Diseases & Conditions Archive

Ask the doctor

Q. I've had some severe bouts of depression before my periods. I have done my own research and I am willing to try an antidepressant. What dosage of Sarafem or Prozac is usually given to treat this?

A. Selective serotonin reuptake inhibitors (SSRIs) are an excellent option for treating premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). In fact, most physicians now consider them first-line therapy. Many different SSRIs have been studied, including the one you asked about—fluoxetine (Prozac or Sarafem)—and they all appear to be equally effective.

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Research we're watching

An analysis published online Sept. 17, 2015, by the British Journal of Sports Medicine suggests that doing tai chi enhances the quality of life for people with common chronic conditions.

Researchers analyzed data from 33 studies involving nearly 1,600 adults. Most were in their 60s or 70s, and all had one or more chronic conditions: osteoarthritis, breast cancer, heart failure, or chronic obstructive pulmonary disease (COPD). All 290 participants in the breast cancer studies were women. There were 452 women (85% of participants) in the arthritis studies, 76 (16%) in the heart failure studies, and 92 (19%) in the COPD studies.

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The raised, tortuous vessels may be controlled with support hose, and they can be eradicated in a quick, outpatient procedure.

Varicose veins are one cardiovascular condition that usually isn't considered serious or life-threatening. Around half of all women have them, and most regard them as a cosmetic annoyance. However, they can be responsible for swollen legs, skin changes, and the development of leg ulcers.

Q. I've been having abdominal pain that may be due to gallstones. Is surgery the best solution, or are there other things I can try first?

A. The first thing to determine is whether your abdominal pain is in fact due to gallstones. They typically cause pain on the upper right side or in the center of the abdomen just below the breastbone that radiates to the back or right shoulder. The pain is often brought on by eating—especially fatty foods—or may occur at night. Sometimes gallstone pain is accompanied by sweating, bloating, nausea, or vomiting.

For optimal results, you need to take your medication regularly and time it correctly to your meals.

Have you tried to cool the burning discomfort of heartburn with medication and failed to get full relief? If so, a few simple adjustments to optimize your treatment may be all you need.

Ask the doctor

Q. I am scheduled for an electrical cardioversion for my atrial fibrillation. What should I expect?

A. Electrical cardioversion is a procedure to convert a fast or irregular heartbeat (such as what happens with atrial fibrillation, or afib) to a normal rhythm. Before the procedure, your cardiologist may recommend a special ultrasound test of your heart to check for blood clots. Cardioversion may dislodge any clots, which can be life-threatening. So if clots are found, the procedure may be delayed for a few weeks, so you can take blood-thinning medications to lower your risk of complications such as stroke.

Adults need an annual flu shot and a Tdap booster every 10 years. People over 60 need a shingles shot, and those over 65 should have two pneumonia vaccines.

For many women, bunions and rigidity are two of the most common—and painful—problems with the big toe. Both are easily treated.

Ask the Doctor

Q. I had a colonoscopy recently and it detected hemorrhoids. I don't have any symptoms. Should I be doing something to get rid of them?

A. Like you, approximately 40% of people with hemorrhoids have none of the common symptoms—bleeding, anal itching, and pain. Their hemorrhoids may be found on a routine physical examination or during a test done for other reasons, such as a colonoscopy for colon cancer screening.

Atrial fibrillation (afib) is affecting far more people than it did 50 years ago, according to a study published July 11, 2015, in The Lancet. Afib is an irregular heartbeat that makes the heart's upper chambers (the atria) quiver, rather than pump steadily. This can lead to the formation of blood clots, which can travel in the blood to the brain and cause a stroke. The Lancet study found that afib cases quadrupled from 1958 to 2007 among 9,500 people. But there is some encouraging news: the study also found that the risk of stroke associated with afib decreased 74% in the last 50 years, and the risk of death decreased 25%.

Why the ups and downs? Researchers point to epidemics of obesity and diabetes as part of the reason, as well as increased awareness of the condition and better detection methods. Meanwhile, improved recognition and treatment of other diseases, such as high blood pressure, may be helping to reduce the cases of stroke and early death linked to afib. So, this study provides further evidence of the importance of maintaining a healthy weight and keeping blood sugar, blood pressure, and cholesterol under control. In addition to reducing the risk of heart disease, stroke, diabetes, and other illnesses, you also reduce the risk of getting afib and developing complications from it.