgency, you should visit your surgeon concerning your present symptoms.  The doctor can then check blood markers for clots, order a Doppler ultrasound to check blood flow in the legs, order a CT or MRI of the left leg, and or check blood pressure at the level of the hip, knees, and feet.  Bottomline is your leg circulation, both arterial and venous, need to be checked.  Clots are also life threatening; thus, you should consult your doctor immediately.  The recovery process is just as important as the actual surgery; thus, for optimum healing, patience is essential.  As you recover from surgery, please know you are in my thoughts and prayers.  God Bless.

Respectfully,

Roshin
DoctorAdvice4u.com









* 2013 HURRICANE SEASON


Hi Doctor,

Are we going to get hit by another Sandy this year?  We appreciated your help last year.  Thanks. Ken (New Jersey)



Dear Ken,

Just as Memorial Day signifies the beginning of the summer season, the summer season ushers in the beginning of hurricane season.  Yes, the 2013 Atlantic hurricane season is set to begin June 1, 2013 extending through November 30, 2013.  For two consecutive years, the I-95 Corridor of the Northeast USA, has felt the wrath of tropical cyclones, Hurricane Irene (2011) and the rare Superstorm Sandy (2012).  Thus, just as people from the Gulf Coast (Texas to Florida), Mexico, Latin America, and the Caribbean stay actively engaged tracking the development of tropical systems, so should we here in New Jersey and surrounding states track storms in the coming summer.  Presently, oceanic and atmospheric conditions, are priming the 2013 hurricane season to be an active to an extremely active period.  The combination of above normal sea surface temperatures from Africa to the Caribbean to Texas and the East Coast Gulf Stream, the lack of development of the Pacific El Nino weather pattern which would suppress Atlantic hurricane development, favorable wind patterns over the Atlantic Ocean enhancing hurricane formation, and the continued strong West African monsoon, the breeding ground for tropical systems, are all bolstering an active season.  In fact, this season, there is a 70% likelihood of 13-20 storms (39+ mph winds), of which 7-11 could become hurricanes (74+ mph winds), with subsequent 3-6 major hurricanes (111+ mph winds).  When compared to the normal averages of 12 storms, 6 hurricanes, and 3 major hurricanes, one can translate that the 2013 Atlantic season will be dynamic requiring constant monitoring.   The United States has not seen a major hurricane make landfall since Hurricane Wilma in October 2005.  With 2013 weather conditions mirroring the 2005 hurricane season, the most active Atlantic hurricane season on record, everyone living in the Atlantic basin should be vigilant as the summer progresses.  Remember, September 15 generally marks the peak of hurricane season; but, as we experienced last year, even late season storms can prove catastrophic (October 2012, Superstorm Sandy).  Where the storms make landfall depends on a steering weather pattern called the North Atlantic Oscillation.  But, let the meteorologists track the storm while you plan and prepare, now, for any potential, future hurricane(s).   Preparation includes compiling a list of emergency numbers (hospitals, your doctor, police, fire, utilities, pet shelters), making an emergency supply kit (water, food, batteries, flashlight, whistle, radio, duct tape, garbage bags for sanitation purposes…etc.), mapping evacuation routes, and implementing an emergency plan if and when needed.  As always, my website, DoctorAdvice4u.com, will provide hurricane coverage, 24/7.  Plan early and stay safe.  Thank you.

Respectfully,


Dr. Roshin
05/30/2013











GOD'S MESSAGE CONCERNING CHILDREN

Dear Readers,


All across our globe, we are witnessing an explosive assault on innocence.  Specifically, no longer do we protect a child’s purity; rather, men and women alike have submitted to the vices of greed and lust condoning questionable actions against kids by citing religious scriptures and the effervescent mighty dollar.  Whether the Christian Catholic church pedophilia scandal, horrific sexual assaults in Brazil, India, and Juarez, Mexico, the recent kidnappings of three teenagers held in bondage for a decade in Cleveland, Ohio, rampant United States military and university system sexual assaults,  Syrian refugees selling young  girls into marriage for survival money, the flogging of a Maldives 15 year old girl based on Islamic law due to consensual sex with another man after being repeatedly raped by her father, this week’s raping of a four year old Indian girl, widespread solicited and unsolicited internet prostitution and pornography,  and numerous countless acts that go unreported,  we, as a society, regardless of faith, should be grappling with how we have allowed incessant excuses to pardon exploitative actions against children.  Societal justifications and exoneration of acts against children is a direct reflection of the perverse self gratifying populace our world has become.  Over time, man has diminished in character disparaging God’s name to absolve his actions against innocent children.   I assure you, God is not pleased.  In an age of so much freedom, sharing of knowledge, quality of life improvements, and the ability to ease suffering, why have we reverted into an undisciplined society where sleeping around determines manliness and conquering of virgins is a goal?  In fact, as life expectancy increases, marrying at a young age should be taken in perspective in today’s climate versus previous generations.  Thus, the youngest of our kids are not commerce for pleasure; rather, the most innocent have a right to the protection of all society irrespective of one’s religion.  We, as a humanity, have an obligation to underscore the philosophy that the welfare of all children is unconditional and is conscientiously dependent on collective affirmation.   Whether you believe in Jesus, Allah, Krishna, Buddha, or God, this is His message. 

Respectfully,

 

Dr. Roshin 
05/16/2013






* BIRTH CONTROL FOR 15 YEAR OLDS?


Hi Doctor Roshin,
As a mother of two daughters, I was wondering what your views are on the Plan B pill? As we discussed, I am not happy with easier access to the pill.  Thanks.  Robin





Dear Robin,
Whether you are aware or not, our country is changing.  More specifically, the moral fiber of our country, here in the United States, is changing.  Last week, the Federal Drug Administration (FDA) approved the sale of Plan B One Step, an emergency contraceptive pill, to all women fifteen years of age and older.  Thus, without a doctor’s prescription, a young lady can walk into any corner drugstore, show identification proving age, buy the $50.00 per pill drug, and administer the dosage within seventy-two hours of unprotected sex.  Some people consider the FDA’s decision vindication for years of assault on women’s rights while other people believe the far left, liberal wing of this country has run amok.  My views are neutral; yet, I am of the belief that in an age of sex driven media and commercialization, last week’s decision erodes societal obligations to teach then reinforce values, such as personal respect, to our children.  More importantly, this latest decision undermines a parent’s ability to reinforce moral teachings from home.  I have always been of the belief that beyond the home, institutions of education, religious organizations, and the community, should always mirror similar messages concerning children.  Granted personal responsibility eventually takes precedence in adulthood; but, children represent a cohort where with consistent guidance and principled messages, conscientious citizens contributing to the betterment of their community are more likely.  Presently, a fifteen year old is not permitted to drive nor vote, is unable to marry without parental consent, can not join any military branch, incapable of legally purchasing a firearm, alcohol, or cigarettes; yet, a fifteen year old is NOW able to purchase and use emergency birth control, without the consent of any individual, because apparently, these children are good decision makers with issues concerning their body.  Are these the new societal norms we as a people now affirm?  This present generation seems to be teaching younger generations that life is all about safety nets.  If you initially make a bad decision(s), do not worry, you will be bailed out.  So, I ask, if a child learns that a rescue plan always exists, why would that youngster bother to learn or be responsible, much less accountable, for their actions?  Please feel free to share your opinion by writing to me at the Brazilian Press paper.

Thank you.


Respectfully,



 

Dr. Roshin





* WHY IS MY GASTRITIS RECURRING?


Dear Doctor,

My stomach hurts especially when I eat.  I had gastritis but it was cured they told me.  Why all this pain again. Thanks Elyn (Philippines)




Dear Elyn,

Nice to hear from you. Elyn.  As you are aware, gastritis is an inflammation or erosion of the stomach wall that when left untreated could result in bleeding of the gastrointestinal tract lining.   The medicines you were prescribed can help treat gastritis; however, other factors such as excessive alcohol use and stress must be conscientiously reduced.   Furthermore, there is a bacterium, Helicobacter Pylori, in the digestive tract that is one of the main culprits of gastritis.  If this “bug” is within your intestinal tract, a different set of medicines, namely antibiotics, needed to be prescribed along with the acid reducing medicines already advised.  However, initially, if Helicobacter Pylori was never tested and remains in the digestive tract, this may be the reason for recurrence of your stomach pain. Elyn, I highly recommend that you seek a doctor who can offer an upper endoscopy exam.  An endoscopy is a procedure that uses a camera to examine the lining of the esophagus, stomach, and intestine allowing the doctor to take tissue samples as needed.  A simpler way to check for the bacteria is a breath test; but, the endoscopy procedure tissue samples could offer other possible causes of your recurrent stomach pain such as a tumor called a gastrinoma or peptic ulcer disease.  If you have any blood loss from the mouth or the stool, you must seek a doctor’s counsel immediately.  Even though we are in different parts of the world, thank you for your trust.  Stay in touch.

Respectfully,
 

Dr. Roshin





* PREGNANT WOMAN ASKS, WHAT ARE EFFECTS OF DIABETES ON MY BABY?

Dear Dr. Roshin
“I think I am pregnant for the first time.  But, I had diabetes before.  Will my baby get diabetes also?  Thank you for your kindness.”  Ms. Till  




 
Dear Ms. Till,
I would like to express my congratulations on your wonderful news!  Motherhood is a new and exciting time for a first time mother, and you are definitely asking the correct questions ensuring your baby will be born healthy.  First and foremost, in order for a baby to be spared diabetic consequences, a pregnant mother must have her diabetes controlled.  The consequences of uncontrolled diabetes are real and and can be life threatening.  Thus, as your prenatal visits begin, your doctor will order appropriate tests, checking and monitoring levels of your blood sugar.  Diabetes, in a pregnant woman, is called gestational diabetes, and if poorly controlled, the following effects are possible:  macrosomia (larger than normal baby size), polycythemia (excess red blood cell development), lack of meconium stool excretion, immature lung development, low blood sugar in baby, yellow skin color ( jaundice),  heart and nervous system defects, digestive tract defects (small left colon), and an increased risk of clot formation.  In addition, miscarriages are common; however, when a  baby is born to a mother with uncontrolled diabetes, a vaginal delivery could result in the baby’s shoulder being displaced  due to the large body size squeezing through a narrow birth canal.  This  last point alone should easily prompt any diabetic mother to seek medical guidance.  Thus, I hope this information clarify’s your question, and as I jokingly mentioned before, please feel free to name your baby after me.  Seriously, enjoy the moment.
Respectfully,
 
Dr. Roshin  






* RUTGERS UNIVERSITY --- PHYSICAL & VERBAL ABUSE.

My website, DoctorAdvice4u.com, more often than none, receives numerous pleas for assistance due to abuse of all kinds.  Whether domestic violence, emotional abuse, physical abuse, or bullying, the prevalence of personal, suffering is utterly shocking.  Thus, hearing about physical assaults at the hands of Mike Rice, Rutgers University men’s basketball coach, was not surprising; however, what was astounding was the lack of leadership before and after this incident.   A video, displaying several years of unquestionable physical assaults and derogatory, homophobic comments made to student members of the basketball team, was brought to the attention of Rutgers University President, Robert L. Barchi, November 2012.  Yet, Rutgers President chose not to view the video until April 2, 2013, leaving all disciplinary matters regarding Mr. Rice to Rutgers Athletic Director, Tim Pernetti.  Mr. Pernetti and colleagues decided a three game suspension, a fine, and anger management classes were sufficient protocols to address Mr. Rice’s behavior.  This decision is absolutely unnerving, yet expected simply due to one fact, this generation’s philosophy has allowed money and image to trump common decency, as well as the guidance of spiritual and moral values.  The result is the mighty dollar taking precedence over people.   Case in point is that because Mr. Pernetti architected Rutgers University move to the Big 10 Conference, ushering in a future of big money and prestige for the campus, he was retained as a sound decision maker.   Yet, any person in his position would have immediately taken measures to protect the students of his athletic program, by removing the person causing the assaults from further contact with any student on the campus.  Tim Pernetti failed, and he was rightfully fired.  Dr. Barchi’s, failure to view the videos and act accordingly, in late 2012, also constitutes negligence to protect the university’s students.  Dr. Barchi should also be fired.  Yet, he is being allowed to retain his position as President due to, you guessed it, money.  Dr. Barchi was hired to oversee, implement, and expand unprecedented access to higher education, inclusive of state of the art medical schools, within the Rutgers University system.  Dr. Barchi’s plans have won support from New Jersey’s Governor Chris Christie, boosters, and alumni alike; however, genuine leadership is defined by making good judgment calls in a moment of crisis.  Not removing the person causing emotional and physical abuse to students on the Rutgers campus is a failure of Dr. Barchi’s judgment and leadership, not the process.  Dr. Barchi should be removed from his position, and he can be rehired as a consultant to continue Rutgers University expansion plans.   But, to leave Dr. Barchi in office as President continues to exemplify this generations lack of spine, much less moral clarity, giving precedence to friendships over leadership.   In light of the Tyler Clementi suicide due to homophobic tendencies on that same campus, the decisions rendered by administration officials is startling.  Rutgers University officials need to look deep within themselves and decide whether money is more important than morals.  Why you might be asking?  As an outside observer, the Golden Rule much less good karma appears to offer little solace or meaning  on that campus.  Thank you.

Respectfully,

Dr. Roshin





* WHY DO MY HANDS FEEL VELVETY?

Dearest Doctor,

“U rember I sho u my hnds.  Plz tel me y my hnds look tis way.”--- Mr. “Gene”



Hi "Gene,"

 

After both of us exited the gym hot tub, I looked at your hands and immediately thought you were merely dehydrated.  However, after you mentioned that the skin on your hands has increasingly “felt velvety for the past two to three months,” other red flags came to mind.  Realizing that you are 73 years old, have a past medical history of chronic smoking  for twenty-six years, and  “on and off  diabetes for as long as you can remember,” with urgency, you should be examined by a doctor to rule out various types of cancer.   Why, you might be asking?   Often times, patients with a stomach or lung cancer may rarely present with tripe palms, the thickened, velvety textured ridges similar to what is exhibited on your palms.  In addition, you have a skin condition in your armpits which appears to be acanthosis nigracans, an indication of uncontrolled blood sugar common in active diabetics.  Put simply, I am not trying to rush to judgment; however, since you have many cancer risk factors, my advice for you is to locate and visit a doctor as soon as possible.  The appropriate imaging and blood tests can be ordered to make sure you do not have cancer.  Please stay in touch, and thank you for your trust.

Respectfully,

   

Dr. Roshin





* BOTSWANA 

- WOMAN SAYS SOMETHING GROWING IN HER EYE.

“ doctor. I have an eye problem. It has grown something inside, and here they said thats they is no SOLUTION --hOW DID THEY KNOW THAT?  I will take the eye a photo to show you. and Load it in my photos so that you will see what am talking about.”  Dankie  Ms. Hlomika (Botswana)





Dear Ms. Hlomika,

 
After receiving  your medical record by fax from Botswana, I read your eye examination and sighed with relief.  The tissue  growing inside your eye is called a pinguecula, a common, non-cancerous growth of the eye conjunctiva caused by continuous exposure to sunlight.  Since you reside in a climate prone to hot  temperatures and copious amounts of sunshine, a pinguecula forms as a natural means to protect the eye from constant irritation.  Thus, a fatty, yellowish  tissue deposits above the white sclera surface.  Fortunately, your vision is not impaired; however, since you have irritation in the eye, you were prescribed 1% Prednisolone Acetate (Pred Forte) eye drops.  In addition to keeping your eyes well lubricated with the eye drops, wearing sunglasses will cut down sunlight exposure, helping to  prevent future eye inflammation.  If a person’s vision is negatively effected, surgery is an option,  or in extreme cases, surgery is done for cosmetic reasons.  Either way, your conjunctiva, pupils, lens,cornea, and vision  are normal; and overall, that is great news.  I am humbled by your trust in me.  God Bless and thank you. Respectfully, Dr. Roshin







* HELP, I CAN NOT BREATH!


“Hi. If u can call now please I am very sick & need your help. A friend of mine here in Texas told me to call you.” --  Tina




Dear Tina (in Texas),

The urgency of your message was evident, and upon us promptly visiting by phone, I felt certain you had developed an unwanted complication of a worsening pneumonia, namely, a pleural effusion; thus, I insisted you visit an emergency room immediately.  My conclusion was based on the fact that you had gone to an Urgent Care facility five days earlier, were given antibiotics and a steroid taper over six days; but, your symptoms had not diminished, rather, your symptoms were exacerbated including worsening shortness of breath, tremendous nausea, dizziness, kidney pain, and laryngitis.  The fact that an X-ray was not done at the Urgent Care facility was perplexing; however, the hospital performed a multitude of examinations including a chest X-Ray.  I am glad we visited on the hour for eight consecutive hours that evening, and upon your discharge from the hospital, the eventual diagnosis was confirmed as an infectious pneumonia but fortunately, an effusion, had not developed.  Nonetheless, breathing treatments were offered, new antibiotics were prescribed, and I am glad to hear that after an additional week of rest and medicines, you are feeling better.  I look forward to hearing the results of blood cultures and the radiology reports beyond the chest X-ray images you sent me.  I am humbled by the kind words you wrote, specifically, “Thank u for your Great Kind heart.”  God Bless.

 

Respectfully,

 

Dr. Roshin







*MY EYE TWITCHES UNCONTROLLABLY. WHY?

Hi Professor,

I have had eye twitching for well over a year and know one can give me an answer as to what is causing this.  It is driving me crazy.  Could you help me, please?  Thx.  Ex-Student



Hi Ex-Student,
I am humbled that you have confided in me concerning your present and past medical history leading up to your question.  Usually, eye twitches are idiopathic, meaning no identifiable cause is found.  However, after we extensively visited in person, your past medical history may illicit the reasons for your 
present eyelid twitches.  Specifically, documented cases have shown that a history of domestic abuse and or depression could cause
uncontrollable eyelid twitching, also called blepharospasm.  You might be wondering how?  Blows to the back of the head may damage the basal ganglia of the brain causing involuntary eyelid twitches.  Furthermore, tapering or stoppage of select antidepressant medications may also lead to the withdrawal symptoms typical of blepharospasm.  In addition, your mentioning the new onset of sporadic, blurry vision and headaches suggests an examination by a neurologist for multiple sclerosis may be necessary. Multiple sclerosis has been implicated with involuntary eyelid twitching.  Other causes of blepharospasm not related to your past medical history include Tardive Dyskinesia, the use of Parkinson’s disease and antipsychotic medications, and generalized  weakness of eye muscles.   Besides the recommended saline eye drops you were told to take, Botox and surgery have proven effective therapies for patients experiencing blepharospasm symptoms.   However, consulting with a neurologist is your first step.  The doctor will be better able to assess your condition offering   scans, tests, and treatment as needed.   Keep up the good work in college as your studies will set a new and better future course for you.  God Bless.

Respectfully,

Dr. Roshin





* WHAT IS WHITE STUFF IN MY SON'S MOUTH?

Hello Sir,

What is the white stuff in my son’s mouth? 

 from Lady at Grocery Store




Dear Ms. Grocery Store Lady.

After briefly visiting with you outside a grocery store this past week, I was concerned that your child may have a medical condition, causing a depressed immune system, resulting in the “white stuff” in your six year old child’s mouth.  However after our visit by phone, I am fairly certain that the “white stuff” in your son’s mouth is due to a side effect of a medication, not a serious medical condition.  Initially, when you mentioned your son being sick quite often over the past year, our conversation seemed to add to the belief that your child had a weak immune system.  However, after visiting at length by phone, your child’s repeated sickness is a lung condition called asthma, and the steroid inhaler, prescribed to maintain open airway passages, is more than likely causing oral thrush, the white substance in your son’s mouth.  Oral thrush is a fungal infection of the mouth, that if not controlled, could spread to the food tube causing difficulty eating.  Thus, your son needs an oral antifungal rinse to rid the “white stuff” from his mouth.  Realizing you are facing economic challenges, without delay, you should take your son to  a  hospital emergency room, not only to obtain the anti-fungal medicine (through charity care); but also, your son should be checked to make sure he does not have diabetes, cancer, a lymphoma, or other serious medical condition that could also cause thrush.  Thank you for your question and trust. 

Respectfully,

Dr. Roshin 





* SHOULD I REMOVE MY OVARIES?

 

“Hello Roshin! 
Remember last time I've mentioned to you that I had a total hysterectomy last 6th of June 2012? But they left the ovaries behind since it is still okey but about two weeks ago I was admitted at the A&E because I had ruptured ovarian cysts in my right ovary and my left side is starting to have almost the same pain as the right I am for another ultrasound this Tuesday...do you think it is best if I had my ovaries removed maybe by June?..Thanks in advance for your advice! God Speed!”   Ms. MDavi



Hi “MDavi,”

I am glad we were able to chat online especially since you reside on one of the Pacific Islands.  Yet, I hope that my advice along with the council of a doctor in your proximity will collectively allow you to make a conscientious, peaceful decision concerning your body.  Ultimately, I believe your decision to surgically remove your ovaries should revolve around whether your family has a history of ovarian or breast cancers.  If these types of cancers are prevalent in your family line, I would strongly opt that your ovaries be removed.  Hopefully, the pain from the ruptured ovarian cysts self resolved, and if no history of ovarian or breast cancer exists in your family, keeping your ovaries would be a good decision.  Remember, the ovaries produce estrogen, a hormone that delays progression of osteoporosis and heart disease in women.  Thus, if you decided to have your ovaries removed at age 43, you would enter into early menopause experiencing symptoms resulting from the lack of ovary hormone production.  Finally, I wish to mention that if your family has a history of malignant ovarian cysts, the removal of ovaries should be strongly considered.  Whatever you decide, consult with as many physicians as possible, research, and tap support groups with women who have faced similar decisions, prior to making your final decision.  I am humbled to be at your and your community’s service, and if I may be of further assistance, simply ask.  God Bless.

 

Respectfully,


Dr. Roshin






HOW LONG UNTIL SEX AFTER HEART ATTACK?

Hi Doctor,

How soon after a heart attack to have sex?  I had heart attack three weeks ago but unable to get the erection.  What for me to do?   Thanks XOXO



 

Dear XOXO,

In order for me to assist answering your question accurately, I must visit with you concerning your past medical history leading up to your question.  Unfortunately, you did not write return contact information; thus, we were unable to converse, at length, beyond your sent question.  Nonetheless, I will answer your question providing general guidelines to resume intercourse after a myocardial infarction.  However, consulting with the doctor who treated your heart attack is still the best option.  Most people, upon discharge from a hospital, wait two to six weeks prior to resuming sexual relations.  However, if upon hospital discharge, your stress test is normal, you can resume exertional activities, including sex, promptly.  As for your inability to obtain an erection, there are heart medications that cause erectile dysfunction post myocardial infarction.  In other words, after a heart attack, some medicines will cause an erection to be limp.  Thus, talking to your doctor becomes all the more important, realizing that the most common reason for failure to have an erection after a heart attack is anxiety.  Give your body and mind enough time to heal prior to resuming sex, much less, profound exertional activities.  In the end, lifestyle changes including a heart healthy diet and moderate exercise are the best medicines to prevent future heart attacks.  Thank you for your question.

Respectfully,

Dr. Roshin






* BLOODLESS TRANSFUSION SURGERY

Hello Roshin,

“Thanks for visiting with me yesterday evening about bloodless transfusion alternatives offered for people who are of the Jehovah Witness faith.   Would  you tell me more about these options?  Thanks.”  Simone 



 

Dear Simone,

Jehovah's Witness patients believe that accepting blood from a source other then themselves defies the scriptural teachings that their religion holds steadfast.  Thus, due to the Jehovah Witness community’s explicit forbidding of blood transfusions, medicine was forced to adapt and advance trying to find bloodless surgical techniques for that community.  I am pleased to say that new bloodless alternatives are growing into an established, standard of care in more hospitals, some of which are located in your proximity of residence.  Yet, one procedure using blood, called a cell savage technique, allow doctors to collect lost patient blood during surgical procedures, filter and clean that patient’s blood, and return the patient’s own blood as needed during or after that procedure is completed.  In essence this procedure is a blood autologous transfusion, where cells from a patient’s own body are collected, stored, and used as necessary.  However, bloodless surgery techniques do not use blood and have shown a benefit by decreasing the risk of adverse transfusion complications, decreasing infection susceptibility, better healing, and decreasing hospital staying time.   Medicine has progressed now allowing all people to consider bloodless transfusion in both emergency and elective surgeries.  Hopefully the need for a bloodless transfusion in your lifetime will never arise; however, if indeed that time arrives, in New Jersey, you should keep Englewood Hospital in mind (Englewood, New Jersey).  This hospital specializes in bloodless surgical transfusion techniques.   I have provided a link below and on my website for your viewing.  Thank you for your question.

 

Respectfully,

 

 

Dr. Roshin

Englewood Hospital (New Jersey)
http://www.englewoodhospital.com/ms_bloodless_video.asp 




 
* WOMAN'S FATHER MAY HAVE COLON CANCER


Dear Dr. Roshin,
“Well This situation started with my father about 12/15/2011. He had fallen off a ladder about roof top high hit his head and he had some problem with his sciatica.  He had a uti. When he came up to Jersey he developed hemrroihds, constant loose stool and at one time he had blood in his stool.  he constantly takes kaopectate and pepto bismuh. I just need to know what may be causing his loose bowl and loss of appetite and the ability to hold down solids?  please help.  Thanks MNicolette




Dear MNicolette,
I am very glad we made extended time to visit concerning your father’s medical condition.  After our discussions, my conclusion is that your father, a 62 year old African American male, must be checked for colon cancer immediately.  His history of a change in stool size, isolated episodes of black stool possibly indicative of bleeding, and a sixty pound weight loss over the past year are
characteristics found in patients with colon cancer.  However, his persistent diarrhea may also indicate inflammatory bowel disease or a gastrointestinal absorption disease, both of which could lead to significant weight loss.  Thus, since your father has not had a colonoscopy since 2002, my recommendation is for him to have this procedure done as soon as possible.  The colonoscopy is imperative to help diagnose whether his symptoms are related to but not limited to the following:  colon cancer, diverticulosis, inflammatory bowel disease, malabsorption syndrome, lactose intolerance, or ischemic bowel disease.  Your dad’s other symptoms of diffuse arthritic joint pain relieved with marijuana use, left arm swelling, buttocks pain, and posterior leg pain will also be evaluated once colon cancer has been removed as a possible diagnosis.  Realizing that your father dislikes hospitals, Ms. Nicolette, with urgency, colon cancer is a life threatening emergency matter that needs an examination without delay.  Please go to the hospital/doctor today.  Thank you.
Respectfully,
 
Dr. Roshin



WHAT ARE SIDE EFFECTS OF ACE-INHIBITORS USE IN THE ELDERLY?

Hi Dr. Roshin,

My grandmother who has had hypertension for most of her life was changed to a medicine called Linopril.  What are the major side effects of this medicine.  I looked on the net but there is so many.   I know you are busy but thanks.  Marjorie 


 

Dear Marjorie,

Your grandmother, who is the young age of 86, is marvelous when considering her independence and wit.  At her age, I hope to be as spry as she presently is.  Nonetheless, being placed on hypertensive medications does involve close monitoring for adverse effects, all of which must be reported to her doctor as soon as possible.  Your grandmother was switched from a beta blocker medicine to Lisinopril, an ACE-Inhibitor medication due to the beta blocker effects of slowing the heart rate below normal.  Lisinopril is a good medicine with proven results to treat hypertension.  However, ACE-Inhibitors do have side effects that include but are not limited to the following: cough, swelling under the skin (angioedema), low blood pressure, increased levels of potassium in blood, and kidney problems.  Yet, the elderly must be extra careful when using these medications.  Specifically, a recent study published by the Journal of Clinical Hypertension, mentions four cases of elderly individuals between the ages of 92 and 101, with memory problems, developed visual hallucinations.  When the ACE-Inhibitor was discontinued, the hallucinations stopped but hypertension ensued.  Thus, any elder person who is taking Lisinopril, Cilazapril, Enalapril, Qunipril, or Captopril, should recognize that visual hallucinations might occur, and your doctor will likely switch you to a different hypertensive medication.  Remember, diet, reasonable exercise, and lifestyle changes, all within your control, will have significant effects on blood pressure regardless of age.  Thank you for your question and trust.

 Respectfully,

Dr. Roshin   







* VITILIGO IMMUNOMODULATOR MEDICINE

Dear Dr. Roshin,

I have been using steroids for my vitiligo for many years; but, the side effects of the steroids are killing me.  I heard about an eczema medicine called topical modulaters  used for vitiligo now.  Is this true and what are there bad effects?  Love your columns.  Thanks “Lady at Inauguration



Dear Lady at Inauguration,

I am glad to hear from you since the Presidential Inauguration.  As we discussed on Inauguration Day, vitiligo, an autoimmune condition, results in antibodies attacking melanocytes, the cells that make pigment giving color to our skin.  Although no cure exists for vitiligo, protection of unpigmented skin with clothing and sunscreen is essential to avoid skin cancers.  Furthermore, although several treatment options exist to manage vitiligo, the use of steroids is common with the hope depigmented patches will regain normal skin tone color.  Topical immunomodulators help regulate the immune system of the skin; thus, these medicines have proven effective against autoimmune skin conditions such as atopic dermatitis, Lupes, eczema, psoriasis,  vitiligo, and many others dermatology diseases.  The most common topical immunomodulators to cover small depigmented vitiligo patches of the head and neck areas are Tacrolimis and Pimecromlimus.   Tacrolimis is available as an ointment with a .03% and .1% concentration while Pimecromlimus is available as a 1% cream.  Topical Immunomodulator side effects ,include but are not limited to, mild skin burning, lymphoma, skin cancer, and blood electrolyte, psychiatric, respiratory, renal, gastrointestinal, cardiovascular, and nervous system disturbances; thus, consulting your family physician is imperative to ensure successful treatment without unwanted life threatening allergic reactions.  Until we meet again, thank you for your question. 

Respectfully,

Dr. Roshin




WHAT ARE THE BENEFITS OF VITAMIN D?

Hi Doctor Roshin,

What are the benefits of taking Vitamin D?   Thanks MarE


Hello MarE

Vitamin D is a fat soluble vitamin that promotes mineralization, a process that increases bone strength.  Without sufficient Vitamin D, the bones become brittle and prone to bending.  Thus, in children, a deficiency of Vitamin D results in rickets, while in adults, a mineralization deficiency results in a condition called osteomalacia.  How does a person prevent Vitamin D deficiency?  The easiest way to receive your recommended daily allowance of Vitamin D is to allow daily sun exposure for 15-20 minutes outdoors.  Sunlight converts to Vitamin D in the skin.   In fact, a research study in 2006, involving 4 million cancer patients from 13 countries, concluded that cancer patients who have surgery during the summer months are more likely to survive their procedures than cancer patients who have had surgical procedures completed in  the winter months.  Furthermore, Vitamin D has anti-cancer activity helping to prevent cancers of the colon, pancreas, prostate, breast, and bone.  Research has also shown that Vitamin D plays a role in preventing cardiovascular diseases such as coronary artery disease, hypertension, and peripheral artery disease.  Thus, as you have read, once Vitamin D from your diet, sun exposure, or supplements, is made active, the benefits for maintaining good overall health, are extraordinary.  So, with that in mind, even as an adult, make sure you drink your milk.  Thank you for your question.

 

Respectfully,

 

Dr. Roshin



WHY DO I HAVE NIGHT SWEATS?

Dear Roshin,
After reading all the posts on your website, I thought I would ask you for your opinion.  For the past eleven weeks, I have had night sweats that drench my clothes and bed linen.  I have gone to numerous doctors; but every time a test is run, all results are normal.  Would you be able to offer an opinion as to what condition I have?  Thanks Ms. “Deep in the Heart of Texas”




Hi Ms. “Deep in the Heart of Texas,”
After visiting with you this past week, I believe you have a condition called hyperhydrosis.   Hyperhydrosis is a medical condition in which an individual sweats excessively and unpredictably.   Realizing that tuberculosis and menopause were ruled out as potential causes of the night sweats, your medical history and blood test results seem to suggest an endocrine disorder, allergic reaction, a dermatology condition, or an infectious di
sease.  In fact, your social history of abundant time in the outdoors, exposure to wild game, allergy testing positive for literally everything under the sun especially mold, and symptoms of fatigue, difficulty breathing, loss of appetite, and fatigue all lend credence to potential etiologies of the night sweats, and consultation with an Infectious Disease specialist, Endocrinologist, and Dermatologist in coordination with your Family Medicine doctor is recommended.  However, first and foremost, I would ask your Family Practitioner to order a thyroid panel checking for hyperthyroidism and a fasting blood sugar check evaluating for diabetes mellitus.  If these blood test values return within the normal range, then more serious causes of hyperhydrosis can be evaluated including lymphomas, cancers, bacterial infections…etc.  Sensing your distress, I want to reassure you that a cause for your condition will be found, and effective treatments will commence.  In the meantime, stay positive, and I hope someday to be as proficient as you are in outdoor, survival skills.  Stay in touch and thank you for your trust.
Respectfully,
Dr. Roshin  



* HOW MUCH CALCIUM DO I NEED PER DAY?


Dear Dr. Roshin
I am a 28 year old woman who has been drinking 3-4 cups of coffee/day for 9 years.   So, my question is how much calcium am I suppose to have and what foods give calcium?  I enjoy reading your columns.  Thanks for the information.  Jina



Dear Jina,
Since no return contact information was received, I am unable to learn your past medical history leading up to your question.  Nonetheless, I will respond to your question with generalities based on what you have written.   A 28 year old woman who drinks only 3-4 cups of coffee/day is not ingesting the appropriate amounts of calcium recommended per day.
  Calcium is needed to maintain strong, healthy bones.  In general, from birth throughout childhood, a person needs 400-800 mg of calcium/day.  As a teenager, the growing individual requires 1200-1500 mg of calcium/day.  Most of adulthood requires approximately 1000 mg of calcium, and the elderly (70+ years old) population requires at least 1200 mg of calcium/day in their diet.  Thus, you must be wondering how many cups of milk should you drink in order to obtain the correct amount of calcium in your body?  The answer is translated as follows:  one cup of milk = 300 mg of calcium.  Thus, you should be drinking 3-4 cups of milk or eating enough calcium containing foods to accumulate a total of 1000 mg of calcium/day.  Other foods that contain calcium include:  1 cup of yogurt (300 mg), 1 cup of tofu (500 mg of calcium), 1 cup of pinto beans (100 mg),  1 cup of spinach (250 mg),  1 ounce of Swiss cheese (270 mg), 3 ounces of canned sardines with bones (330 mg), 1 ounce of American cheese (175 mg), 3 ounces of baked perch fish (125 mg), and 1 cup of broccoli (75 mg).  The importance of changing your eating habits now becomes evident since women become increasingly susceptible to osteoporosis (less dense bones) after menopause.  Although pharmacological medicines exist to counter osteoporosis effects, diet is within your control helping to prevent the rapid progression of this disease in your later years.  Thus, you are never too young to change your lifestyle, and working with your doctor is a great first step.  Thank you for your question.nly 3-4 cups of coffee/day is not ingesting the appropriate amounts of calcium recommended per

Respectfully,
 
 
Dr. Roshin 





* POSTERIOR VITREOUS DETACHMENT

Dear Dr. Roshin,
A few days ago, all of a sudden, the vision in my left eye became blurry.  There were black spots floating in my field of vision, so I went to the emergency room, and I was told I had a posterior vitreous detachment.  Would you explain more about this condition?  Thanks Scared



Dear Scared,
Vitreous is a gel like substance located between the lens (gives eye color) and the retina which is located in the posterior eye.   As we age, the vitreous undergoes syeresis, a process where the gel shrinks detaching from the retina in the back pack part of the eye.   Syeresis is comparable to week old jello peeling away from the side of a glass bowl.  The result is the appearance of black spots or shadows in your field of vision.  Overall, although posterior vitreous detachment does not result in serious complications or loss of vision, the appearance of flashes of light may signal a retinal detachment, a medical emergency which must be addressed to prevent blindness in the effected eye.  Due to this condition not producing serious symptoms, posterior vitreous detachment is often left untreated.  However, if the floating objects become overly bothersome, the vitreous may be surgically removed.  Your history of nearsightedness and an age of fifty-three years old placed you at increased risk for posterior vitreous detachment; yet, with proper education of your condition, you can still live a full quality of life enjoying the beauty of our world with your vision.   Thank you for your question.

Respectfully,
 
Dr. Roshin










* HEMORRHOID TREATMENT OPTIONS

Hi Doctor Roshin,
I hate to send this picture but I'm extremely concerned. I have had hemorrhoids in the past, and my schedule has been extremely stressful as of late and my diet has been poor. 
I've been applying tucks to the affected area and researched to change my diet, drink much more water and increase my fiber intake.  A few weeks back when moving my bowels I bled.  The affected area near my rectum has never been this bad. If in the next few days the area does not get significantly better, can you offer both in short term and thereafter what is best course of action? I am hoping more than anything that u tell me that while a bad outbreak, as long as I stick to my plan and anything additional should help the inflammation to subside.

Thank you JJ




Dear LC,

The anal and rectal area of our body has an extensive network of blood vessels, which upon swelling, enlargement, or protrusion of these vessels, a hemorrhoid condition could result.  Two types of hemorrhoids result:  1) Internal hemorrhoids – characterized by painless, marked bleeding and 2) external hemorrhoids – illustrated by uncomfortable, painful, itchy, bleeding, prolapsed vessels.  The picture you sent appears to show external hemorrhoids; however, any type of rectal bleed must be checked for possible colon cancer.  Thus, a visit to your doctor to evaluate the source of the gastrointestinal bleed becomes apparent.  If the diagnosis is hemorrhoids, you are correct that short and long term treatments do exist to help prevent repeated hemorrhoid flares.  Since anesthetics are found in both hemorrhoid crèmes and medicated wipes, these medications should temporarily soothe hemorrhoid pain.  Furthermore, eating fiber containing foods, taking stool softener supplements (Metamucil), exercise, and performing a sitz bath for the anal area after each bowel movement, should offer long term relief of repeated hemorrhoidal pain.  More severe hemorrhoid cases may require procedures including banding the hemorrhoids with a rubber band or removing the hemorrhoids all together (called hemorrhoidectomy).  Most recently, stapling of the hemorrhoids to prevent prolapse from the anal canal, has proven a viable option for hemorrhoid therapy.  Based on your personal medical history, you and your doctor can discuss the best treatment option(s) for you.  Whatever you decide, hemorrhoids are readily treatable and prognosis excellent for relief of your present symptoms.  Thank you for your question.

Respectfully,

 

Dr. Roshin







* HOW WILL EXERCISE HELP MY HYPERTENSION?

Dear Doctor,

Would you tell me the benefits of exercise on my hypertension?  Thanks JJ





Hi JJ,

Weight loss is exponentially beneficial for any person’s future health.  In fact, exercising is an inexpensive method to control blood pressure levels without the use of medications, and more importantly, the benefits of weight loss go far beyond controlling hypertension.  From increasing an individual’s life span, decreasing the risk of heart attacks and strokes, improving Type II Diabetes Mellitus disease, and decreasing the risk of cancers, weight loss stemming from moderate exercise (1-3 hours/week of cycling, brisk walking, running, water aerobics, swimming) will add between three to ten additional years to your life.  If you lose ten pounds, your blood pressure will decrease 5-10 points, while a twenty pound weight loss will decrease blood pressure readings 20-30 points, the equivalent of most hypertensive medications!  As many as 33% of people can be kept of medications with diet and exercise alone.    Furthermore, since obesity contributes to the development of Diabetes Mellitus Type II, weight loss can taper a person’s insulin dependency decreasing and potentially reversing the diabetic condition.  Although exercise programs vary from one individual to the next, a consistent exercise routine should help maintain your blood pressure in the normal range (120/80) well into your golden years.  The trick is to find the exercise program that works for you, consult with your doctor on the exercise program you wish to begin, then remain committed and in control of your health.  Thank you for your question.

Respectfully,

Dr. Roshin




DO MOTION SICKNESS BRACELETS WORK?

Hi Roshin,
I was wondering if pressure bracelets are good to rid motion sickness?  Thanks Bej



Hello Bej,
Motion sickness results when the brain’s input from vision and balance receptors are mismatched.  In other words, the brain receives conflicting balance information from the eyes, the inner ear, the joints/muscles, and the skin.  For example, when reading a book on a boat, your eyes perceive no movement; thus, you are able to read the book; however, the balance receptors in the ear do detect movement of the boat, which may result in common motion sickness symptoms such as nausea, vomiting, pale complexion, sweating, and or a fast heart rate.  The conflicting signals received by the brain effects hormone levels (acetylcholine, histamine, and norepinephrine); thus, many of the pharmacological treatment options such as scopolamine (Transderm patch), meclizine (also called Dramamine), or belladonna work to modify the hormone levels back to normal.  As for your question concerning motion sickness bracelets, the bracelet mimics acupuncture treatments, placing pressure on a nerve that is expected to relieve motion sickness symptoms.   However, a 2004 study, tested on 77 patients, compared two bracelets (Acuband and Reliefband) for motion sickness relief.  The results of this 2004 test indicated that neither band prevented motion sickness whether that individual used the band correctly or incorrectly.  Thus, there does not appear to be a direct link to bracelet use and motion sickness relief; but people respond to alternative medicine treatments differently; thus, trying the bracelet or consulting with a licensed acupuncturist should be considered as the potential benefits definitely outweigh the consequences of continued motion sickness.  Thank you for your question.
Respectfully,
Dr. Roshin



SOLDIERS EYES MOVE INVOLUNTARILY - NYSTAGMUS

Hi Roshin,
As you know, I have been in the Army for just under a decade.   I am in pretty good shape but this past month, there is a pounding sensation deep inside my head and when this happens, my eyes move up and down uncontrollably.  Do you have any idea what is happening to me?  Thanks “Terry”



 
Hi Terry,
The involuntary vertical movement of your eyes, called nystagmus, coupled with an intracranial pulsing sensation should be examined by a neurologist for a possible brain tumor infringing on eye nerves and or a tumor occupying space leading to obstruction and a resulting in a developing aneurysm.  Nystagmus can be caused by medicines, thiamine and B12 deficiency, multiple sclerosis, Parkinson’s disease, and ear disorders.  Thus, first and foremost, a visit to a Veterans Administration clinic, should be scheduled immediately.  A head CT with and without contrast may be ordered checking for tumors, abscesses, bleeding, plaque development, cranial and ear pathology, myelin loss, and increased intracranial pressure.  Besides impaired vision and incoordination of gait, untreated nystagmus could lead to complications including paralysis, transient or permanent unconsciousness, and loss of cognitive skills as well as motor skills.   Furthermore, depending on size, an aneurysm when found, could become a medical emergency.   Keeping track of symptoms not limited to a headache, dizziness, a spinning room, imbalance, vertigo, ringing of the ears, muscle weakness, loss of urine/bowel continence, must be reported to your doctor.  A treatment plan based on your symptoms will then be developed.  Thank you for your question, and thank you for your service to our country.  
 
Respectfully,
 
Dr. Roshin



* TEEN ALCOHOLIC DEVELOPS PNEUMONIA -HOW?


Dear Roshin,
After a recent festival, my friend developed pneumonia.   How could he develop this condition when he is only 28.  This does not make sense.  He is in the hospital getting treated. Thanks for your time.  Amelio




Hi Amelio,
However young, your friend’s alcoholism history predisposes him to an increased risk of developing aspiration pneumonia.   Aspiration pneumonia develops when swallowed food or liquids is regurgitated from the digestive tract into the lungs.  The vomited contents can cause chest pneumonia, a lung abscess, and or a lung inflammatory response to develop.  The shortness of breath, wheezing, foul smelling breath, chest pain, and fever are common symptoms requiring prompt medical treatment.  Bacteria from the oral cavity and digestive system have infiltrated the respiratory system; thus, antibiotics have been given to kill the bacterial infection.  His swallowing process may be evaluated; but, more than likely, your friend must come to terms with his alcoholism problem.  Alcoholics Anonymous and other public support groups are successful keeping people abstinent from alcohol use; but, success is completely prerequisite on your friend admitting to himself that his alcoholism is controlling his life.  No age is exempt from this form of pneumonia; thus, at this point, only self acknowledgment that alcohol overuse caused his hospital admission, will help prevent future occurrences.  Thank you for your trust.
Respectfully,
Dr. Roshin



XANAX SIDE EFFECTS:
Dear Dr. Roshin,
Over the past two months, I have been had increased anxiety and panic attacks.  After visiting the doctor, I was given Xanax.  Would you explain major side effects I should be aware of please?  Thanks.  Mr. WC



 
Dear Mr. WC,
A panic attack is a psychiatric medical condition often accompanied with your mentioned symptoms including heightened anxiety, a rapid heart and breathing rate, sweating, and a feeling of loss of control.  More than likely, your panic attacks were provoked by your anxiety concerning a close family member’s impending death.  Subsequently, your doctor prescribed Xanax (also called Alprazolam), a schedule IV controlled substance, with low potential for abuse with short term use but with a high side effect profile.  Xanax’s  most common side effects include changes in appetite,  fatigue, decreased sexual desire, gastrointestinal symptoms (diarrhea, constipation, dry mouth),  dizziness, light-headedness, nausea , drowsiness, and weight changes.  Blood Xanax levels may increase in combination with certain medications; thus, always check with your doctor as to the dosing of Xanax which will help to prevent more serious side effects including life threatening allergic reactions (rash, hives, itching, difficulty breathing, chest tightness, swelling of the face, edema of limbs), behavior changes, chest pain, hallucinations, loss of balance, memory problems, confusion, suicidal thoughts, and depression.  Since you were unable to contact your doctor a couple of nights ago, I was glad to assist your question;  however,  since beginning the Xanax medication, if any of the above mentioned side effects have developed, contact your doctor immediately.  He/She may need to change the medicine.  Thank you.
Respectfully,
 
Dr. Roshin 


WOULD A CAT BITE CAUSE RABIES?

Hello Roshin,
Last week, I brought a stray cat to my home.  The cat swiped at my arm causing a scratch.  Do I need to worried about the rabies?  Thanks Renn



Hi Renn,
However cute, stray cats should always to be handled with care.  Yet, the concern for rabies, due to cat bites in the USA, is truly minimal as compared to other potential infections.  However, when bitten and if rabies is suspected, symptoms including weakness, fever, and headache progressing to confusion and agitation, generally occur within a two to ten day period.  If the disease further worsens, a person may experience more severe symptoms including delirium, abnormal behavior, and hallucinations.  Thus, if you are experiencing the mentioned symptoms, call your doctor as soon as possible, as well as an animal control agent to collect the cat.  Animal control will either hold the cat for observation or euthanize the cat and test for rabies.  If left untreated, rabies is fatal; thus, seeking assistance is imperative to survival.  The doctor should also check your wound for Cat Scratch Disease (caused by Bartonella Henslae) or an infection with Pasteurella multocida (common in cat bite wounds) as well as any nerve or tendon injury.  Upon inspection, the wound can be cleaned and vaccinations, a tetanus shot, and medications can be offered as treatment options.  Whatever transpires, I am enlightened to hear that you were merely trying to feed a starving animal.  I commend you for your passionate feelings.  Take care.  
Respectfully,
 
Dr. Roshin

ESOPHAGITIS IN HIV+ PATIENTS:

Dear Dr. Rowjee,
I am from Eritrea going to university in USA.  My sister is HIV+ and recently, she has been unable to swallow.  Do you know what is causing her not to be able to eat like normal?   What medicines should she take?  I know a pharmacist who will fill the prescription.  Thanks ETek




Dear ETek,
The story of your sister’s battle with AIDs is both compelling and a reality check for the importance of developed countries assisting developing countries combat the spread of the HIV+ virus.  Education is key for putting a dent in myths versus reality.  Your sister’s latest CD4 count is well below 50; thus, her immune system, which normally fights bacteria, viruses, and fungal infections, has become dramatically weakened.   The inability to fight any type of infection results in “bugs” causing your sister’s present symptoms.  Your sister has esophagitis, which is inflammation of the esophagus causing painful swallowing.  Typically, esophagitis is caused by a fungus, called Candida.  The doctor should first place your sister on an antifungal medicine for 3-5 days.  If the esophagitis does not improve with antifungal medicine, your doctor should then order an esophagoscopy to collect tissue samples as well as view the oral cavity, esophagus, and the entrance into the stomach.  The tissue biopsy should identify what bug is causing the esophagitis.  If the esophagitis is caused by the Herpes Simplex Virus, an antiviral drug (Acyclovir) will probably be prescribed.  If the esophagitis is caused by Cytomegalovirus, Gangcyclovir may be prescribed.   Whatever the cause of the esophagitis, seeking treatment as soon as possible is important, since both respiration and nutritional intake could be compromised.   My prayers are with your sister.  
Respectfully,
 
Dr. Roshin 
* * 

WHY IS LAETRILE NOT IN USA?
Hello Doctor,
I have been unable to find the medicine Laetrile in the USA?   Why?  Thanks JPerez




 
Hi JPerez,
I must admit that answering your question took more time than usual to locate an exact answer.  Laetrile is a chemically modified form of amygdalin, a chemical found in the pits of raw nuts, fruits, and plants, used worldwide as an anticancer treatment.  In fact, the Hunza and the Karakorum people located between Pakistan and China, are considered to be the only cancer free societies in the world due to the ingestion of amygdalin.  Promoters of amygdalin use indicate that this chemical keeps cancer patients in remission in addition to providing pain relief.  However, due to Laetrile’s side effect of cyanide poisoning and documented cases of cyanide poisoning deaths, the Federal Drug Administration has not approved Laetrile as a treatment for cancer in the United States.  This is the reason you have been unable to acquire Laetrile within USA borders.  On the other hand, in Mexico, your home country,  Laetrile is made and used as a cancer treatment.  Ms. Perez, if taking this medication (pill or injection) has resulted in marked success of tumor regression, you might want to consider returning to Mexico continuing those treatments.  However , please consult  with an oncologist (cancer doctor) who should be able to suggest other cancer medicines to substitute for the Laetrile.  I would be more than willing to locate an oncologist who has an office close to your present residence in Connecticut.   When dealing with cancer, as I am sure you are aware, time is of the essence; thus, please let me know if I may be of further assistance as soon as possible.  My prayers are with you.  
 
Respectfully,
 
Dr.  Roshin    


CHAGAS DISEASE

Hi Roshin,
Thanks for giving your time to our community here in Ironbound.  There are not too many people who would give their time and advice for free.  When I saw you the other day, I told you that I have never felt so tired than I do now.  I have difficulty playing soccer because I get short of breath.  At the first of the month, I also noticed fluid in my feet.  Can you help figure out what is going on?  Fellpe

    
 
Hi Felipe,
We were fortunate to meet each other on a chance encounter.  After visiting with you, I was puzzled as to why a 33 year old individual would develop edema in the feet.  Commonly, the renal, urinary, lymphatic, or cardiovascular systems would yield the clues as to the cause of your symptoms.  However, after our discussion, the only significant finding from your medical history was your travels and duration of stay to and from Brazil.  Thus, one possible cause of your present symptoms may be Chagas disease.   Chagas disease is caused by a protozoan parasite, called Trypanosoma Cruzi, which is transmitted to humans through food or blood contaminated with the insect feces.   Chagas has a short lived acute phase where an infected person would typically experience symptoms such as fever, nausea, vomiting, swollen glands, difficulty breathing, muscle aches, or chest pain.  If not detected early, the condition could evolve from the acute phase into the more serious chronic phase which predominantly affects the heart and colon.  Chagas disease affects the heart causing an abnormal rhythm, an inflamed heart, congestive heart failure, and or possible cardiac arrest.  In addition, Chagas disease affects the digestive tract by causing constipation and abdominal pain.  Your mentioning cold symptoms roughly two months ago coupled with today’s symptoms raises red flags that you should consider being tested for Chagas disease.  Thus, with urgency, please consult your family physician to not only check for Chagas disease; but also, the doctor should order exams to check your heart function and digestive tract.  Nifurtimox and Benznidazole have shown 100% efficacy in curing Chagas as long as the acute phase still exists.   Thus, detecting the disease as early as possible is key to preventing more serious organ damage.  Wherever my medical and life journey takes me, I am humbled to be of service to Ironbound and all communities, domestic and international.  Thank you for your question and trust.  
 
Respectfully,
 
Dr. Roshin
 
 


DOES THE POWER OF PRAYER EXIST?


Dear Readers,
Losing a child is every parent’s worst nightmare.  Yet, that is exactly what Ms. JG and her family had to endure this past May 5, 2012.  As a recently graduated doctor, I have always wondered about the connection between spirituality and health.  Can the power of prayer actually propel healing?   Well, after visiting and reading Ms. JG’s account, the answer is written in her words and thoughts.  What do you think?

Respectfully,

Dr. Roshin

 

Dear Roshin,
“My son died on his 19th birthday.  The cause of death is still unknown, as the autopsy has not been finalized.  What I find amazing about this child was that it was not until his funeral that I realized the impact he had, and continues to have on this world.  Over 1200 people attended his funeral!  There were three busloads of students from his college and three busloads of students from his high school, alongside many family members, other friends, neighbors, and more.  
    

The minister who delivered his eulogy asked attendees who, as a result of this child, felt a need to develop a closer relationship with God, and the response was approximately 60% of attendees.  Perhaps it was mainly the students.  Only God knows.  But the important thing to note is that they wanted to have a deeper relationship with God.  As the minister later told my husband and I, it is now up to the Holy Spirit to do his work in strengthening that relationship.  Our work was done.  We raised this child, along with his two older brothers, to hear the Word at the dinner table throughout their childhood.  We also prayed for many things in their lives, and we continue to read the Bible and pray for them and for each other.  
          
We have been told that we raised three wonderful sons.  We feel we have been truly blessed in this way and in many other ways.  But it was interesting to see how this child touched and continues to touch so many people’s lives.  Even a month and a half after his death, we would receive about 10 sympathy cards a day and half of them were from people we did not know.  They had heard about his death on the news, and they too were moved spiritually. 

There were spiritual things that occurred prior to his death, and now spiritual things continue to occur.  Many people have told me how they have been spiritually moved because of that child.  I have also spoken with other mothers who have lost their children and they all seem to agree that time does not heal the loss of a child.  I lost both parents and time has somewhat healed.  But in terms of closure for this child’s death, I believe closure will occur on the last day.” 

Sincerely,

Ms. JG





BRAIN SWELLING
Hello Roshin,
My sister who is 49 years old has had a long history dealing with cancer.  She started out with breast cancer and then different cancers all over her body this past decade.  I received a call this past weekend that she was developing severe fluid buildup in her brain.  She has been through so many procedures already, and I am afraid I will lose my sister soon.  Would you explain more about the increased fluid in her brain?  Thanks.  Mr. CB


 
Dear Mr. CB,
There are truly remarkable people in our world, and your sister is one of those shining stars.  She is a fighter, and I know you are proud of her spirit.  Yet, swelling of the brain, also known as increased intracranial pressure (ICP), if left untreated, can be fatal.  In an adult, the skull encloses a total volume of 1450 ml (brain, blood, and spinal fluid).  This total volume produces a normal adult intracranial pressure of 10- 15 mm Hg.  ICP values between 20-25 mm Hg require treatment, and values above 40 mm Hg indicate severe, life threatening intracranial hypertension.  Whenever increased ICP is diagnosed, a general sequence of symptoms exists initially beginning with a headache along with nausea and vomiting, progressing to confusion, convulsions, pupil swelling, slower breathing rate, profound altered mental status,  loss of consciousness, coma, and possible death.  Your sister’s intracranial pressure is 22 mm Hg, and judging by our conversation, her ICP may be due to a relapse of brain tumors.  The brain tumors may be obstructing the flow of spinal fluid causing her increased skull pressure.  Thus, emergency treatments must commence to decrease her ICP either by drainage of the fluid using a shunt or by having the sedated patient infused with medications (mannitol, hypertonic saline) to rid the brain of all the swelling.  A shunt uses a catheter that drains all the excess fluid from the brain to the abdomen.  Shunt placement does have complications both during and after the procedure; however, the risk is worth the try if death is the eventual outcome for the patient.  I know the next few weeks will be trying for your sister, and I write this column sending heartfelt prayers to all your family.  May your faith bring comfort during this difficult time.   God Bless. 
 
Respectfully,
 
Dr. Roshin


ACHILLES TENDONITIS:
Dear Roshin,
After running a 5K race this past Sunday, I developed pain in the back of my left heel the next day.   I am having difficulty walking much less running.   Could you explain what this condition is and how to treat?  Thanks Mr. R



Dear Mr. R,
Achilles tendonitis is inflammation of the Achilles tendon, strong tissue fibers that connect the calf muscles to the back of your heel bone allowing walking, running, and jumping.   Since this was your first 5K race in over two years, the pain and discomfort you are presently feeling, are probably related to an over straining injury.  The tendonitis, caused by a sudden increase in the intensity or amount of an activity, may manifest as a combination of the following:  difficulty walking, pain, tenderness, swelling, or tendon stiffness.  Yet, most forms of tendonitis are manageable by limiting activity on the effected tendon, applying ice to decrease swelling, elevating the leg above the level of the heart, avoiding surfaces that elicit pain, using elevators/escalators for both uphill and downhill mobility, replacing running with swimming or cycling as tolerated, or using  a hot tub to decrease tendon stiffness.   Depending on the severity of the tendonitis, the pain should resolve in weeks with worst case scenarios being a couple of months.  However, consult your doctor for prolonged and worsening pain as the tendonitis may be a more serious tear requiring surgery or possible immobility casts.  Thank you for sharing your experience.
 
Respectfully,
 
Dr. Roshin 



PSORIASIS & VITAMIN D TREATMENT
Dear Doctor Roshin,
“I have had psoriasis for close to five years.  We have tried steroids, sunlight, moisturizing creams, and medications to get rid of the scales; but, some areas such as under my elbows still remain.  I heard that Vitamin D works to get rid of the scales.  Is this true?”  Gwen



Dear Gwen,
Psoriasis is a skin condition characterized by itchy, white to silver plaques overlying a thickened, reddish skin.  This condition is triggered by a good cell in the body, called a T-lymphocyte, unfortunately, attacking an individual’s immune system.  When adding triggers such as cold weather, skin trauma, infections, smoking, certain medications, obesity, and genetics, red scales form
 often accompanied by bleeding and pain without treatment.  Judging by sent pictures, your psoriasis has receded quite well; thus, you might want to consider continuing the present treatment unless serious side effects have manifested.  Nonetheless, you are correct that certain forms of Vitamin D have been used to counter the effects of psoriasis.  Dovonex (also called calcipotriene) is a Vitamin D derivative that has been shown to alter skin cell growth; thus, this medicine has a potent effect reducing psoriatic plaque formation.   Another study that was completed in 2007 showed “that treatment with high-dose topical becocalcidiol (Vitamin D analog) for eight weeks led to almost or complete clearing of moderate plaque-type psoriasis in over a quarter of patients. Therapy was safe and well tolerated.”  Finally, Rocaltrol, although pricier, has also been show to be an equally effective Vitamin D medication against psoriatic plaques.  If you change treatment plans, please consult your doctor ensuring that any Vitamin D derivative medication does not cause an allergic reaction with the Cyclosporin medication you have been prescribed.  Thank you for your question.

Respectfully,


Roshin

*
 WALKING PNEUMONIA:

Dear Doctor Roshin,
“For close to a month, I have had a really bad cough.  You heard my cough, and you were worried.  Thanks.  You mentioned I may have pnumonia but I feel fine.  Could you explain what may be causing my cough.  I also had this cough a few months back also lasting about a month.”   Ms. Ruth

Dear Ms. Ruth,
Your persistent dry cough was alarming, not only due to the sound; but rather, the duration of your cough coupled with other respiratory symptoms seems to point to a case of Mycoplasma Pneumonia.  Mycoplasma Pneumonia, also called atypical pneumonia or walking pneumonia, is one of the most common community acquired pneumonias in healthy people.   In other words, this pneumonia is atypical due to the fact that an individual is still able to work and perform daily activities unlike typical pneumonia which often requires hospitalization.  Your symptoms of occasional fever and or a scratchy throat, headaches, muscle aches, and a persistent, worsening dry cough added ammunition to a walking pneumonia diagnosis.  Furthermore, the fact that your doctor prescribed Claritin allergy medicine, which has provided no relief, once again, fuels my belief of a possible respiratory condition caused by the Mycoplasma pneumonia bacteria.   Fortunately, this pneumonia is treatable with antibiotics (Macrolides, Tetracycline) after the diagnosis is positively confirmed with a blood test (called cold agglutinins).  You should reconsult with your doctor about a possible Mycoplasma infection.  The fact that you work in a college is the perfect breeding ground for this bacterium; thus, please seek medical consultation as soon as possible.  Thank you for your question and trust.
Respectfully,
Roshin


BED BUGS
HI Doctor,
Two weeks after moving into a room of a shared apartment, I found bed bugs in my sheets.  Although the owner has changed the mattress and fumigated the room, I was wondering if bed bugs carry disease.  I have insect bites all over my arms.  Thanks.  Mr. Cluz





Hi Mr. Cluz,
Bed bugs, also called Cimex lectularius, have shown a remarkable ability to adapt and survive insecticide treatments.  Thus, bed bugs have seen a resurgence in all corners of our world.  Most of the clinical manifestations of bed bugs include an insect bite that leads to a skin reaction.  The bite leaves a red, circular, itchy skin lesion that should disappear within a week after washing with soap and water and the application of an anti-itch cream.  However, some people have shown serious allergic reactions, skin rashes, or a worsening skin infection (oozing pus) all of which require urgent medical evaluation.   Some studies have shown bed bugs to be carriers of  antibiotic resistant bacteria (Methicillin Resistant Staphylococcus Aureus and Vancomyocin Resistant Enterococcus faecium); however, although carriers, bed bugs have not been shown to transmit disease from one human to the next.  Thus, HIV, liver hepatitis, and other blood born diseases are not transmitted by bed bug bites.  Mosquito bites, on the other hand, do transmit blood diseases such as malaria and the West Nile virus.  Nonetheless, I am glad to hear your landlord has taken steps to rectify the situation.  Washing and changing linen, personal hygiene, vacuum and disinfecting the mattress, filling in cracks in walls and floors, and placing mattress covers will all help prevent future infestations.  If all fails, call a pest control specialist to handle the matter.  Have a safe and wonderful Memorial weekend holiday.  Thank you for your question.  
 
Respectfully,
 
Dr. Roshin


HEARTBURN

Hi Roshin,
Let me get rite to the matter.  I have been experiencing a burning sensation right in the middle of my chest for several months now.  It happens mainly after eating dinner.  I never had this problem before, and I wanted to know if you can recommend anything I can buy from the drug store.  Glad you are around.  Diamin



 
Hi Diamin,
As much as I would like to say the burning sensation in your heart is related to you hopefully falling in love, in actuality, you seem to be presenting with symptoms of heartburn.  The burning sensation is likely acid that has regurgitated from the stomach into the food pipe.   Spicy foods, caffeine, smoking, obesity, and eating within a couple of hours of sleeping tend to increase the chance of experiencing heartburn.  Thus, making gradual lifestyle modifications in diet as well as the timing of eating should relieve your present symptoms.  However, even one episode per week of heartburn requires medical evaluation from a doctor.   The doctor must order tests to rule out any heart condition as well as perform more focused exams on the digestive tract.  Specifically, the doctor may order an upper gastrointestinal scope, acid level readings, and check the pressure of digestive system sphincters making sure these valves are functioning properly.  If your symptoms are simply a case of heartburn, a short course of medicines to decrease stomach acid production should halt your symptoms.  Taking the medicine is important, since untreated heartburn attributed to gastric acid reflux, could evolve into a food tube cancer.  Whatever the cause, please be advised that serious adverse complications such as bleeding, hoarse voice, abdominal pain, vomiting, and weight loss are possible; thus, seek medical treatment as soon as possible.  Thank you for your question, and please stay in touch.  
 
Respectfully,
 
Dr. Roshin


MY SHOES NO LONGER FIT

Hi Doctor,
“My shoes do not fit me anymore.  This is not usual for me since I have had the same shoe size for all my life.  * Any ideas.  Thanks for your columns.”  Ms. SM


 
Dear Ms. SM,
Having to change your shoes twice over the past sixteen months is rather alarming; thus, your medical concern should be further investigated by a family physician.  Several etiologies do come to mind, all of which may require a physical exam, imaging, and blood work to confirm the diagnosis.  These etiologies include but are not limited to hypothyroidism, acromegaly, or fluid retention in your body.  The decreased production of thyroid hormone (called hypothyroidism) may result in weight gain; thus, your shoe size is altered.  Acromegaly, an endocrine disease, results in the excessive secretion of growth hormone on certain areas of the body including the hands, head, and the feet that could also contribute to rapidly changing shoe size.  Finally, fluid retention, due to a kidney or liver problem, heart failure, or pregnancy could result in shoe sizes being changed every few months if the water is not removed from the body.  Whatever the cause, you should visit a doctor as a means to identify the cause and treat accordingly.  Remember, a healthy diet and regular exercise regimen are imperative to keeping pounds off the body; thus, lifestyle changes may be the sole conservative, easy fix for your present concern.  Thank you for your question.  
 
Respectfully,
 
Dr. Roshin  


APHTHOUS ULCER
“Good morning Dr. 
My question is, I took my daughter to the dentist for normal control, the dentist did cleaning, on Sunday she began to feel irritation in the mouth as aphtous, fever started, I would like to explain to me about it.”  Thanks in advance, C.L.



Hi Ms. CL
The lesions on the inside of your daughter’s mouth, more than likely, are aphthous ulcers (also called canker sores).  Her multiple, painful  sores located on the gums are characteristic of canker sores as opposed to an isolated, cold sore caused by the Herpes virus, which are typically located on the lips.  Canker sores are caused by any irritation to the gum line including but not limited to hormonal changes, food allergies (coffee, fruits, chocolate, eggs, nuts, spices), mineral deficiencies (folate, vitamin B12), emotional stress, and digestive tract bacteria.  Your daughter’s recent visit to the dentist for a teeth cleaning may have irritated the gum line and cheeks resulting in the mouth sores.  However, her fever is disconcerting simply due to the fact that a fever is rare with canker sores.  Fever along with tooth pain is classic for a tooth abscess, and if an abscess is present, this dental condition requires immediate treatment.  Inform your dentist of developments since the visit to his office this past weekend, and ask if bitewing X-rays can be promptly taken.  These X-rays will immediately rule out any possible abscess formation.   At that point, a doctor or dentist has available options including prescribing a toothpaste or a mouthwash to help ease the canker sore pain.   Once the pain is relieved, your daughter should be able to talk and eat with relative ease.  In the meantime, pureed, softened foods should be given as opposed to solid foods.  The canker sores should heal, disappearing in one to two weeks.  I hope this information clarifies your concerns, and I thank you for your question and trust.  
Respectfully,
Dr. Roshin



JUVENILE ARTHRITIS:

Hi Roshin,
My daughter has been diagnosed with arthritis.  I had no idea that a child could have joint pains.  From the rash to not wanting to play on the jungle gym to mornings where she experiences much soreness and pain, all makes sense now.  Thanks for talking with me.  Sincerely, LPage

Dear LPage,
Juvenile arthritis is a term that envelopes inflammatory conditions of joints in children less than 16 years of age.  Juvenile idiopathic arthritis (JIA), once called juvenile rheumatoid arthritis, is diagnosed with a positive arthritic blood test and when a child experiences pain in one or more joints for at least six weeks.  A child may experience the following classic JIA symptoms including but not limited to joint pains, on and off daily fever, rash, muscle tenderness, dental problems, ligament tightness, awkward walking, eye problems, joint inflammation, and swelling.  Although no cure exists, treatment is based on the JIA type (polyarticular, oligoarticular, or systemic).  Furthermore, treatment options are  based on the severity of the  child’s symptoms,  and may include pain medications such as NSAIDS (Ibuprofen), Disease Modifying Anti-Rheumatic Drugs (Methotrexate), gold shots, steroids, or Biologics (Enbrel, Humira, Remicade).  Steroids cause serious adverse side effects in children; thus, all children must be weaned off this type of medicine as early as possible.  Most of the time, a simple pain analgesic will allow the child to resume normal activities at home and school.  However, some children with extreme arthritis may require a health care team including an ophthalmologist, pediatric rheumatologist, home health nurse, physical therapist, and or a dentist.  Educating the affected child as well as family members is key to maintaining a routine quality of life.  At the appropriate time and as the child progresses in age, more responsibilities for arthritic self care can be taught.  I know this seems like an earth shattering condition; but, please rest assured, that children I have known with this condition play sports, work, wed, and live a fruitful life.  My thoughts and prayers are with your youngest child.  Thanks for your question.  
 
Respectfully,
 
Dr. Roshin



WHAT ARE TICS?

Hello Doctor,
My cuzin was told he is moving all ovr and he cant stop b/c of ticks.  How can a bug cause ths?  Thx boss…  DJ Rip


Hi DJ,
Thanks for your question.  Fortunately, we communicated in person, clarifying that the “tick” you mentioned in your question is not the insect, rather a “tic” is an uncontrollable body movement.  Whether an eye blink, clearing the throat, sniffling, nasal flaring, mouth opening, grunting, twitches of the neck, humming, or cursing, tics can be vocal or bodily muscular twitches.  Tics may be caused by the following but not limited to stress, sleep deprivation, genetic and metabolic disorders, encephalitis (caused by ticks -the insect), and medications (Tegretol, Adderall).
  Your cousin has Attention Deficit Hyperactivity Disorder (ADHD), and he has been prescribed Ritalin medicine.  Although research results have been inconclusive, Ritalin has been known to cause tics; thus, he may want to consider changing medicines as recommended.  Your cousin’s doctor will and probably has made the best assessment for your cousin based on his allergic and past medical history.   Although no cure exists, tics are harmless often resolving on their own without medications (such as Haloperidol) or behavioral therapy.  Let us pray his tics are transient, disappearing just as fast as the twitch appeared.  In the meantime, stay well. 

Respectfully,



Dr. Roshin










BITTEN, DEFORMED NAILS
* * ** * * * * * * * Doctor Roshin , 
"how do i get my nails back to looking healthy? i been biting my nails for many years. Thanks." Andy Rodrigues




Dear Andy,
Nails serve the function of helping us open objects, peel fruit, scratch, protect the finger tips, and cover the nail matrix with a transparent, hard protein covering.  The nail matrix is responsible for nail growth; thus, a diet rich in vitamins is essential for the matrix to produce keratin, a protein necessary for restoring and maintaining the nail bed.  We are able to see the nail matrix with our eyes, as the white crescent called the lunula, at the junction of the nail bed with the skin.  Biting your nails for many years has resulted in your finger nail architecture being profoundly distorted.   Thus, first and foremost, you must identify the psychological reason behind why you bite your nails.  Whether stress, nervousness, anxiousness, or boredom, all probable causes have propelled an occasional occurence into a harmful habit.  Thus, although I have listed common Western and Eastern therapies to maintain good nail bed health, consulting a dermatologist or your family physician is essential to determine which supplements and vitamins ahould be taken based on your medical background.  The following treatments improve nail health.
 
1)      Western Medicine: Magnesium, Zinc, Vitamin C, Biotin, Riboflavin, Silicon, and Inositol (to promote nail growth).  Vitamin A (white spots),  Iron (Spoon nails)
2)      Chinese Herbal Medicine: Watermelon and Nori(Seaweed) for brittle nails.
3)      Homepathy: Antimonium (brittle nails).  Thuja (brittle & ingrown toe nails).  Graphite (deformed nails). Silicea (white spots, deformed nails), Belladonna (Yeast)
4)      Aromatherapy: Rosemary Oil (Improves blood circulation in nail bed).
Thank you for your question.
Respectfully,
 
 
Dr. Roshin




VIPoma:
Dear Dr. Roshin,
“Is there such thing as a cancer causing the runs?  My friends laughed at me when I said there was.  They said I should shut up.  Can you tell me.”   Thx PO



 
Dear PO,  
Thanks for your question.  Yes, there is a cancer that causes diarrhea (“the runs”), and the name of the cancer is a VIPoma.  VIPoma is a rare pancreatic cancer that secretes a hormone called vasoactive intestinal peptide, and this hormone causes the tremendous watery diarrhea.  Thus, if a person is losing weight and maintains persistent diarrhea symptoms, consultation with a physician is absolutely necessary since this untreated condition could result in dehydration (water loss), a loss of electrolytes leading to a heart arrhythmia and possible death, or spread of the cancer throughout the body.  In fact, usually, at the time of diagnosis, metastasis (spread) of the cancer has already occurred, and prognosis is dismal.  As long as the tumor is active, the cancer and diarrhea will continue to be present in that individual.  Thus, if you suspect a cancer, consult medical professionals as soon as possible.  Surgery of the tumor can cure the person of the cancer.  I hope this information has helped educate you and eventually your friends on this serious health issue.  I welcome further inquiries. 
 
Respectfully,
 
Roshin  Rowjee
 
 

SCOLIOSIS:

 
Hi Roshin, 
I have scoliosis.  Although I am aware of my condition, my scoliosis has not prevented me from going to college and being active.  However, I want to do exercises that will help prevent the condition from worsening.  What do you think?  Could you help me find physical rehabilitation centers where I live?  Thanks, Kathy


 

Dear Kathy, 
Scoliosis is a curvature of the spine that mainly occurs during the adolescent growth spurts.  Although this condition does not discriminate gender, females and genetics do play a role in overall prevalence.  Your condition is classified as a mild curvature of the spine; thus, routine visits to your doctor, observation (with X-Rays), and physical therapy should suffice in maintaining a good quality of life.  However, for some people, as the degree of scoliosis worsens, tremendous pain can result due to the uneven symmetry of the hip, shoulder, rib cage, and gait.  Thus, braces and or surgery may be offered as treatment options.  I have listed the following physical rehabilitation centers in your area, and I hope we continue to correspond well into the future.  Keep staying active!

1) Exercise Rehabilitation Program
201 Lyons Avenue, Newark, NJ 07112
Newark Beth Israel Medical Center
(973) 926-7245

2) Ferry Pain & Rehab Center LLC
    128 Ferry Street, Newark, NJ
    (973) 344-0129

3) Total Care Physical Therapy
17 Academy Street Suite 312 Newark, NJ 07102(973) 802-1160

‎  

Respectfully,

 

Dr. Roshin


GLUCOSE 6 PHOSPHATE DEHYDROGENASE DEFICIENCY:

Hi Roshin,
Thanks for mentioning that I should go to the hospital at that moment a couple of weeks ago.  It turns out as you said, I did have a worsening urinary infection that had gotten into the kidneys.  Also, thank you for mentioning that I should not be taking Bactrim, even though I have taken in the past for similar infections.  Anyway, this is just a thanks note to you.  Your friend,  BH.



 
Dear BH,
Your complexion that day, along with the fact that you missed work and classes, is unlike your normal nature.  Thus, I stopped and visited with you at length as to how your immediate medical history led up to your concerns that day.  After tapping your medical background,  I realized your past medical history of Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD), coupled with an extensive  urinary tract infection history, could be contributing to your present symptoms of fever and chills along with burning pain on urination, tenderness in the lower back where the kidneys are located, fatigue, and skin paleness.  When a bladder infection (called cystitis) ascends to the kidneys, there is little time to spare, and treatment must be initiated immediately.  I am glad to hear intravenous antibiotics were provided at the hospital followed by the subsequent dosing of Ciprofloxacin.  With your history of G6PD, Bactrim medicine should be completely avoided.  Glucose 6 Phosphate Dehydrogenase Deficiency causes red blood cells to rupture, and all medications that contain sulfa (such as Bactrim, Dapsone, and others) are a trigger for the condition; thus, these drugs, along with certain foods (Fava beans) should be avoided, always.  In fact, since G6PD does not have a cure, the patient must be selective and conscience of avoiding all triggers of this condition.  I gather that since you are writing a “thanks note,” you are feeling better, and that alone makes me happy.  Stay in touch. 
 
Respectfully,
 
Dr. Roshin


COCCYDYNIA:

Dear Roshin,
Thanks for taking time out of your weekend to help my family concern.   As I mentioned before, back in November 2010, my mother had a shot for back pain; but, ever since then, she has severe pain in her buttock area.  Do you have any idea what may be causing this?  I will bring test results as you asked. 
Thanks. 
Jen 




Dear Jen,
I realize your mother’s pain is causing you much distress; however, please try to stay focused on your studies.  I will help find the appropriate medical personnel to address your concerns.  After looking at your mother’s nerve conduction studies and EMG (electromyelogram) results, I must admit that there did not appear to be any definitive indication of the cause of your mother’s pain.  Furthermore, although the test results indicated an S1/S2 radiculopathy, the actual location of pain seems to
 indicate an S4/S5 source.  Specifically, every person has dermatomes, a region of skin innervated by a nerve.  Your mother’s pain seems to mimic the S4/S5 nerve distribution which would place the coccyx bone (tailbone) as a potential etiology for her discomfort.  Your mother may have coccydynia, inflammation of the tailbone located between the buttocks.  Coccydynia is often caused by trauma but this condition is known to occur spontaneously, causing pain and or tenderness at the tip of the tailbone.  Usually, a steroid injection does “miracles” by reducing inflammation, thus, reducing the pain.  However, since your mother mentioned excruciating pain at times while sitting and upon movement, surgery may be a last resort as determined by a neurosurgeon.  I have provided a list of both orthopedic surgeons who specialize in coccydynia surgeries as well as neurosurgeons in your locale.  An MRI of the lower spine and pelvis will probably be ordered in an attempt to locate the exact source of pain.  Please keep me abreast of findings, and your mother is in my prayers.  Thanks for your question. 
 
Respectfully,
 
Dr. Roshin




TOOTH PAIN:

Hello Doctor,
Thanks for visiting the other day.  I have a tooth where the top came off.   Over the past few month, my tooth is becomming more sore (kills me).   I do not have enough money to get this checked but I am scaredas to what is going on.  Could you take a look at my tooth.  Thanks man.  Lennie




 Dear Lennie,
After visiting with you at your job site, your upper, right second bicuspid tooth has a missing crown (top portion of tooth), but no exposed root was visualized.  However, since the missing crown is a product of a brawl you encountered one year ago, more than likely the root has become irritated if not inflamed. The crown of a tooth acts as a shield to the nerve and pulp, both of which are located in the root.  If the nerve has become inflamed, the sensitivity you are feeling to cold drinks is explained.   However, a more lasting concern, is preventing infection of the root.  If decay were to occur, both the nerve tissue and pulp become readily susceptible to oral (mouth) bacteria, and a possible abscess (collection of bacteria) could form infected tissue deep within the gums.   Infection of the tooth and root may already be occurring due to the fact that my pressing down on your tooth with a finger elicited noticeable pain.  Without treatment, a bacteremia (bacteria spilling into the blood) is possible; thus, further progression of the necrosis (decay) must be stopped immediately.  Please visit a dentist’s office as soon as possible; however, if a persistent fever develops or has developed, go to a hospital emergency room immediately, as antibiotics may be necessary to ward off a blood bacterial infection.   Once your tooth is evaluated clinically and with X-Rays (bitewings), a treatment plan (root canal, removal of tooth) if not emergency treatment may be offered.  In the meantime, puréed food instead of solid food should be eaten as to avoid the “killing pain of a tooth” as well as maintaining nutritional sustenance for your body.  Stay in touch and thanks for your question.
 
Respectfully,
 
 
Dr. Roshin



*CREPITUS:

Good afternoon, Doctor, 
when I read your columns, and I like what you writes, today was my turn to ask: have felt discomfort in the knee, squat when I feel it, and makes noise, because it occurs? because the? what are the complications and what should I do? It has to do with the menopause? Arthritis? Answer me please.  Ms. C.




 
Hello Ms. C,
Your knee “singing” as you so eloquently mentioned is a condition called crepitus of the knee.  Crepitus is a popping sound or crackling sensation, occurring in joints or tissues, due to friction caused by the rubbing of bones or air under the tissues.  Knee crepitus is common in people with a history of arthritis, osteoarthritis, occupations involving high knee impact movements, and natural aging.  Thus, with your notable history of arthritis and years of extensive leg impact movements, more than likely the cartilage in your knee may have thinned to such an extent, the knee joint bones may be in very close contact; thus, the crepitus sounds manifest on bending of your knees.   Fortunately, your past medical history is not significant for any trauma that could lead to air under the tissues causing the crunching sounds.  However, there is no cure for crepitus, and treatment options are based on the severity of the symptoms.   Your symptoms are mild without involvement of  pain, stiffness, weakness, swelling, or skin redness around the knee; thus, eating healthy (fish diet), maintaining an ideal body weight, brisk exercise (especially swimming instead of running), and wearing shoes that lessen the impact when walking, should help prevent the development of pain in the near future. 


 For people with crepitus and worse knee symptoms, steroid and hyaluronic acid injections, braces, physical therapy, knee replacement, or arthroscopic surgery are all options that can be discussed with the doctor.   If and when pain develops, the doctor may order a MRI to check for cartilage thinning, soft tissue injury, loss of lubricating joint fluid, and air in the joint space.  As for menopause,  crepitus is prevalent since the cessation of hormones leads to bone conditions such as osteoporosis.  Osteoporosis is characterized by bone erosion processes; thus, crepitus typically results.  However, since you are light years (nine years to be exact) from menopause, a modification of your lifestyle patterns will serve well in enjoying your post menopausal years.  Thanks for your question.  
 
Respectfully,
 
Roshin




* DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS:


Dear Roshin,
After visiting the doctor for an unrelated condition, I was informed that I have “parrot’s beak” in my back.  I was told to take fish oil to help treat the condition.  Could you write more about this condition in the spinal cord?  Thanks Mr. “Silver”



 
Dear “Silver,”
Parrot’s beak is the term given to bone formation (called osteophytes),  found on a X-Ray, located in front of and distinct from the spinal cord’s vertebrae.  This finding is associated with a condition referred to as Forrester’s Disease or Diffuse Idiopathic Skeletal Hyperostosis (DISH).  Since the vertebral disc space is not commonly narrowed, adverse effects including nerve impingement may not pose an immediate problem.  However, calcification resulting in hardening of the ligaments and tendons that attach to the spine may produce varied complications, notably, pain and stiffness of the back.  Occasionally, the spinal bony protrusions may protrude into the esophagus (our food tube) or the trachea (our wind pipe) effectively making swallowing and breathing difficult.  Nonetheless, I am glad to hear that your symptoms are mild in comparison to the trauma you sustained from your recent fall.  In fact, the DISH was an incidental finding on the X-Ray by your doctor when in actuality, he was looking for rib fractures.  There is no definitive cure for DISH; however, the combination of pain medications and physical therapy should assist in maintaining flexibility.  The glucosamine chondroitin, you mentioned, should only help this condition; however, consult with your doctor as certain medicines mixed with glucosamine chondroitin are known to cause serious side effects such as excessive bleeding when used with blood thinner medicines.  Furthermore, studies do suggest that fish oils (omega 3) have anti-inflammatory actions; thus, increasing your fish diet or supplementing fish oils should provide additional security against the possible development of symptoms.  Take care and thanks for your question. 
 
Respectfully,
 
Dr. Roshin



STATUS EPILEPTICUS: WOMAN SEIZURES (> 35 min)

Dear Roshin,
Thank you for helping my wife at the gym when she started seizing.  My family thanks you also.  The doctors are still trying to find an explanation for her prolonged seizures but as of now, they are unable to explain.  Do you know what might have caused the seizures?  Thanks “Ade”



 
Dear “Ade,”
When your wife began to seize, the circumstances of my being in the right place at the right time is fortunate.  After your wife’s seizures did not cease following approximately twelve, consecutive minutes, my main concern was making sure her circulation and breathing were maintained.  Your wife had a strong carotid pulse and was breathing the entire thirty five minutes I was with her prior to the paramedics arriving and taking over the emergency.  Yet, I am very sorry to hear that after four days since the incident, she remains unconscious in the hospital.  Your wife had a status epilepticus attack.  Status epilepticus is defined as continuous seizure activity or seizures that occur without return of full consciousness between episodes lasting longer than 30 minutes.   While attending to your wife, I was actively, pondering the cause of her prolonged seizures.  Usually, doctors try to identify four possible etiologies of status epilepticus:  1) Nervous System Causes (brain tumors, brain abscesses), 2) metabolic causes (too low or too high Na+/Ca+/other electrolyte levels), 3) infectious causes (bacteria that cause meningitis, encephalitis, HIV infection), or 4) medications/toxins (aspirin, anti-depressants, isoniazid).   Your wife’s medical history of a brain tumor removed by surgery three years might prove to be the most important link to her present state.  However, since all her electrolytes were in the normal range and her CT scan ruled out tumor, edema, and bleeding, this was the reason neurologists were asked to consult on your wife’s condition.  At your request, I did consult with the Emergency Physician who was assigned to your wife upon admittance, and he mentioned that ativan medication was given both in the field (at the gym) and at the hospital.  Ativan (also called Lorazepam) is known to be successful in terminating status epilepticus episodes in 60-90% of patients.   Other medicines such as Pentobarbital, valproate, propofol, and levetiracetam, have been used with reliability; undoubtedly, ativan proves superior.  Your wife was intubated due to fear of respiratory depression due to the prolonged seizures as well as the use of propofol anesthetic.   The breathing tube is necessary to ensure adequate oxygen reaches the brain thus preventing permanent brain damage.   As far as prognosis, I would ask that the neurologist who have been called to consult on your wife’s condition could better answer your question.   I wish I had the capability to do more for your wife; however, please know that my heartfelt thoughts are with her to not only to regain consciousness, but also, I pray for her full recovery.  God Bless.  
 
Respectfully,
 
Roshin
 


LOW POTASSIUM LEVELS:

Hello Sir,
“I am always so tired.  I belief I have amnemia.  After getting a cold, I went to a clinic, and they said I have no pottsasiym (?).  My friend said eat bananas.  /what shud I do.  At Walmart, I saw pottsasiym medicine.  Shud I take this.  Need ur doctoradvice4u help.”  Rosemary in NY

 


Dear Rosemary in NY,
Thanks for your question.  Since there was no follow up contact details sent with this question, first, I must express that all information I have provided must be consulted with your local doctor or clinic health professionals.  Feeling continuously tired opens a realm of possibilities.  Whether a low thyroid level, immune disease (AIDS), lack of nutrition, lack of sleep, natural aging process, depression, obesity (causing sleep apnea), a heart condition, dehydration, anemia or low potassium, all these conditions could lead to fatigue-like  symptoms and must be evaluated by your doctor.  Once your past medical history is obtained, blood tests and imaging scans are ordered as needed, and future, regular visits maintained, an appropriate treatment plan should help remedy your tiredness.  As for potassium supplements to increase your low potassium levels, this is not a good idea especially since one lab result does not necessarily mean you have a low potassium level.  Potassium is a key element in the body that is necessary for your heart, muscles, and digestive tract to function.  Potassium allows muscles to contract (allowing movement such as walking), allows the digestive tract to process the food we eat, and the heart to beat properly, thus partly regulating blood pressure.  People who are diabetic (and taking insulin), alcoholics, have an eating disorder,  malabsorption syndromes, kidney problems, excessive vomiting/diarrhea, an adrenal gland condition, or taking specific medications, are all at increased risk for low potassium levels.  However, taking potassium supplements by yourself without a doctor’s supervision is not advised because too much potassium could also lead to your heart not beating properly as well as other health complications.  Thus, by now, I am sure you can appreciate the importance of visiting a doctor to further evaluate the cause of your fatigue.  If I may be of further assistance, please feel free to ask.  Take care.  
 
Respectfully,
 
Dr. Roshin 


DOES VACCINATIONS EFFECT KIDNEYS?

Hi Doc,
I wanted to take the flu shot earlier this month but I am worried that it would effect my kidneys and make them worse.  What do you think? (Gerald, age 59, male)




Dear Gerald,
Vaccinations are biological agents that help the body improve immunity to disease.  The vaccine contains a weakened form of the bacteria or virus, and upon administration, that person’s immune system is stimulated, conferring protection as needed if the actual strain becomes prevalent in the body.  Although many questions are posed concerning side effects of vaccines, for many, the benefits far outweigh the risks of not having the vaccinations.  For example, the influenza vaccine is beneficial for the elderly who are age 65 years of age and older, residents of chronic care institutions such as nursing homes or assisted living facilities, health care workers, children, people with chronic diseases, and pregnant women.  Yet, influenza vaccine side effects do occur especially if an individual has an allergy to eggs (avidin); thus, in those instances, influenza vaccines are never indicated.  
As for your question, however rare, there are documented cases of vaccinations suspected of altering kidney histology resulting in compromised kidney function.  Specifically, some vaccinations, such as the Hepatitis B vaccine, meningococcal vaccine, influenza and pneumococcal vaccine, and tetanus/diphtheria vaccine have been linked to a lupus nephritis, minimal change disease, and other types of nephrotic kidney diseases.  Yet, for the vast majority of people, administered vaccinations complete the intended purpose…boost the immune system.  
Thus, since your blood tests seem to indicate a growing renal insufficiency problem, my recommendation would be to consult a nephrologist (kidney doctor) about obtaining a vaccine.  Your past history of no significant ill effects with previous influenza vaccines holds well; yet, better to be safe than sorry when new agents are being placed in the body.  All people vary in their response to medicines and vaccines, and that poses a definite challenge in the practice of medicine; however, your asking questions should culminate in a desired outcome.  Thanks for your question.  
 
Respectfully,
 
Dr. Roshin


*
 BAKERS CYST OF KNEE:

Hi Roshin,
I have this swelling that has formed behind my knee on the right side.  Sometimes I get pain and discomfort but most of the time, the swelling is just there and doesn’t cause a problem.   Could you tell me what this is and what should I do?  Thanks Marge
 



Hi Marge,
Nice to hear from you.  Realizing that we merely talked as opposed to my viewing the swelling behind your right knee, first and foremost, please visit a local clinic or emergency room for further evaluation.  Swelling behind the knee could range from inflammation, to an aneurysm of a knee artery, to a Baker’s Cyst, or a developing blood clot.  All these mentioned conditions require prompt examination and treatment especially if a blood clot has formed causing pain in your lower leg.  Knowing you have a history of joint arthritis leads me to think of a Baker’s Cyst; but, as stated, if a clot has formed, this is a life threatening condition requiring immediate attention.  A Baker’s Cyst, a swelling located posterior to the knee cap, often forms due to the excessive formation of synovial fluid, a watery liquid that bathes the knee. The excessive fluid may be due to trauma or an inflammatory condition to the knee.  Depending on the severity of symptoms, treatments may involve steroid injections, surgery, removal of the fluid (called an aspiration procedure), or observation.  Nonetheless, a Doppler ultrasound of the lower leg must be done to evaluate the swelling size and potential cause.   Please have this ultrasound procedure done as soon as possible. Thanks for your trust.
Respectfully,
Roshin


NONULCER DYSPEPSIA:

¡Hola Medico,
Thanks for the time to help mi familia.  Doctor say mi mami has stomach gastritica and de medicina to make it better he giv.  I go to the pharmacia in Decembre  to get the medicina but mi mami  no taken it.  She says she has been to busy and keeps to forget.   Porque importante de medicina para mi mami.  Gracias.  JDS



Dear JDS,
I am humbled that you have asked me to explain to your mother the importance of taking the medicine she was prescribed to combat her gastritis.  Actually, after 
visitingwith her doctor, your mother has
 nonulcer dyspepsia, the most common disorder linked to recurrent pain in the upper abdomen.  Nonulcer dyspepsia mimics symptoms of ulcer disease (pain, bloating, and nausea) but no ulcer exists (thus no upper gastrointestinal  bleed).  Your mom’s persistent pain and tenderness upon palpation prompted an endoscopy procedure and an acid level test; however, both were negative; thus , nonulcer dyspepsia is the more appropriate diagnosis versus gastritis.  Commonly, food, alcohol, certain medicines (aspirin, ibuprofen), and smoking  cause the nonulcer dyspepsia symptoms.  Thus, compliance with the prescribed medicines is very important to prevent worsening of her condition. Noncompliance with the prescribed medicines could result in increased acid secretion causing a full fledged gastritis and more importantly, the risk of stomach ulcers along with gastrointestinal bleeding significantly increases.  The Dexilant is a medicine to prevent excessive acid formation, and the 10 day course of Pylera was prescribed to combat Helicobacter pylori bacterium.  Although your doctor did not mention this bacterium in our conversation, she must have a hint that this “bug” may exist in your mother’s body.   The Pylera will rid your mother’s body of the bacteria.  Helicobacter pylori bacteria is the source of eventual peptic ulcer disease; thus, the importance of taking the medicine is apparent.  Once your mom begins the antibiotics, she must complete the course as recommended by her doctor.   Failure to complete the course of antibiotics as prescribed could potentially result in the Helicobacterpylori bacteria not only thriving but also potentially building resistance to the
 medicine.  Your mom should understand that as long as she takes the medicine that was prescribed and avoid the triggers that cause her acid levels to increase, the nonulcer dyspepsia should be a short term hassle.   Dexilant does have serious allergic reactions; thus, if your mother develops facial swelling, difficulty breathing, or if blood is found in the stool, contact your doctor immediately or dial 911.  Thank you for your question.   
 
Respectfully,
 
Dr. Roshin




SHOULDER ROTATOR CUFF TEAR:

Dear dr. Roshin, 
I often read your articles in Brazilian Press newspaper. In the last two months I have felt a pain in the shoulder. It has cost me to sleep because the pain is very strong. I am a hairdresser, and I'm having trouble doing my job. Can you help me? Thank you, Mrs. L.
 

 
Dear Ms. L,
 
After visiting with you and examining movements of your left shoulder, your pain appears to be attributed to either a rotator cuff tear or severe bursitis.  Since your X-Ray several months ago, you mentioned that your doctor’s office never contacted you with the
 
results; however, judging by your explanation of steadily increasing pain, and witnessing your inability to raise your arm over your head, the condition may have become worse due to lack of early treatment.  In addition, the fact that your arm’s range of motion (elevating your arm from the side of your body) is limited to less than sixty degrees before pain ensues, this necessitates a magnetic resonance image (MRI), a scan that vividly details tissue and muscle damage.   The rotator cuff is composed of four muscles (teres minor, subscapularis, supraspinatus, and infraspinatus), all of which envelope the shoulder joint allowing rotation and elevation of the shoulder.  When muscles of the rotator cuff tear, symptoms such as weakness of the effected arm, pain when sleeping on the effected arm, and lack of use of that arm due to pain, become common.  The extent of the possible tear or severe inflammation of the cavity that houses the shoulder joint (called a bursitis), can both be assessed using the MRI image, and treatment options can be offered accordingly.  Pending interpretation of the MRI images, in combination with your present symptoms, the doctor may suggest treatment options including but not limited to steroid shots (to decrease inflammation), pain medicines, ice and rest of that arm, and or future surgery.  Thus, to avoid possible further worsening of your shoulder condition, please visit your doctor as soon as possible.  Let us begin the New Year 2012 pain free.  Thank you for your question and trust.
 
Respectfully,
 
Dr. Roshin



* **   *CANCER & OXYGENATED WATER

HI dOCTOR,
* **   *

“my cousin suffer pankreas cancer & she drink oxygen water continuosly....then wat is the effect to her disease condition?”  Thank you HerTS (Indonesia) 





Dear HerTS (Indonesia),
Pancreatic cancer is cancer of the pancreas organ.  Like all cancers, normal cells of the pancreas, undergo changes (called mutations) leading to abnormal cells, which grow uncontrollably, becoming the eventual tumor.  Pancreatic cancer can effect either the pancreatic ducts and or the cells that produce pancreatic hormones.  Either way, usually, upon diagnosis, most pancreatic cancers are already in advanced stages requiring aggressive treatment measures with radiation and or chemotherapy.  Your mentioning that your cousin uses oxygen water as the sole means for cure of her pancreatic cancer is troubling.   Oxygenated water, or more specifically, oxygen, is used in conjunction with radiation or chemotherapy, to reduce pancreatic tumor size.  In fact, this past summer, researchers at the Alfred Mann Institute for Biomedical Development at Purdue University in America developed a device called an oxygen generator, which when placed in the vicinity of the pancreatic cancer (in mice), generated oxygen, which effectively enhanced the chemotherapy’s effect to reduce the tumor size.  If the oxygen generator was not placed in the area of the pancreatic cancer, the tumor took much longer to shrink in size.  Also, this month (December 2011), a vaccine has been developed that dramatically reduces the tumor size of breast and pancreatic cancers.  I have provided links for both the oxygen generator, the researcher’s oxygen experiment abstract, and the vaccine on my website, DoctorAdvice4u.com.   Thus, although, oxygenated water is touted as an immune booster, an augmenter of vitality and energy, and a cancer preventer, there is much published medical literature that seems to indicate the opposite.  Bottom line, HerTS, the benefits of oxygenated water, alone, to cure pancreatic cancer are inconclusive.  Thus, I recommend you consult a doctor in Indonesia who specializes in treating cancers (called an oncologist).  Chemotherapy is very strong medicine that is toxic to cancer cells, and your cousin needs these chemotherapy drugs with urgency to live.  Although many alternative treatments, home remedy’s, herbs, and folklore  exist for fighting cancer, the truth is time is of the essence, and the sooner you can locate a doctor who specializes in the treatment of cancer, the better your cousin’s long term prognosis.   I will help you locate an oncologist in Indonesia from the network of doctors I know living around the globe.  In the meantime, have a safe, wonderful holiday season, with blessed wishes for your upcoming New Year.  God Bless.

Respectfully,

Roshin

Links:

1)  PURDUE UNIVERSITY ARTICLE  http://www.purdue.edu/newsroom/research/2011/110830ZiaieOxygen.html

2) RESEARCHER ABSTRACT   
http://ieeexplore.ieee.org/Xplore/login.jsp?url=http%3A%2F%2Fieeexplore.ieee.org%2Fiel5%2F10%2F6047315%2F05975204.pdf%3Farnumber=5975204&authDecision=-203

3) CANCER VACCINE
http://www.mayoclinic.org/news2011-sct/6614.html

ALLERGIC REACTIONS

Dear Dr. Roshin, 
I got your email through newspaper Luso-Americano. I am recovering two weeks ago from shingles, varicella such as "zoster." I'm only 47 years, and got a fright. It started with severe pain and burning in my right breast. I thought the bad thing, nodular. Suddenly appeared to me an allergy in the back, and went sprawling. Four days later, there was water and pus. On the fifth day I went to the doctor and he found that area was. He told me that my immune system was weak. I'm allergic to many things, and I take Crestor 20 mg and Omega 3 Lovas. My cholesterol and triglycerides are high. I have them controlled with medication and diet, sometimes also take maximum factor Rejoice, all with a prescription. Due to the virus, I have anti-viral medicines (pills rock) and strong medicine for pain, too strong. My question is: What must I do to my immune system is strong and resistant to allergies in this country? Thank you, VS

 

 

 

 

 

 

 

 

 



Dear VS,
An allergic reaction occurs due to the immune system perceiving a substance (called an allergen) as being foreign within your body. Allergen types that may provoke an allergic reaction include mold, medicines, pollen, pet dander, food, and venom. The allergen, suspected to be potentially harmful to the body, prompts the body to manifest symptoms such as swelling, fever, hives, wheals, reddening of the skin, blisters, runny nose, sneezing, wheezing, edema, and or possible, fatal anaphylactic shock. Since you mentioned having allergies “to many things,” identifying then avoiding those triggers is important. Methods used by doctors to identify specific allergic triggers include a skin test (called a prick test), blood tests, and an elimination diet test. The prick test involves placing different allergens under the skin (of the arm or back), and awaiting an allergic reaction within seconds to minutes of its placement. A positive prick test means symptoms were detected, and the patient must alter their lifestyle to avoid any fatal consequences of an adverse reaction. Blood tests are used to measure antibody levels to various allergens, while the diet elimination test removes then adds specific foods while anticipating an allergic response. Yet, in general, the immune system can be bolstered by a healthy diet and daily exercise regimen. Foods rich in antioxidant fruits and vegetables, vitamin and mineral supplements (A, B,and C Vitamins, Zinc, Magnesium, Iron), herbs (garlic, echinacea, licorice, ginseng), nuts, fish, yogurt (for bowel health), and aromatherapy (lavender oil or melissa) are known to boost the immune system warding off infection. However, before trying any suggestion(s) listed above, consult your doctor as your past medical history is necessary to recommend specific allergen testing methods and treatments over others. Thank you for your question.


Respectfully,


Dr. Roshin



PAPILLARY THYROID CANCER

Hello Doctor,
This past week, my doctor said I hav the thiroid cancer. But he says, will be ok. We make the plan for the cirugia. Why ok, I hav the cancer? Gracias Galena



Dear Galena,
Cancer of the thyroid glands is called thyroid cancer. This cancer changes normal, functioning cells in the thyroid gland to cancerous cells due to some of the following causes: prior irradiation to the neck, genetic causes, low iodine intake, and a hypothyroid condition called Hashimotos Thyroiditis, The thyroid gland determines your basal metabolic rate, in other words, your energy level. Thus, your symptoms of seeing an enlarged neck in the mirror, coupled with difficulty swallowing and increased fatigue, warranted an examination of the head and neck area. After your doctor ordered neck tissue images, did blood hormone levels, and performed a biopsy, your results suggested a thyroid cancer, specifically,papillary carcinoma. Papillary thyroid cancer is the most predominate cancer of the thyroid gland accounting for 80% of all thyroid gland malignancies. However, of all the thyroid cancer types, papillary carcinoma has the best prognosis. In fact, a total thyroidectomy (total removal of the thyroid gland) is virtually curable in cases of papillary carcinoma. With total resection of thethyroid gland, ninety percent of patients have a twenty year survival rate. Thus, the reason your doctor said all “will be ok,” is that you have a cancer that is known to be treated with much success. The surgery will involve removal of the thyroid glands and the lymph nodes, both of which contain the cancer. Radioactive iodine may be used after the surgery to remove any remaining cancer; however, this treatment is contingent on a person's immunity and pregnancy status. As compared to other types of thyroid cancer which are more aggressive and spread easily through the blood, papillary carcinoma of the thyroid is benign. Therefore, aside from possibly taking thyroid hormone after the surgery is complete, your life should resume normality, and yes, at that point, you can eat as many quesadillas as you wish. Thanks for your question.

 

Respectfully,

 

Dr. Roshin



INGUINAL HERNIA

Hello Roshin,
Since I have known you, I have always had health insurance. But, this past year, I dropped my health insurance coverage because the premiums increased. So, I am working, but I have no coverage. For the past six weeks, I have had a hernia but over the last two weeks the pain is much worse. In fact, on a couple of days the pain was excruciating. I can not afford the total cost of the surgery, and even a payment plan is going to be difficult to pay since I am barely making all my bill payments. I have trusting my faith that all will be well. Could you help please?” Thanks Mr. LC



Hi Mr. LC,
I am sorry to hear the difficult choice you faced of having to cancel your health insurance coverage due to the premium costs increasing from $1100.00 to $2400.00 this past year. Although you presently do not have insurance, since the injury occurred on the job, there still might be an avenue to claim for the injury, possibly. An inguinal hernia is a tear that occurs in the lower abdominal wall allowing organs or a segment of the intestine to protrude through the opening, noticeable as a groin bulge. Your tear was likely due to increased abdominal pressure elicited from picking up heavy objects at your workplace. Furthermore, having a family history of hernias (your father), older age (57), male gender, bouts of constipation, and occupation are all factors that specifically increase your risk for a possible hernia. You mentioned that upon a visit to an emergency clinic, a doctor performed a physical exam and subsequently diagnosed youwith an inguinal hernia. Although at the time, the doctor mentioned that the hernia would be addressed in the interim with observation only , your excruciating pain symptom is disconcerting. One of the major complications of an untreated hernia condition is incarceration and strangulation. Incarceration is a segment of an intestine kinking on itself while strangulation is the blood supply being compromised due to the kink of the organ. Both complications present with pain of varying levels, nausea, vomiting, and possible fever, and both require emergent treatment. I took the liberty of contacting a general surgeon in your city, and he has not only agreed to work with you on a payment plan; but, the surgeon's secretary has offered a hospital contact who should be able to assist with potential charitable contributions offsetting majority of the total cost of the hernia treatment. In addition, there are out of hospital rehabilitation centers that offer various payment options after substantial discounts. I will forward all the information to you. Treatment will likely involve placing a wire mesh over the tear (called hernioplasty); and, this treatment is necessary for you to resume normal daily living free of pain. Just as your pain is upsetting to your wife, I too am not accustomed to seeing you in pain; however, the surgeon I have referred you to is a personal acquaintance and understands the economic challenges facing many families. If your hernia pain becomes completely unbearable, go immediately to the emergency room or call 911. As you consult with the surgeon, if I may be of further assistance, simply ask. God Bless and stay in touch.

Respectfully,

Roshin




MARGINAL CELL LYMPHOMA

Hello Roshin,
We have been concerned about “Freddy” due to his recent diagnosis of Nodal Marginal Cell Lymphoma. Unfortunately, for close to two months, he has missed appointments, possibly due to his homelessness.  Yet, his prognosis will become worse the longer he remains untreated.  Realizing he asked you to be his patient surrogate, we support your attempt to try to reach him. --- "East Texas Docs'



Dear “Freddy,”
After consulting with your oncologist and gastroenterologist this past week, this column has been written specifically to you in the hope that you read the information, then contact either your doctors or me. The reason for our concern is simple. Your bone marrow procedure landed a diagnosis of aggressive Stage IV Marginal Cell Lymphoma. Thus, time is of the essence to reverse the effects of this cancer. 

Marginal Cell Lymphoma is a cancer that changes the cells in an area of the lymphocyte called the marginal zone. Lymphocytes are good cells in the body that fight off infection; however, the cancer's ability to change these cells results in loss of the lymphocyte's function to repel infectious processes.

According to your oncologist, the Marginal Cell Lymphoma will be treated with a chemotherapy treatment called CVP (Cyclophosphamide, Vincristine, and Prednisolone). Another medicine called Rituximab may be added as an adjunct to the CVP regimen. 

However, the CVP regimen is not able to be initiated due to one fact. You have also been diagnosed with Hepatitis C Genotype1.Yet, your gastroenterologist wishes to enroll you in a clinical trial involving the use of a triple medication treatment to cure the Hepatitis C. The triple therapy uses Ribavirin, Interferon, and either Telaprevir or Boceprevir medications. The success rate of cure with use of this triple therapy is 70-80%. Once the Hepatitis C is cured, your chemotherapy treatment will promptly begin. 

Additional good news includes the fact that Medicaid has been approved for both your chemotherapy treatment as well as the triple therapy clinical trial for the Hepatitis C. 

As you can see, unlike the past, the stars, now, have definitely aligned in your favor. You must contact your doctors or me as soon as possible. The sooner you are able to reschedule your appointments, the sooner the lymphoma can be placed into remission. With that in mind, I extend a prayer to you hoping that you read this column, realize your life hangs in the balance, then make the appropriate phone calls. God Bless.


Respectfully,


Roshin





* HEART CATHETERIZATION

Dear Roshin,
“ Two weeks ago, I was told to pay a $275.00 copay before I could see the doctor. I had a heart attack about six weeks ago, and I was taken to the hospital. There were tests done, and they told me I had a heart attack but I left the hospital due to them upsetting me after a procedure was scheduled by not never done without an explanation. Could you look at all the paperwork and tell me what I should do now? By the way, I do not have all the money to pay the doctor right now.” Thanks. Mr. M



Dear Mr. M,
After you brought a copy of all your doctor, hospital, and test records, I sifted through the information confirming that you indeed had a heart attack. Judging by the EKG results, you suffered an anterolateral myocardial infarction. Furthermore, the heart enzyme tests were positive for a possible heart infarct, but your stress test results were more definitive showing ischemia, defined as chest pain due to decreased blood flow through the coronary vessels of the heart. The procedure that was scheduled at the hospital was a heart catheterization. A heart catheterization is a procedure that determines the number of occluded vessels and the extent of occlusion in each heart blood vessel. From the heart catheterization information, either a heart angioplasty, a procedure that opens the clogged vessel with or without a heart stent, or a CABG (coronary artery bypass procedure) is done to circumvent the infarcted areas of the heart. A heart stent is a cylindrical wire mesh placed in the area of the occluded blood vessel to help prevent reocclusion of the vessel. Why did your heart vessels occlude in the first place? Your medical history of high cholesterol, fatty diet, stress, and hypertension are all major contributors to atherosclerosis and plaque build up causing clogging of the vessels. In fact, I believe an eventual heart catheterization test will probably show a blockage of the Left Anterior Descending Artery and or its branches. Nonetheless, whatever misunderstanding you had with your doctors, leaving the hospital against medical advice, leaves your life in the balance. In the other words, without significant changes in your lifestyle, another heart attack is almost certain, except the next time, the outcome may be fatal. The heart catheterization procedure is both an investigational and interventional tool necessary to prevent future heart attacks; thus, I emphatically recommend that you have the heart catheterization procedure done as soon as possible and with extreme urgency. Time is of the essence, and since you still have many goals in life yet to fulfill, your ambitions may not come to fruition without this procedure. As far as the copay is concerned, setting up an affordable payment plan should allow your visit(s) to proceed. I will make a call on your behalf. Thanks for your question, but please, do the heart catheterization TODAY if possible.


Respectfully,


Dr. Roshin

 


TRANSVERSE MYELITIS

Hello Dr. Roshin,
I was ok one morning, 3 months ago, and like 1,2,3, I lost my power from waist down.I lost my walk, and my back and front burning all the time,and my foot are burning and cold the most the dime, I still not controle my #1 and 2, but I never have any pain. No one doctor nows what hapens to me, I only have terapia 3 times a week, I walk a little better now, but my foot and back & front still burning all the time and I still not control my #1&2.Can you please help me? Thank you for your time “ --- Ms. E

 

Dear Ms. E,

After visiting with you and your husband concerning your present symptoms, I truly felt your worry, confusion, and uncertainty about the future. Realizing you are 70 years old with no significant medical history other than hypertension, the symptoms you experienced on the morning of July 29, 2011 were certainly shocking. Waking up one morning, only to have weakness in both lower limbs, no power from the waist down, urinary and fecal incontinence, and a burning sensation in the pelvis, buttocks, and legs, symptoms that never been experienced before, is very alarming. Furthermore, being admittted then released after a one week hospital stay, requiring an extensive course of both intravenous and oral steroids is significant. Yet, like yourself, I am stunned that two MRIs, one body CT, an electromyogram (EMG), and blood work were all normal. Thus, your doctors have been conflicted on a diagnosis suggesting a range of possibilities from Cauda Equina Syndrome to a viral etiology to no diagnosis at all.

I wish to offer my opinion based on the imaging results as well as the history you provided leading up to our conversation. I believe you may have a neurological condition called transverse myelitis. Specifically, transverse myelitis results due to an inflammatory process effecting a certain segment of the spinal cord. In your case, more than likely the lumbar (lower level) spinal cord had intense inflammation resulting in symptoms similar to those you mentioned including weakness of the legs or arms, pain, bowel and bladder dysfunction, sensory alterations, and motor incoordination. Typically, the inflammation will cause demyelination of the nerves; thus, the very substance that allows our motor abilities including walking, running, and control of bowel movements, rapidly disappears when left untreated. However, the fact that after steroid administration, your motor skills improved during and after your hospital stay and now during physical therapy, lends significant credence that an inflammatory process was reversed. Furthermore, Cauda Equina Syndrome is more often than none due to a herniated disc causing saddle anesthesia (bowel and urinary problems), sensory, motor, and bowel dysfunction; yet, since the MRI and CT scan were negative for any vertebrae disc protrusion, the diagnosis of transverse myelitis seems more apparent. 

Autoimmune disorders, viruses, and bacteria are also additional causes to transverse myelitis yet, I wish to make one suggestion related to the doctor who suggested a viral etiology. Specifically, consult with your neurologist about conducting a lumbar puncture to obtain the fluid that bathes the brain and spinal cord. This procedure might definitively rule in a viral cause for your condition versus mere speculation.

The fact that your husband mentioned your rehabilitation has shown profound motor skill recovery these past two months, holds well for overall recovery from transverse myelitis. Often, little improvement in the first three to six months holds a dire prognosis that significant recovery is unlikely. Nonetheless, continuing to work with your neurologists, family doctor, and physical therapists should aid in the recovery time. I offer a heartfelt speedy recovery, and if your optimism is any indication, that recovery should come much sooner rather than later. God Bless.

Respectfully,


Roshin

 

 

 

DRUG ADDICTION:
 

Hello Roshin,
“ I met you a few years ago in passing but I kept your card knowing this day would eventually come.  As much as I hate to admit it, I am a drug addict. I have yet to do anything about it besides print out where cocaine anonymous meetings are in my geographic area and send this email. I have ordered a book that deals with addiction but have yet to read. My first question is what immediate and long term damage am I doing to my body and my brain. I know it is taking a toll on my body and i do not want to go out this way for this. If I get the help I need now, is there anything I can do to repair the damage I may have already done/caused? Secondly, despite my addiction I have successfully started a business that makes it difficult to take the time away to probably entire a full time rehab facility. That being said, I have looked into outpatient rehab. Is it correct that this is available and would allow me work when necessary? Thanks in advance for your help.” Sincerely, Mr. L

Dear Mr. L.,
I am deeply humbled that after many years, you remembered me and have sought information accordingly. Thus, to better help you, I took time to visit with a licensed drug addiction counselor, who was a cocaine addict herself, prior to turning her life around. She has shared some profound, powerful personal words of wisdom (written below) to help you overcome your addiction. The mere fact you have recognized a problem and have the will to change the direction of your life, after many years of addiction, is a huge hurdle many people in your shoes never reach. Thus, congratulations on attaining this first milestone, realizing the road to recovery will have many more challenging days; but, with support groups, medical professionals, and the assistance of licensed addiction counselors, your new life begins today.

As far as your health is concerned, all forms of substance abuse, depending on the amount and duration of use, can cause profound changes to the brain and body. Thus, detoxifying from the substances within your body is the first step in treatment, and since withdrawal side effects are common, having medical personnel assist this initial step is key to eventual success. I have provided a national link for the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA, http://dasis3.samhsa.gov/), and this link provides location information on nationwide rehabilitation substance abuse facilities for any and all people who seek treatment and recovery. 

The use of cocaine causes vast psychiatric and vascular disorders including but not limited to paranoia, auditory hallucinations, mood disorders, delirium, delusions, anxiety, sexual dysfunction, sleep disorders, heart attacks, arrythmias, stroke, chest pain, bowel gangrene, seizures, headaches, respiratory failure, blood born sexually transmitted diseases, and allergic reactions. Reversing cocaine's effects begins the day you stop taking the drug; however, organ damage can only be evaluated after further imaging scans and medical procedures are completed. Withdrawal from cocaine will create a whole new set of symptoms you have not yet experienced, and your strength and commitment will be tested. Thus, consulting with a physician from the start of your treatment plan till its completion is highly recommended not only to achieve success in your recovery; but also, your doctor can provide advice on countering established and residual effects based on your past and ongoing medical history. You can do this, and please know that I am praying for you in your challenging yet achievable recovery journey. God Bless.

Respectfully,

Dr. Roshin

"WORDS OF WISDOM" FROM FORMER ADDICT TURNED COUNSELOR

" In "trying" to stop using cocaine, I would really like to provide some words of encouragment.  Cociane is a very "captvating" drug.  It effects the pleasure reward system of the brain, and truly "takes" captive the ability to feel good and/or experience pleasure, unless you are "under the influence" of the drug.  What starts out as a 'weekend" thing becomes 2 x's a week, then 3 x's a week, and then daily.  At some point you find yourself using and can't imagine why you haven't stopped yet.  I know because this is what happened with me.  A model citizen, a good job, and a wonderful family.  But somehow after experiencing cocaine, these things were not as important anymore.  Yes, I still went to work, and yes I still saw my family, but felt I had to have my cocaine to enjoy anything or even to function.  At some point I found myself using and tears would be falling down my face, and I still had lots of cocaine left.  I could no longer get the same pleasure and I identified with how my life was falling apart.  I tried to stop several times, and found myself going back.  But the time came I knew that no matter what the challenges were, I had to do this.  There will be days when it's hard to think, there will be days when you feel only depression and  posibly don't even understand why you are still alive.  There will be days you want to use so bad.........., and you tell yourself, "just this 1 time", then I'll stop.  You have to be willing to seek help, and then follow simple instructions.  Truly, today with 17 years this past July 17th, clean/sober, I am so grateful I have not had ANY, not ONE LITTLE BIT, of cocaine.  I would never go back to that, but I do this one day at a time with the help of a power greater than myself, whatever you chose to call that power.  In the beginning you will need lots of support, and that is your biggest challenge, along with being willing to USE that support, and not just feel that you should be able to do this on your own.  Addiction is a brain chemistry disease, and it is truly cunning, baffleing and powerful.  We are not weak, we are the strongest of the strong, when we are willing to humble ourselves and just ask for help.  Someone you can go to when you are thinking about using, or maybe wanting to use so badly......  Learn to follow simple suggestions, and be open, honest and willing most of all to allow yourself to heal and to grow.  But you cannot do this if you are still using.  So truly 1 is too many and a thousand is never enough.  You cannot use just 1 time.  Stopping means staying stopped.  Even though the challenges will be hard, there is every reason to follow them through and succeed.  Please take the time to seek out the appropriate resources, treatment, counseling and support. Start your journey today, don't wait, make that first call.............. You will not regret it.        Sincerely from 1 addict to another." -- Ms. LJ

 

 

OSTEOARTHRITIS:

Hi Doctor Rowjee,

I have been long afraid of hearing that I have osteoarthritis but that is what I now have. The pain in my knee on the left side is really bad exspecialy when I walk or plant my foot hard on it. Tryed to kick a ball the other day, forget it, it hurts really bad. I was told that due to my age ( I am 55) there joint wears down resulting in pain. Been searching the internet, but there is so much inforrmation, I do not know where to start. A friend said glucose chondro works to fix a joint. Is this true? Just need to no what has happened. A lot has changed. Need your smarts. Thanks man. “ JJ



Dear JJ,
Osteoarthritis (OA) is the most common form of joint disease (called an arthropathy) effecting twenty eight million people in the USA. In fact, close to 12% of the world's population age 60 and older has osteoarthritis. Once diagnosed, changes in your lifestyle are virtually guaranteed if only because this condition forces those alterations. Osteoarthritis arthropathy, characterized by degeneration of cartilage as well as bone proliferation at the joint margins, results in an insidious onset of pain that may initially present as stiffness followed by a gradual increase in joint pain due to excess weight bearing or activity on that joint. The severity of the joint pain tends to determine treatment options. If your pain is constant both on exertion and at rest, joint replacement therapy may be needed. However, if your arthritic pain is mild, Tylenol or NSAID medicine, along with lifestyle changes in diet, exercise, and weight should suffice to offset the pain. Yet, this condition is prone to weight bearing joints (such as the hip, knee, and hand) which results from the normal wear and tear due to use of the joints. As we age, the cartilage, which acts as a cushion to keep the bones apart, degrades, and when one bone impacts an adjacent bone, osteoarthritic pain occurs. Some of the main components of cartilage include substances called proteoglycans, specifically, chondroitin, glucosamine, and hyaluronidase. Presently, the thought behind ongoing research is that if people with osteoarthritis took glucosamine chondroitin sulfate supplements, the cartilage would regenerate and the painful symptoms would decrease. Unfortunately, in large part, the studies remain rather inconclusive. The latest ongoing, study conducted by the National Institutes of Health (NIH), called Glucosamine Chondroitin Arthritis Intervention Trial or GAIT, provided chondroitin sulfate to patients afflicted with OA with the net goals of reducing joint pain, improving function and mobility of the joint, decreasing the need for joint replacement, and reducing OA progression. What were the results? For the patients with moderate to severe OA, the glucosamine combined with chondroitin sulfate supplements provided statistically significant relief of joint pain; however, for those patients with mild OA, there was no statistically signifcant pain relief. My best suggestion JJ is that since responses to medicines and supplements vary from one person to another, as long as there are no allergic reactions, you s

         

USA:  WHERE CAN YOU GET A FLU SHOT?



CLICK BELOW TO FIND A FLU CLINIC:
  
           
1) 
FLU VACCINE LOCATOR:    http://www.lung.org/lung-disease/influenza/flu-vaccine-finder/
or
2) USA STATE FLU CLINIC LOCATOR -WEBSITE LINKS & NUMBERS: 
http://www.cdc.gov/flu/protect/pdf/pub_health_dept_flu_clinics.pdf





* DIFFERENCE BETWEEN FLU & COLD IN ADULTS/CHILDREN.

- ADULTS:

   


- CHILDREN:
 


WHAT SHOULD YOU DO IF YOU HAVE THE FLU?


  • Drink lots of fluids. Juice, water, and soup are great ways to get fluids in. But avoid caffeinated drinks, which won't hydrate you as well.
  • Get lots of sleep and take it easy. This is a great time to chill with your favorite DVDs without your mom or dad asking you to help out around the house!
  • Take acetaminophen or ibuprofen to relieve fever and aches. Over-the-counter cold or cough medicines may also relieve some flu symptoms. Avoid taking aspirin, though, unless your doctor says it's OK. Aspirin can put teens at greater risk of developing Reye syndrome, a serious illness that sometimes follows infection with the flu virus.
  • Wear layers. You might be cold one minute and hot the next, and wearing several layers — like a T-shirt, sweatshirt, and robe — makes it easy to add or remove clothes as needed.
  • Wash your hands frequently. You don't want to spread the flu to everyone else, if you can help it. Also, avoid sharing cups and eating utensils with other people.

Most people who get the flu get better without having to see their doctor. But if your flu symptoms get worse, if you have a high temperature for more than a few days, if you have any trouble breathing, or if you seem to get better but then feel worse again, call your doctor right away.





 
* To protect others and reduce the spread of the flu :

  • Stay home from school or work and limit contact with others
  • Wash your hands often with soap and water or alcohol-based hand sanitizer– especially after sneezing or coughing.
  • Cough or sneeze into a tissue or your upper sleeve, not your hand. Dispose of tissues immediately and wash you hands.
  • Keep commonly touched services clean and disinfected.
  • Avoid sharing anything that may carry germs such as towels, lipsticks, cigarettes, and drinks.
  • If you live alone, contact a friend or family member to help if you are too sick to buy groceries or go to the pharmacy.

           






* ¿Qué debe hacer si usted tiene la gripe?


Si contraes la gripe, intenta seguir estos consejos:

  • Bebe muchos líquidos.
  • Duerme mucho y descansa. ¡Este es un momento estupendo para que disfrutes con tus DVD favoritos sin que tu madre o tu padre te pidan que ayudes en alguna tarea doméstica!
  • Toma paracetamol o ibuprofeno para aliviar la fiebre y el dolor. Los medicamentos de venta sin receta para la tos y el resfriado también pueden aliviar los síntomas de la gripe. Evita tomar aspirina, excepto si tu médico te autoriza. La aspirina aumenta el riesgo de que los adolescentes sufran el síndrome de Reye, una enfermedad grave que a veces aparece después de la infección por el virus de la gripe.
  • Abrígate con capas de ropa. Es posible que tengas frío y al minuto siguiente calor. Si llevas varias capas de ropa, como una camiseta, una sudadera y una bata, será más fácil que te quites o te pongas la ropa según lo necesites.
  • Lávate las manos a menudo. No querrás contagiar la gripe a otros, si puedes evitarlo. Tampoco compartas con otras personas tazas ni otros utensilios para comer.

La mayoría de las personas que contraen la gripe se recuperan sin necesidad de que les visite el médico. Pero si tus síntomas gripales empeoran, si tienes fiebre alta durante más de unos pocos días, si tienes problemas respiratorios o si parece que mejoras pero luego empeoras, llama a tu médico enseguida.