Ask Your Doctor Ask Your Doctor

Ask Your Doctor

Healthy Times, our quarterly newsletter, has a column called "Ask Your Doctor," which provides an opportunity to get basic medical questions answered by a St. Luke's physician. Individuals do not get a personalized email from a doctor. Answers are printed in the newsletter, as well as posted here -- and they are not intended as a substitute for advice from your own doctor. Click here to submit a question for publication. To find a personal physician, please call our Physician Referral Service at (415) 821-DOCS (3627), or click here to Find a Physician.

I have tendonitis in my left elbow, and had two cortisone injections in the past 12 months. Lately I’ve had blood blisters or dark red splotches appear in the area. What could that indicate? I’ve had surgery on my right elbow to repair the tendon, and I hope to avoid surgery on the left elbow.

A: In Your problem may be “tennis elbow” or “golfer’s elbow,” both of which can result from overuse or a specific strain. In tennis elbow, the outer part of the elbow becomes painful and tender, while golfer’s elbow affects the inner side. “Tendonitis” refers to an inflammation of a tendon, the body tissue that attaches muscles to bones. We’ve learned, though, that tendonitis may not be caused as much by inflammation as by degeneration of tendons.

When conservative treatments such as rest, physical therapy or non-steroidal anti-inflammatory drugs do not ease the symptoms, cortisone injections may be used. Such injections should not be done too frequently – no more than three a year. The injections must be placed in the precise area and go deep enough into the fat pad under the muscle. Otherwise, you may get complications such as “petechia” (small purplish spots on the skin), “ecchymosis” (ruptured blood vessels that cause a purple discoloration of the skin), bruises or even loss of skin pigment in people with darker skin color. If your tendonitis is not responding to treatment in about six to nine months, you may require surgery.

-- Teo Nissen, MD,
Orthopedic Surgery
1580 Valencia Street, #703
(415) 642-0707





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If I have droopy eyelids, would plastic surgery be considered medically necessary?  What does the surgery entail?

A: In order for eyelid surgery to be declared medically necessary, the patient would need to see an ophthalmologist or optometrist for a visual field test to determine if vision is impaired.  The surgery is performed under intravenous (IV) sedation and local anesthetic.  It takes about an hour to perform the surgery.  The sutures can come out in about four days, and you would need to be careful while washing your face for about a week.

-- Clyde Ikeda, MD,
Plastic Surgery
1199 Bush Street, #640
(415) 775-1199



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I suffer severe back pain from arthritis, even though I had back surgery a year ago. A lot of the pain is in my hips and could be radiating out from my back. Morphine only takes the edge off. Would anything else work for me?

A: Many people have back pain due to aging of the discs, which function like shock absorbers. Radiating back pain, called sciatica, may be due to pinched nerves when the discs break down. Doctors who specialize in physical medicine and rehabilitation or pain management can perform special tests, such as nerve conduction studies or MRI, to determine the area of nerve involvement. These days, there are some exciting new treatments for this condition, including medications or injections directed at the nerves that are pinched. The medications, which were originally used in neurology and sometimes psychiatry, have a beneficial effect on quieting down nerve pain.

--Moshe Lewis, MD,
Chief, Physical Medicine & Rehabilitation (Physiatry)
1580 Valencia Street, #703
(415) 642-0707




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My 19-year-old son recently had a collapsed lung without suffering any injuries or illness prior to the lung collapse. Can you tell me what might cause a young man's lung to collapse and what he can do to prevent a recurrence?

A. Your son had primary spontaneous pneumothorax -- a collection of air in the chest cavity outside of the lung that causes the lung to collapse in the absence of a traumatic injury to the chest or lung or without any known underlying lung disease.  But in most cases of spontaneous pneumothorax, bullae or blebs (blisters) were found at the surface of the lungs. Spontaneous pneumothorax is more likely to occur in males than females. Tall, thin males appear to be especially susceptible.  Other risk factors include smoking and family history.  The recurrence rate is 25-50 percent during the first year.  Smoking, airway inflammation, bronchiolitis and asthma can increase chance of recurrence, as can activities such as scuba diving, flying and mountain climbing where the atmospheric pressure is increased or decreased.

-- Gordana Bjekic, MD,
Pulmonology
1580 Valencia St., #606
(415) 923-3421



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What do my cholesterol numbers mean, and what are the ideal levels?

A: There are three cholesterol levels:  LDL, HDL and overall cholesterol.  LDL, the “bad” cholesterol, is a major source of the cholesterol that blocks arteries and may lead to a heart attack or stroke.  HDL, the “good” cholesterol, helps keep LDL cholesterol from collecting in the arteries. You also need to pay attention to the level of triglycerides – another form of fat in the bloodstream – because it also can raise your risk for cardiovascular disease.  Your overall cholesterol level is the combination of LDL, HDL and one-fifth of your triglycerides. The American Heart Association recommends an overall cholesterol level of less than 200.  For LDL, the optimal level is less than 100, 100-129 is acceptable, 130-159 is borderline high, 160-189 is high, and over 190 is very high.  For HDL, 50 or less is considered low for women, 40 or less is considered low for men, and over 60 is considered optimal for both men and women.  For triglycerides, less than 150 is optimal, 150-199 is borderline high, and 200 or more is considered high.  While you can’t control factors that affect cholesterol such as heredity, gender and age, you can control lifestyle factors such as diet, weight and exercise.   If making changes in your lifestyle aren’t sufficient to lower your cholesterol, consult your physician about various medications for lowering cholesterol.

-- John Cranshaw, MD

1580 Valencia St., #201
(415) 550-0877



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I'm going to Greece this summer on vacation, and I’m concerned that all the walking will be difficult because I have bunions.  What can I do to prevent making the bunions more tender?

A: Bunions are a common problem, and you need to attend to them before they interfere with daily life. Bunions are generally hereditary, but poor-quality shoes can contribute to development of bunions in people with a genetic predisposition.  Today, they are relatively easy to correct with outpatient surgery using local anesthesia and sedation.  The surgery takes about an hour, and patients generally achieve 80 percent recovery within six weeks, with the remaining 20 percent occurring over six months to one year.  Because your trip is so soon, I would not advise surgery now.  Instead, buy some very good shoes and get them well broken in before you leave.  You may need to have a shoemaker stretch them to accommodate a bunion.  A podiatrist also can provide temporary removable cushions. When you arrive, consider buying a souvenir cane or walking stick, which will help on unpaved paths and cobblestones. You also can take certain anti-inflammatory medications to reduce discomfort.  I suggest you seriously consider surgery before your next vacation-- so as not to be limited by pain that can be easily and safely helped with today’s techniques and modern instrumentation. Have a great trip!

-- William Lehrich, MD,
Podiatry
1580 Valencia St., #109
(415) 285-7711



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What can I do about my baby's colic?

A:  We don’t really know what causes colic, and medications are rarely, if ever, used. There is some evidence that colic occurs because the baby’s digestive system is still immature. Most of the time, colic starts at about 2 to 3 weeks of age and disappears on its own by the age of 3 months.  Because colicky babies seem to have symptoms of gas in the digestive system, breastfeeding moms should avoid foods that produce gas, such as broccoli and cabbage.  You also should avoid carbonated beverages and beverages containing caffeine, since it is a stimulant.  Babies whose parents smoke also are more prone to colic.  Some colicky babies seem overly sensitive to stimulation, so it may help to minimize noise and distractions.  Rock your baby gently in a quiet, darkened room.  Or place the baby in an infant seat on top of a running clothes dryer so the gentle sound and vibration can help lull the baby to sleep – but do not leave the baby unattended.  Many parents put the baby in a car seat and drive around until the baby dozes off.  If none of these methods help and the crying continues – or if the baby has other symptoms or is not thriving – consult your pediatrician to rule out any serious problems.

-- Agnes Alikpala, MD, Pediatrics
1580 Valencia St., #601
(415) 285-6210



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What other options do I have besides surgery for dealing with chronic pain in my lower back?

A:  Only a limited number of cases of back pain warrant surgery.  The vast majority of people suffering from back pain, including people with herniated disks, can be treated conservatively.  The most common causes of lower back pain are muscle strains or sprains and normal wear and tear on the spine as the patient ages.  People who are overweight or lead a sedentary lifestyle are at greater risk for recurrent back pain.  The first line of treatment includes rest and the use of anti-inflammatory medications, and perhaps muscle relaxants, during the acute phase.  If the pain continues, your physician may recommend epidural steroid injections to relieve the pain.  Most patients will see an improvement in an acute injury within three to six weeks, after which they can be further helped by learning exercise techniques for strengthening the back and abdomen, as well as proper techniques for lifting.  Even herniated disks can improve over three to four months.  If your pain doesn’t go away, or if you develop severe pain, problems with bowel or bladder control, or numbness, tingling or weakness in your legs, please seek immediate medical attention.

-- Jules Steimnitz, MD,
Physiatry
1580 Valencia Street, Suite 504 
(415) 641-8631



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Is it necessary for adults to get their tonsils removed?  If so, when?

A:  Years ago, it was quite common for patients to have their tonsils removed, but these days it is much more rare.  The only time we advise adult tonsillectomy is when patients have recurrent tonsillitis, with two to three or more serious tonsil infections a year that require them to miss work or school and seek medical treatment, including antibiotics.  Those people could realize a benefit from tonsillectomy.

-- Dale Tipton, MD,
Ear, Nose & Throat  (Otolaryngology)
1580 Valencia Street, Suite 103 A
(415) 641-1884



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I recently started a light weightlifting program for fitness, and I’ve been having pain in the front of my shoulders.  What is the cause, and what can I do about it?

A:  The vast majority of shoulder pain is caused by rotator cuff tendonitis, which is inflammation of the tendons in the shoulder.  The good news is that 85-95% of the time, tendonitis can be controlled with a balanced stretching and strengthening regimen.  If the pain is severe, anti-inflammatory medicines or a corticosteroid injection may be necessary.

--Dave Atkin, MD,
Orthopedics
1580 Valencia Street, Suite 703
(415) 642-0707



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Why is my metabolism so slow?

A:  When we talk about “metabolism,” we’re usually referring to our basal energy expenditure – the amount energy that we burn over the course of the day during normal daily activities and exercise.  Certain medical problems such as hypothyroidism can decrease our basal energy expenditure, thereby slowing down our “metabolism.”  The biggest factor, however, is aging.  As we get older, we all have an age-related decrease in lean body mass and proportionally more body fat as a result.  With a decrease in lean body mass, our basal energy expenditure decreases because having less muscle equates to burning less “fuel,” or calories.  The decreased basal energy expenditure makes it more difficult to lose weight because our bodies burn fewer calories over the course of the day.”

-- Christian Tuan, MD,
Internal Medicine, Metabolism Specialist
1580 Valencia Street, Suite 701
(415) 695-7661



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