Medical Mailbox

Written By: Sam Savage

Published Date: July 13, 2008 Last Edited: July 13, 2008

By SerVaas, Cory Braun, Wendy

“If you don’t think every day is a good day, just try missing one.”-Cavett Robert Glaucoma and Central Corneal Thickness

Dear Dr. SerVaas,

I was diagnosed with glaucoma about three years ago at age 65. Only last month was my corneal thickness measured. It was discovered to be thin, which necessitated adding four points to my eye pressure for a more accurate reading. What are the ramifications of thin corneas for my future eyesight? How is the thickness of the cornea related to glaucoma?

Any other pertinent information would be appreciated.

Wilma Harp

Selah, Washington

In people with glaucoma, a buildup of aqueous humor fluid damages the optic nerve and threatens vision. Laser and non-laser surgery help drain away fluid or slow its production.

Glaucoma expert Darrell WuDunn, M.D., Ph.D., at Indiana University School of Medicine responds:

“Having a thin central cornea does have some ramifications for glaucoma. Persons with thinner corneas have a higher risk of developing glaucoma when the eye pressures are elevated. There has also been some speculation that a thin central cornea thickness may reflect a thin back wall of the eye and thus an increased susceptibility of the optic nerve to elevated eye pressure. However, this has not yet been well studied.

“Conventional devices for measuring eye pressure tend to underestimate the true pressure in eyes with thin central corneal thickness. As a result, the doctor and patient may be under a false sense of security if the eye pressure seems to be in a good range. However, close, regular monitoring of the optic nerve and visual fields will help determine if the eye pressure control has been adequate, regardless of the corneal thickness.”

There are many types of eye drops that ophthalmologists may prescribe to help reduce or stabilize internal ocular (eye) pressure. If drops don’t work adequately, surgical procedures may further lower ocular pressure by draining away excess eye fluid. Laser surgery is an option. In laser trabeculoplasty (and a newer procedure called selective laser trabeculoplasty), ophthalmic surgeons direct a beam of light at the eye’s drainage system. Other laser therapies target the colored area of the eye or the ciliary body that produces eye fluid (see picture above). Laser procedures for glaucoma are usually painless and performed in an ophthalmic surgeon’s office or hospital.

Blood Donation

Dear Dr. SerVaas,

After I gave blood at a local drive, I received a letter saying that they had “Identified a red cell antibody called antl-big-K (KeIl).” The letter added that having the antibody had no bearing on my health, but may be important in the event I required a blood transfusion. Could you explain what anti-big-K (KeIl) is and how one contracts it? Does it ever go away? I was asked not to donate blood in the future.

Vera Arthur

Winters, California

We sent your letter to Dr. Christopher D. Hillyer, director of the Emory Center for Transfusion and Cellular Therapies in Atlanta, Georgia. Dr. Hillyer, who is also a professor at Emory University School of Medicine and editor of several textbooks on transfusion medicine, comments:

“Red blood cells, or erythrocytes, have many interesting and different molecules on their cell surface. Referred to as blood group antigens, these molecules are determined by our genetic makeup. The most familiar blood group antigens are A, B, and O. People with Type A blood have the A antigen and those with Type B blood have the B antigen-again based on their genes.

“You ask about the K antigen, which is also called KeIl. There are more than 20 different KeIl molecules with names such as big-K and little-K. When someone who does not have K on her red blood cells is exposed to the K antigen, her body ‘sees’ the K antigen as a foreign molecule and responds by producing an antibody.

“You were told you have anti-blg-K, an antibody directed at big- K molecules. This raises the question of how or when you were exposed to red blood cells with the K antigen. Typically, this type of exposure happens through transfusion. It may also occur during pregnancy or delivery when the baby inherits the K gene from the father.

“Therefore, making antl-K Is a normal response in some circumstances and does not cause harm. The antibody may go away on Its own accord, but knowing whether it Is (or was) present is important when considering future transfusion, transplant, or pregnancy. Fortunately, the risk of medical issues In these situations is low and quite readily managed.

“Finally, there is no regulation against a person with antl-K donating blood. Some community blood programs, however, may choose to not accept the donation because of concern that transfusing the antl-K might lead to some (likely minor) complication in a specific recipient.”

Give blood whenever possible. One unit could help save multiple lives. For local donation sites, visit aabb.org.

Seeing Flashes After Eye Surgery

Dear Dr. SerVaas,

After cataract surgery on both eyes, I began to see flashes of light with the left eye. usually only once every day or two. My ophthalmologist could not find any problem with the retina, and since his exam I only see much smaller flashes. Do you have any suggestions as to what is causing these flashes? My optician says it is not due to my glasses.

Mrs. L. Myers

Tampa, Florida

You were right to follow up with your eye specialist. New Orleans ophthalmologist Monica L. Monica, M.D., Ph.D., a clinical correspondent for the American Academy of Ophthalmology, offers the following information:

“Seeing flashes of light is common after cataract surgery. The problem is due to a separation or pull on the gel-like material inside the eye called the vitreous. When disturbed by the ‘trauma’ of cataract surgery, the vitreous may pull on the retina and stimulate flashes of light. Flashing tends to calm down over a period of days to weeks. For most people, it is resolved within about one week after surgery. If not, a more significant separation or pull may exist, and the retina should be checked.”

As explained above, seeing flashes of light after cataract surgery may be part of the normal recovery process. It also may signal a serious complication. Ophthalmic surgeons advise their patients to report sudden vision changes right away.

Lichen Sclerosus

Dear Dr. SerVaas,

I have consulted several gynecologists regarding a problem called lichen sclerosus. I have also had a biopsy done due to constant vulvar burning. Pills and creams do not seem to work. I would appreciate any information on this problem and what might be done to help it.

Mrs. M. Larson

Tinley Park, Illinois

We suggest that you might consider seeking the opinion of a dermatologist with special interest in lichen sclerosus, a long- term problem of the skin. Strong cortisone creams are considered first-line therapy. For hard-to-treat cases, retinoids (vitamin A- like drugs) and tacrolimus ointment may be of benefit. In initial stages, small white spots appear on the skin. The spots later grow into patches that usually itch and sometimes burn or scar. Lichen sclerosus is not contagious. Ongoing research suggests that genes, hormones, and an overactive immune system may play a role in its development. To find a local dermatologist, contact the American Academy of Dermatology by phone (866-503-7546) or computer (www.aad.org).

Help for Pelvic Floor Problems

Dear Dr. SerVaas,

I have a pelvic floor muscle injury that occurred in January of 2006. I continue with my struggle to locate a physician who understands my particular injury. My hope is that you or one of your many readers will know of a facility that specializes in pelvic floor muscle injuries. Thank you for any help.

Nancy Bell

Roopville, Georgia

Left untreated, women with injuries to pelvic floor muscles often experience musculoskeletal pain and urinary problems. Dr. Colleen M. Fitzgerald, chief of staff and medical director for the Rehabilitation Institute of Chicago’s Women’s Health Rehabilitation Program, provides the following advice:

“I am sorry to hear about your pelvic floor muscle injury, especially since you have been suffering with your pain for so long. No matter where you are in your treatment course, I can assure you that you are not alone. A recent study Indicated that one in three women has a pelvic floor disorder.

“Despite the numbers, the pelvic floor musculature Is often a ‘forgotten’ entity. Many women with pelvic floor pain and weakness are often led to believe that this is an acceptable course of femininity. Most physicians are not trained in assessing the pelvic floor, so related problems remain hidden. Women, if educated at all about them, are told that they should do Kegel exercises. Ironically, only half the women who are told to do this have any Idea how to do Kegels, and, In the setting of pain or injury, this may be the wrong advice.

“Please be reassured that there is help out there. I would advise seeking out a physlatrist-a physician who specializes in physical medicine and rehabilitation-who can diagnose your specific problem and prescribe a course of physical therapy, exercise, and treatments that may include injections or, in some cases, medication. Consulting someone who specializes In pelvic floor assessment and rehabilitation can help you relieve pain and regain inner strength. Best wishes.” She Needs Help for Heel Pain

Dear Dr. SerVaas,

I have had heel spurs for two years. Cortisone shots, ultrasound treatment, and arch supports have offered little or no relief from the pain. I have also used heel lifts, cold gel, and every imaginable exercise for stretching and (supposedly) healing. Surgery has been suggested, but I doubt that would help.

Just a small amount of walking can cause pain, sometimes to the point of nausea. I try to stay within my appropriate weight for my height. Is there anyone who can give me some ideas of how they dealt successfully with this pain?

Edith M. Wubben

Arlington, Virginia

We will explore the research and seek expert recommendations about heel spurs that defy conventional treatment. Perhaps Post readers can help, too. A preliminary Internet search turned up a product called EZorb Calcium that claims to help heel pain. However, a review of the medical literature reveals no published studies on the product. Interested computer users may search for EZorb or visit www.elixirindustry.com/heelspurs.htm.

Heel spurs commonly form where the plantar fascia attaches to the calcaneus (heel) bone.

HDL and Omega-Ss: The “Good” Fats

Dear Dr. SerVaas,

In the Jan. /Feb. 2008 copy of The Saturday Evening Post, you wrote about fish oil supplements and triglycerides. I was wondering what omega-3s do for HDL cholesterol. Is there anything that will raise the HDL besides exercise? Also, my husband says that fish oil supplements help his knee joints.

Walona Ulrich

Clear Lake, Wisconsin

While regular exercise is key, experts agree that dietary changes can also help raise levels of HDL, the “good” cholesterol. Current recommendations include:

* Replace dietary trans fats with monounsaturated fats such as canola, peanut, or olive oil. Fats in peanut butter, for example, may increase HDL. Trans fats reduce “good” cholesterol.

* Eat at least two daily servings of soluble fiber found in oats, fruits, vegetables, and legumes.

* Consume omega-3s from foods and supplements. Fish oil may have a positive, but modest, effect on HDL in addition to lowering LDL cholesterol and triglycerides.

Emerging research confirms that omega-3s promote heart, joint, and mental health. For more on the beneficial fats, see Ted Kreiter’s interview with Harvard-educated Dr. Carol Locke on page 28.

Gesundheit

Dear Dr. SerVaas,

My nose runs whenever I eat. Also, I sneeze at least five but no more than nine times in a row. I’ve never found an explanation. Will you help me?

Dorm Ashcroft

Fremont, Michigan

We suspect that our genes determine the variety of ways that people sneeze-as well as what causes one. Pepper, cold air, and dust make most of us sneeze. Looking at bright light triggers a sneeze in about 30 percent of the population.

People who get a runny nose when they eat may have a condition that doctors call gustatory rhinitis. According to The Merck Manual of Geriatrics, this problem may be linked to nerve fibers in the nose that overreact to eating foods (especially cold, heated, or spicy ones). The exaggerated response makes blood vessels dilate, or widen, and produces a watery nasal discharge. In general, ipratropium bromide nasal spray may help relieve gustatory rhinitis. It is only available by prescription.

Check Labels for Vitamin K

Dear Dr. SerVaas,

In answer to Alan Timm’s inquiry in the March/April issue about multivitamins without K, I have a suggestion. Go to a health food/ supplement store and explain your needs. Ask about the prices. These products come in a range of prices, so be careful not to spend too much. I went to a GNC store and found a brand that is easy to take and not expensive.

Zelda Cooke Wilson

Dahlonega, Georgia

Dear Dr. SerVaas,

In response to the letter in the March/April issue, I have been getting vitamins without vitamin K at a CVS pharmacy and convenience store for a number of years. It is necessary to check the various forms.

Joan Artz

Beacon, New York

Tart and Tangy

Dear Dr. SerVaas,

I’ve enjoyed things that tasted sour since I was a kid. Now I’m 86 years old and come and go as I please. My wife has a fit when I drink pickle juice left in the jar. Is there anything that is not good for me in pickles and their juice?

I have a pacemaker and had open-heart surgery and a stroke in 1993.

Harold Gilbert

Dans ville, New York

An occasional pickle or sip of pickle juice seems safe. Check the label on the jar for sodium content. In general, doctors advise their heart patients that eating too many salty foods may cause fluid retention and contribute to puffy eyes, swollen ankles, or high blood pressure. When we have a taste for something sour, we opt for a three-bean or spinach salad with vinegar dressing. A summertime favorite is sliced cucumbers served with vinegar and pepper.

Hard to Swallow

Dear Dr. SerVaas,

For years I was told I had acid reflux, but a recent motility study showed that my esophagus is not working. Two prescribed medicines provided no relief. The one thing that does help is to lay down flat shortly after the pain begins. I can get up after about 30 minutes, and the symptoms will not return. Eating smaller meals also helps but is no guarantee. Hopefully someone out there has discovered something to ease the discomfort. Thank you.

Barbara Gerriets

Topeka, Kansas

We hope other readers will offer some helpful suggestions for you. A properly functioning esophagus moves food from the mouth to the stomach in a synchronized series of muscle contractions. When this process fails, swallowed food may remain in the esophagus for extended periods-a condition that gastroenterologists call achalasia. Characteristic symptoms of the disorder include difficulty swallowing, heartburn, weight loss, and chest pain.

Treatment options include oral medicines, botulism toxin injection, and balloon dilation to improve esophageal emptying. Surgery to cut the muscle between the stomach and esophagus may be recommended in some cases. The cause of achalasia is not yet understood. Some researchers believe a virus is to blame.

Microwave Cooking Preserves Nutrients

Dear Dr. SerVaas,

Recently, I heard brief remarks on television cooking shows to the effect that heating foods in a microwave oven destroys much of the food’s nutritional value. I am trying to find someone who will research the facts and report the truth. Can you help me with this?

I have always cooked in large quantities and then frozen the leftovers in meal-size containers. So many of our meals are wanned in the microwave. I need an answer on this.

Margaret Roth

Fort Way ne, Indiana

Registered dietician, nutrition consultant, and author Colleen Pierre reports the following:

“Microwave rumors abound, but this one is pretty surprising. Although there isn’t an abundance of research, what exists is pretty clear: microwave cooking is one of the best ways to preserve the nutrients in vegetables-probably because you cook them so quickly without boiling the water-soluble vitamins into the cooking water. In one recent study, for instance, boiled broccoli lost 34 percent of its vitamin C and steamed broccoli lost 22 percent. In addition, both cooking methods destroyed an antioxidant called sulforaphane that appears to fight cancer, especially breast cancer. Meanwhile, broccoli cooked by microwave or pressure cooker retained more than 90 percent of its vitamin C and all of its sulforaphane.

In another study, stir-frying and microwaving preserved the most flavonoids (another health-protective antioxidant) in nine different vegetables, while boiling and stewing lost the most.

It’s possible the TV hosts were comparing cooked and raw vegetables. But even then, many nutrients such as beta carotene and other antioxidants become more available when vegetables are lightly cooked. You can relax and continue to reheat your food in the microwave, knowing you’re getting the most nutrients possible.”

Persistent Perspiration

Dear Dr. SerVaas,

For the past five or six years, my mother has had sweating episodes during which she perspires across her upper back, shoulders, chest, and the crooks of her arms. She becomes chilled and quite uncomfortable. The problem only happens when the weather is cold. It starts around noon and lasts until 7:00 or 8:00 pm. She wears compression hose and takes medicines, as her blood pressure has been fluctuating. I would appreciate any feedback you might provide.

Jeannette Snyder

Virginia Beach, Virginia

It is interesting to note that she has sweating episodes as well as blood pressure problems. Both body functions are controlled by the autonomic nervous system, a part of the nervous system that also regulates heart rate, digestion, bladder and bowel emptying, and blood flow to the arms and legs. Autonomie testing can help neurologists detect whether this part of the nervous system is under- or overactive. In general, autonomie function testing laboratories are located at major medical centers,

Readers may send their letters to Medical Mailbox, 1100 Waterway Blvd., Indianapolis, IN 46202. Please include mailing address. Via e- mail: [email protected].

by Cory SerVaas M.D. & Wendy Braun, R.N., B.S.N.

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