August 13, 2003

Note to our users: This interactive feature is in no way a substitute for the examination and advice of a physician. You are responsible for all actions you take after reading material on this site. Always seek the advice of a doctor for concerns about your health or a specific condition.

Body1 : Welcome to today's discussion with Dr. James Whynot of Cambridge, MA.

Body1 : Dr. Whynot is a graduate of the University of Massachusetts Medical School. He has practiced Internal Medicine and Complementary Medicine in Cambridge, MA since 1984, and he has an extensive background in Quality Assurance and Peer Review.

Body1 : His medical interests include Geriatric medicine, complementary medicine, critical pathways and medical informatics.

Body1 : We are pleased to have Dr. Whynot joining us for our Body1 Summer Health Series, every Wednesday at 1pm ET.

Body1 : This is the 5th of 6 discussions with Dr. Whynot.

Body1 : Dr. Whynot, thank you for joining us. Users, we welcome your questions!

matt : My fiancé has extremely bad bladder infections at least that's what we think the doctors still haven't fixed the problem she is rarely not in pain and feels she must urinate but nothing comes out except an occasionally drip. She can't sleep And the doctors aren't helping much with an answer can you please give any help with this situation.

Dr James Whynot : This is a very complex problem. The symptoms that are present can be either coming from the bladder or the vagina. The first thing to do is to make sure that she has had a physical exam and a very through gynecological examination. The urine should be examined for the presence of white cells (a sign of infection) and bacteria among other things. Any infection should be proven by urinary culture and treated with antibiotics. If she has a normal physical exam and gynecological exam, as well as documented urinary tract infections, then the next step is a urological examination - a cystoscopy to look for abnormalities in the urethra the tube that empties the bladder and the bladder itself. If everything is normal, then urinary tract suppression for about 6 months is done with an appropriate antibiotic. There are other things that can be done also - such as specific urinary hygiene measures which should have been mentioned and done by the gynecologist

joyousmin@hotmail.com : Would like to know more about SVT....Supraventricular Tachydia?

Dr James Whynot : SVT or supraventricular tachycardia is when the heart beats rapidly. It is a heart beat (rhythm) that occurs from the top part of the heart (the atrium) and above the ventricles (the major storage and pumping chambers of the heart). The atrium has a pacemaker in it - an area where the number of beats per minute are regulated. When the heart beats go above 100 beats per minute, that is a tachycardia, when we can see where the origin of the fast beats are we call it either a supraventricular tachycardia or a ventricular tachycardia. Ventricular tachycardia is always life threatening, whereas supraventricular tachycardia is usually not. The goal is to find out why the heart is beating rapidly and correct the underlying cause. Supraventricular tachycardia can be caused by medications, dehydration, stress, thyroid disease, heart abnormalities and abnormal conduction down the heart's electrical path. The treatment is aimed at the underlying cause.

Tim : I'm an adult recently diagnosed with ADD, how is this possible? I thought this was a children's disorder. What treatments might my doctor suggest? I'm worried about the side affects of medication... might they lead to hypertension?

Dr James Whynot : Its a rapid heartbeat. It is caused by increased electrical activity in the electrical system in the heart that makes the heart pump faster. There are many causes and it can be a medical problem (such as thyroid disease) or a heart electrical system problem. To treat it one must know the underlying cause. This is determined by a cardiologist who will do various tests and may even do a catheterization - an x-ray of the heart - to determine the cause.

Dr James Whynot : ADD can be an adult disorder. It is characterized in adults by not being able to sequence and finish tasks - and probably has been present since childhood. The treatments are varied and usually consist of medications - some physicians use antidepressants, others use amphetamines (like Ritalin) to assist in correcting the disorder. Some of the medications can lead to hypertension or high blood pressure, but the important thing is to be sure that ADD is the correct diagnosis (this is done in conjunction with a psychologist or psychiatrist, and with extensive testing) and if ADD is the correct diagnosis, then discussing with your doctor various treatment options and any concerns you may have with those options

Karen : Does night cramps in the leg that had a former DVT signify another clotting episode?

Dr James Whynot : No, night cramps in a leg with a former DVT does not signify another clotting episode. One of the best ways to determine if there is another clotting episode is to measure the circumference of the leg at 3 points. One point is 10 cm or about 4.5 inches above the top of the knee cap, a second point is 10 cm or 4.5 inches below the top of the knee cap and the third is 20 cm or about 8 inches below the top of the knee cap (the top of the knee cap is a constant reference so that you are measuring the circumference in the same area). You should know your baseline circumference in these areas and if there is a difference of 1 cm or about 3/8 of an inch in diameter, then this is something to talk to your doctor about

maybaby : I was just diagnosed with rheumatoid arthritis (healthy 26 year old female). What does this mean for me? I've read that I should keep up moderate activity and keep my joints loose. The pain has predominately been in a knuckle in my right hand and my right knee. Can I expect this to be a lifelong problem? Or will it subside after a few attacks?

Dr James Whynot : Rheumatoid arthritis is a chronic disease that exists for a lifetime. The body's immune system destroys part of the joints. This is one disease that really needs to be followed by a specialist all the time - that specialist is a rheumatologist. It is important because you want to modulate the effects of the disease, to keep the inflammation levels down to prevent further joint destruction. You should definitely keep up moderate activity as this promotes better function of the joints. A rheumatologist can evaluate you, determine the severity of your disease and whether any of a whole host of medications should be used to modulate the disease. In the future there will be better treatments and knowledge of this disease - there are some exciting developments on the horizon which is why it is important to see a rheumatologist who will keep up with the rapidly advancing treatments in this field. Once the joint is destroyed, there is no going back and at time, people now need surgery to replace the joints. Surgical joints though, are not as good as natural joints and can wear out quickly. The key to this lifelong disease is modulation of the immune system to make it not destroy the joints.

kyko : What are the potential risks of botox?

Dr James Whynot : I think the short term risks of botox are that the person injecting the botox is poorly trained and will either inject into the wrong area or too deep, causing unwanted paralysis of the muscle or damage to a nerve. Long term effects we do not know since we do not have a large collective experience as to what happens to people 5 10 or 15 years after botox injections. Once one starts botox injections in an area though they will have to be continued to achieve the desired cosmetic result

Laura : my son keeps on having nosebleeds. 3 or 4 a week about once 2 months. My doctor says that he has Hassell's Triangle. What does this mean will he have to live with this for the rest of his life?

Dr James Whynot : I do not know what Hassel's Triangle is - maybe he said Kisselbach's triangle which is the front part of the inside of the nose where all the small blood vessels come together and where most of the nose bleeds occur. Usually these are not serious nose bleeds, although it always looks like a lot of blood is flowing. The treatment is to hold the nose tightly pinched for 5 minutes by the clock and this will stop the bleeding. Normally kids outgrow this. If it is frequent cauterization may be employed. It is also good to be sure that your son does not have any bleeding disorders which is done by a physical exam and some blood tests.

Pam : I'm menopausal and I am exhausted. I have been experiencing night sweats as well as insomnia; can you suggest anything to help me?

Dr James Whynot : Without examining you I can not make a specific suggestion. Common symptoms of menopause are fatigue, weight changes, sweats and a sleep disorder. You should be examined by a physician to be sure that this is due to the menopause. If so there are various treatments for the symptoms that are non-hormonal that work and can correct symptoms. Herbal treatments have been used successfully for years without long term or short term side effects.

Beth : Dear Dr. Whynot, I am a 41 year old female who works out in a health club by doing cardio and weight training. I have worked with a trainer to make sure I do my exercise correctly-however, I continue to experience knee pain and do not know why. I do a leg press utilizing proper form-yet each time I try to increase my weights, even by only adding 10 pounds, my knee or knees will cause me pain and burning, usually on the top to outside. Sometimes its one knee vs. the other. if I stop I will need to do so for a couple of weeks before I can try again, but I cant seem to progress and I don't know why! I also will get pain in my lower back as well. My physician tells me to skip the weights and use an elliptical which is easier on the knees. I'd like to find out what is wrong and then devise a plan that is best for me, and I really like weight training. Will an x-ray tell me what is wrong? What kind of x-rays should I ask my doctor to order? Or do I need an MRI? If a patient came to you with this information, could you help me to design a plan of action to understand what is going on? I'm so frustrated! Thank you Beth

Dr James Whynot : Knee pain is very common and one of the most common injuries in the knee from training is the ilio-tibial band syndrome (ITB) which can be resolved by specific physical therapy exercises. I think that if you have been evaluated by your physician and you have modified your exercise regimen, then the next step would be to be evaluated by an orthopedist who specializes in sports medicine. They are experts in dealing with the knees. Before going on to x-rays and MRI scans I would send someone to a sports medicine physician for a consultation. If you have been examined and your knee is normal, I would bet you have ITB and this is easily treated by physical therapy for a short time, and the therapist or a physiatrist (who is a physician who specializes in designing these programs) can make suggestions for appropriate exercises.

Lucas : I've heard of seasonal affective disorder hitting people during the winter months. Is it possible for this condition to affect people during the summer months as well?

Dr James Whynot : In the classic sense no - theoretically people become depressed because of a relative lack of light. SAD or seasonal affective disorder) is tied in with depression so it is very difficult to tell the two apart sometimes. If the symptoms are not seasonal (in the winter) then its probably not SAD

Jessica : Dr Whynot... I suffer from painful sinus infections every fall and spring, they usually last about 2wks+. I usually am unable to drive, suffer from severe congestion, and lose my voice. My doctor usually prescribes large antibiotics that seem like sufur-ish and well has anti decongestants. Both of these upset my stomach horribly. With fall coming can you suggest anything to avoid another infection?

Dr James Whynot : Sinus infections occur when the sinus do not drain correctly. What I usually do with my patients to prevent sinus infections in the fall/winter and spring is to use a saline nasal spray 3-4 times a day (this is available over the counter) so that this keeps the nasal linings moist and things draining. I also make sure that they are as allergy free as possible at home, use a cold water humidifier in the bedroom at night (making sure it is cleaned every week or so to get rid of fungus buildup). If they have hayfever, I place them on a non-sedating antihistamine during the times that I know that they get infections and if all this fails, I usually start a nasal steroid inhaler during the times that I know they get infections. Generally though the simple things like a humidifier, saline nasal spray and non-sedating antihistamines - all available over the counter- help

Lucy55 : DDr. Whynot, what sort of health problems can be associated with hot tubs? Can they interfere at all with pregnancy/fertility? And how easily are germs passed from person to person in a relatively public tub (like in a hotel)? Thank you.

Dr James Whynot : Most public hot tubs are chlorinated but chlorine loses its effectiveness above 84 degrees F - the key is to be sure that the tub is adequately disinfected, and the filters cleaned. Ventilation is also important - if the ventilation is not adequate you can be exposed to aerosolized bacteria at times from the hot tub jets. Usually you can not depend on the adequacy of the disinfectant and cleaning in public tubs so I tell people to avoid them. Heat from the tubs can be a risk of you have heart disease or high blood pressure because they vasodilate (enlarge) the arteries. I don't know of any link between pregnancy/fertility and hot tubs

David : My daughter has been diagnosed with lyme disease. She had the bull's eye. She is currently being treated with antibiotics. I'm concerned what this will mean for her long term?

Dr James Whynot : Usually if the disease is treated adequately and early there are no long term consequences. The key is to treat within a few days of the bite and to be sure that the bacteria has not spread to the central nervous system.

Caroline : My daughter is going on a college-sponsored trip to Ecuador for a month this fall. Are there any special immunizations she should be getting before this trip?

Dr James Whynot : Yes there are - it depends whether she is going to the city or out in the country in Ecuador. Your local hospital or state or local health department should have a travel clinic that will keep up to date on what is needed as far as immunizations and any malaria prophylaxis. There is a US sponsored website that is also helpful: http://www.cdc/gov/travel/travel_clinics.htm

Mike : I have a canker sore... I think. I've never had one before... it's an annoying little bump that is burning/ tender... What can I do to get rid of it

Dr James Whynot : Well it depends where it is, whether it is a canker sore. Its best to be examined by your doctor to determine if it is a canker sore and then there are specific treatments for the sores.

Body1 : Users, thank you for joining us. We are out of time. Please join us again next week for our final discussion with Dr. Whynot. As usual, he'll be joining us at 1pm on Wednesday, August 20.

Body1 : Dr. Whynot, thank you again for joining us.