Question: I am 20 years old, and I have gotten cold sores all of my life. While I know they are no big deal, they are annoying, not to mention ugly. Will I ever outgrow these? Why did I start getting them in the first place? My friends don’t seem to have them. Is there any treatment for them?
Answer: Cold sores, also called “fever blisters” are a common viral skin eruption that affects about 50 percent of the national population. This virus, called “herpes simplex type I,” often infects the mouth in childhood. Once this initial infection has occurred, the virus remains in your system, but usually in a dormant, or inactive form. Any time the virus reactivates, it causes another cold sore.
Reactivation of this virus can be triggered by stress, illness, fever, sun exposure, menstruation and other causes. When the reactivation occurs, a lesion-like blister appears, usually on the lip. Without treatment, it generally takes about seven to 10 days from the initial outbreak until the sore is completely healed and gone. Many people also notice pain or sensations of itching, tingling or burning on the lip while the blister is there, and even up to two days before the cold sore actually appears. If you do notice pre-blister lip pain, that is the optimal time to treat the cold sore.
There are several over-the-counter topical medications available at drug stores, but more recently prescription antiviral medications -- both oral and topical -- have proven very effective in shortening the course of cold sore outbreaks. Researchers are developing a promising vaccine, but the studies are still in early stages, so the vaccine has not yet been approved for the general public. Also under development is a potential oral antiviral medication that might help prevent cold sore outbreaks.
For people who get cold sores due to sun exposure, the use of sunscreen on the lips can dramatically reduce their frequency. The bad news is that, so far, this is the only known preventive method for cold sores, and it only applies to sun-induced outbreaks. The good news is that, as I mentioned above, coming years may see a vaccine or preventive medication.
The herpes simplex type I virus can be spread by direct contact any time between the beginning of the pre-blister phase to when the sore is completely healed. Avoid kissing someone who has an active cold sore, and if you have a cold sore, avoid touching the blister.
Most people with cold sores get about six outbreaks per year. After the age of 35, the recurrences do become less frequent, and the lesions tend resolve a bit faster. So while you will never completely outgrow this condition, it will improve as you get older –- and hopefully, so will the treatment options.
Tuesday, March 30, 2010
READER’S NIGHT SWEATS TOO FREQUENT FOR COMFORT
Question: I am a usually healthy man, aged 50. For the last couple of weeks, I have woken up once or twice every night drenched with sweat. I sweat so heavily that I have to change my pajamas. My wife experiences these heat spells at night due to menopause, but what can cause them in a man? I have been feeling a little run down as well. Do I need to see the doctor, or will this pass?
Answer: Night sweats like the ones you describe are fairly common and are usually not a sign of a medical problem. Simple things like troubling dreams, the room being too hot or using too many blankets can actually cause drenching night sweats. That being said, if the night sweats persist and adjusting your environment doesn’t help, you should discuss the problem with your family physician.
As you mentioned, menopause is the leading cause of night sweats in women over the age of 40. However, both men and women can experience this annoying condition.
If this occurs frequently and interferes with your sleep, your doctor can help you rule out more serious medical issues that may underlie night sweats.
A simple review of your medical history may reveal the problem, as excessive sweating at night is a frequent side-effect of some medications. Most commonly, antidepressant medications and fever-reducing medication can lead to night sweats. Some high blood pressure medications, hormone therapies and niacin can also cause spells of excessive sweating at night.
If you are a diabetic on medication and you are having frequent night sweats, check your blood sugar level when a sweat occurs. If your blood sugar level is low during a night sweat, let your physician know. Your medications may need to be adjusted.
Recently an association has been identified between gastroesophageal reflux disease (GERD) and night sweats. Some preliminary studies suggest that when GERD is treated, the night sweats go away. Other conditions, such as an overactive thyroid or obstructive sleep apnea, can also cause night sweats.
Even more serious medical conditions can also cause night sweats. But typically, with very severe illnesses, such as tuberculosis or HIV/AIDS, you will notice other symptoms as well. These symptoms may include high fever, frequent coughing and rapid weight loss. Night sweats can accompany some types of cancer, particularly lymphoma, but they are also associated with rapid weight loss and usually enlarged lymph nodes.
It sounds like your night sweats are frequent enough to warrant a conversation with your family doctor. At this point, the problem is cutting into your sleep cycle, which probably explains why you feel run-down. Your doctor can test for underlying illnesses and determine whether medications should be adjusted. If nothing else, he or she may calm your worries, since anxiety aggravates insomnia. Be sure to seek immediate medical attention if you experience sudden weight loss, cough or fever.
Answer: Night sweats like the ones you describe are fairly common and are usually not a sign of a medical problem. Simple things like troubling dreams, the room being too hot or using too many blankets can actually cause drenching night sweats. That being said, if the night sweats persist and adjusting your environment doesn’t help, you should discuss the problem with your family physician.
As you mentioned, menopause is the leading cause of night sweats in women over the age of 40. However, both men and women can experience this annoying condition.
If this occurs frequently and interferes with your sleep, your doctor can help you rule out more serious medical issues that may underlie night sweats.
A simple review of your medical history may reveal the problem, as excessive sweating at night is a frequent side-effect of some medications. Most commonly, antidepressant medications and fever-reducing medication can lead to night sweats. Some high blood pressure medications, hormone therapies and niacin can also cause spells of excessive sweating at night.
If you are a diabetic on medication and you are having frequent night sweats, check your blood sugar level when a sweat occurs. If your blood sugar level is low during a night sweat, let your physician know. Your medications may need to be adjusted.
Recently an association has been identified between gastroesophageal reflux disease (GERD) and night sweats. Some preliminary studies suggest that when GERD is treated, the night sweats go away. Other conditions, such as an overactive thyroid or obstructive sleep apnea, can also cause night sweats.
Even more serious medical conditions can also cause night sweats. But typically, with very severe illnesses, such as tuberculosis or HIV/AIDS, you will notice other symptoms as well. These symptoms may include high fever, frequent coughing and rapid weight loss. Night sweats can accompany some types of cancer, particularly lymphoma, but they are also associated with rapid weight loss and usually enlarged lymph nodes.
It sounds like your night sweats are frequent enough to warrant a conversation with your family doctor. At this point, the problem is cutting into your sleep cycle, which probably explains why you feel run-down. Your doctor can test for underlying illnesses and determine whether medications should be adjusted. If nothing else, he or she may calm your worries, since anxiety aggravates insomnia. Be sure to seek immediate medical attention if you experience sudden weight loss, cough or fever.
NARCISSISM: IT’S ALL ABOUT “ME”
Question: I thought “narcissism” was just a personality trait, like impatience or shyness, but a friend recently said it’s an actual medical condition. Is that right? And if so, is it treatable?
Answer: The more current term for narcissism is “narcissistic personality disorder.” This mental disorder is characterized by people who have an abnormally inflated sense of self-importance and superiority. Often they are preoccupied with personal success and power, and they seem to have little regard for other people’s feelings.
While people suffering from narcissistic personality disorder usually appear very confident, they often are very insecure and, beneath the perceived self-love, they harbor low self-esteem. These people also behave in socially distressing manners and have difficulty with relationships, work and school.
To some extent and at some stages of life, we all may be guilty of behavior that resembles narcissistic personality disorder. Symptoms of the disorder include a sense of superiority over others; a preoccupation with personal success, power and attractiveness; and exaggerating personal accomplishments. People with narcissistic personality disorder expect others to always go along with what they want, and they are unable to recognize the feelings and viewpoints of others. They often have a sense of entitlement or exceptionalness, and they thrive on the praise and admiration of others. When these expectations are not fulfilled, people with this condition are prone to inappropriate or even violent outbursts.
The causes of narcissistic personality disorder are not known, but the condition is probably related to early childhood development. Some believe it results from over-pampering in early childhood, but many other researchers suspect that parental neglect is a more likely explanation. Usually this disorder can be diagnosed by early adulthood.
At this time, psychotherapy is the only treatment for narcissistic personality disorder. If other complications, such as substance abuse, depression or eating disorders are also present, be sure to consult with your family physician. These complications can contribute to the problem, and often they require medical intervention. Some of the problems associated with narcissistic personality disorder can be treated with medications. Family therapy and group therapy can be helpful as well.
As with many conditions, it is important to make sure there are no underlying medical conditions causing a change in personality. If you notice these symptoms in a loved one, it is important that they see their family physician. He or she will review the medical and family histories, conduct a physical examination and possibly conduct some laboratory tests to rule out underlying medical problems.
Answer: The more current term for narcissism is “narcissistic personality disorder.” This mental disorder is characterized by people who have an abnormally inflated sense of self-importance and superiority. Often they are preoccupied with personal success and power, and they seem to have little regard for other people’s feelings.
While people suffering from narcissistic personality disorder usually appear very confident, they often are very insecure and, beneath the perceived self-love, they harbor low self-esteem. These people also behave in socially distressing manners and have difficulty with relationships, work and school.
To some extent and at some stages of life, we all may be guilty of behavior that resembles narcissistic personality disorder. Symptoms of the disorder include a sense of superiority over others; a preoccupation with personal success, power and attractiveness; and exaggerating personal accomplishments. People with narcissistic personality disorder expect others to always go along with what they want, and they are unable to recognize the feelings and viewpoints of others. They often have a sense of entitlement or exceptionalness, and they thrive on the praise and admiration of others. When these expectations are not fulfilled, people with this condition are prone to inappropriate or even violent outbursts.
The causes of narcissistic personality disorder are not known, but the condition is probably related to early childhood development. Some believe it results from over-pampering in early childhood, but many other researchers suspect that parental neglect is a more likely explanation. Usually this disorder can be diagnosed by early adulthood.
At this time, psychotherapy is the only treatment for narcissistic personality disorder. If other complications, such as substance abuse, depression or eating disorders are also present, be sure to consult with your family physician. These complications can contribute to the problem, and often they require medical intervention. Some of the problems associated with narcissistic personality disorder can be treated with medications. Family therapy and group therapy can be helpful as well.
As with many conditions, it is important to make sure there are no underlying medical conditions causing a change in personality. If you notice these symptoms in a loved one, it is important that they see their family physician. He or she will review the medical and family histories, conduct a physical examination and possibly conduct some laboratory tests to rule out underlying medical problems.
HEALTHY LIFESTYLE BEST MEDICINE FOR CHRONIC LEUKEMIA
Question: My dad was recently diagnosed with leukemia. He said I shouldn’t worry since it is “chronic leukemia.” How can it already be considered chronic when he was just diagnosed –- and why should that make me worry any less? Can you explain the difference between regular and chronic leukemia?
Answer: Most likely your father was diagnosed with chronic lymphocytic leukemia (CLL). CLL is called “chronic” from the beginning because this form of leukemia progresses very slowly over a longer span of time. In that sense, CLL is less severe than acute leukemia, which grows and spreads much more rapidly.
CLL is relatively rare, with about 15,000 new cases diagnosed in the United States every year. Although CLL can occur at any age, it usually affects older adults. The disease is more common in men, in Caucasians, and in people over the age of 50. A family history can predispose a person to CLL, as can exposure to some chemicals, including benzene, as well as some solvents and herbicides. People who work in construction, with cars or at petroleum refineries may have an increased risk for CLL.
CLL is the result of a change in the DNA of the cells that produce blood. No one knows why this change occurs in the first place, and it has become a topic of intensive biomedical research. The change affects lymphocytes, a type of white blood cell important for immune defense. It renders lymphocytes unable to fight infections as usual. It also sparks the production of excessive numbers of these ineffective lymphocytes, which crowd out the healthy white blood cells and make it difficult for them to do their job.
Physicians suspect CLL when a person complains of fatigue, fever, night sweats, weight loss, frequent infections and enlarged, painless lymph nodes. When your family physician hears these symptoms together, he or she will most likely order a battery of tests, including a complete blood count (CBC). If the CBC shows a higher-than-normal number of lymphocytes, your doctor may then order a bone marrow biopsy. This test takes blood-producing cells from inside the pelvic bone or sternum, to see how many abnormal lymphocyte-producing cells are present compared to healthy cells. Sometimes doctors also order a CT scan of the body, which helps to determine the severity of the illness. If the CLL is an early stage, your father’s doctor will probably want to monitor the disease for now. Medical interventions for CLL are more effective when the disease has reached intermediate or advanced stages. If the disease progresses far enough, a range of therapies may be recommended, but many people diagnosed with early stage CLL never need any treatment.
With CLL, it’s more important to make healthy choices that prevent infections, such as eating well, exercising and getting plenty of sleep. If your father smokes, urge him to seek help to quit. Of course, he should also avoid infections by regular and thorough hand washing and by staying away from sick people whenever possible.
Answer: Most likely your father was diagnosed with chronic lymphocytic leukemia (CLL). CLL is called “chronic” from the beginning because this form of leukemia progresses very slowly over a longer span of time. In that sense, CLL is less severe than acute leukemia, which grows and spreads much more rapidly.
CLL is relatively rare, with about 15,000 new cases diagnosed in the United States every year. Although CLL can occur at any age, it usually affects older adults. The disease is more common in men, in Caucasians, and in people over the age of 50. A family history can predispose a person to CLL, as can exposure to some chemicals, including benzene, as well as some solvents and herbicides. People who work in construction, with cars or at petroleum refineries may have an increased risk for CLL.
CLL is the result of a change in the DNA of the cells that produce blood. No one knows why this change occurs in the first place, and it has become a topic of intensive biomedical research. The change affects lymphocytes, a type of white blood cell important for immune defense. It renders lymphocytes unable to fight infections as usual. It also sparks the production of excessive numbers of these ineffective lymphocytes, which crowd out the healthy white blood cells and make it difficult for them to do their job.
Physicians suspect CLL when a person complains of fatigue, fever, night sweats, weight loss, frequent infections and enlarged, painless lymph nodes. When your family physician hears these symptoms together, he or she will most likely order a battery of tests, including a complete blood count (CBC). If the CBC shows a higher-than-normal number of lymphocytes, your doctor may then order a bone marrow biopsy. This test takes blood-producing cells from inside the pelvic bone or sternum, to see how many abnormal lymphocyte-producing cells are present compared to healthy cells. Sometimes doctors also order a CT scan of the body, which helps to determine the severity of the illness. If the CLL is an early stage, your father’s doctor will probably want to monitor the disease for now. Medical interventions for CLL are more effective when the disease has reached intermediate or advanced stages. If the disease progresses far enough, a range of therapies may be recommended, but many people diagnosed with early stage CLL never need any treatment.
With CLL, it’s more important to make healthy choices that prevent infections, such as eating well, exercising and getting plenty of sleep. If your father smokes, urge him to seek help to quit. Of course, he should also avoid infections by regular and thorough hand washing and by staying away from sick people whenever possible.
KIDNEY INFECTIONS MAY SEEM MILD, BUT CAN BE SERIOUS
Question: I went to the emergency department recently with back pain, and they said I had a kidney infection. I really didn’t have many other symptoms except generally feeling run-down. They gave me some antibiotics, and my pain got better, so they must have been right. How did I get this? Why didn’t I have any other noticeable symptoms?
Answer: Pyelonephritis is the medical term for an infection in the kidneys or the ureters, which are the tubes that lead from the kidneys to the bladder. Pyelonephritis is usually caused when bacteria moves up the ureters from the bladder, in what we call an “ascending infection.”
Pyelonephritis can be caused by a number of things, including bladder infections, bladder catheterization, urinary tract surgeries, kidney stones, prostate enlargement or structural problems in the urinary system that block urine flow from the kidneys to the bladder.
The most common symptom of pyelonephritis is back pain. Pain caused by kidney infection is usually felt just below the rib cage and close to the spine. Typically the pain is described as a dull ache, much less intense than the acute pain associated with kidney stones. Kidney infection pain also tends to come and go, and it may extend to the side of the body or down into the pelvic area.
As you noted, sometimes the symptoms are limited to back pain alone. If you experience new and sudden back pain, it is a good idea to see a doctor about it. Many people also have associated symptoms of painful urination, frequent urination, blood in the urine, fever and nausea or vomiting. If you notice these symptoms, see your doctor immediately.
In some cases, people become extremely ill with pyelonephritis and have to be hospitalized. This can occur when the kidney infection spreads to the blood stream. This is called septicemia, and it often begins with rapid breathing, increased heart rate, chills and a sharp spike in fever. Severe pyelonephritis can also cause the kidneys to stop functioning, which is a potentially fatal situation with a number of symptoms, from bloody stools and breath odor to tremors and swelling of the lower body.
When you went to the emergency department, the doctor probably began by tapping on the kidney area to see if it caused you pain. Then, most likely, your blood was drawn to be checked for a high white blood cell count, which would indicate infection. They probably also obtained a urine specimen to examine for bacteria. Once bacteria are cultured and identified, the doctor can prescribe the most effective antibiotic.
Most people respond quickly to antibiotic treatment, and their symptoms resolve without further complication. A thorough follow-up usually calls for x-rays of the entire urinary tract to look for structural problems in the system that may have caused the problem.
Answer: Pyelonephritis is the medical term for an infection in the kidneys or the ureters, which are the tubes that lead from the kidneys to the bladder. Pyelonephritis is usually caused when bacteria moves up the ureters from the bladder, in what we call an “ascending infection.”
Pyelonephritis can be caused by a number of things, including bladder infections, bladder catheterization, urinary tract surgeries, kidney stones, prostate enlargement or structural problems in the urinary system that block urine flow from the kidneys to the bladder.
The most common symptom of pyelonephritis is back pain. Pain caused by kidney infection is usually felt just below the rib cage and close to the spine. Typically the pain is described as a dull ache, much less intense than the acute pain associated with kidney stones. Kidney infection pain also tends to come and go, and it may extend to the side of the body or down into the pelvic area.
As you noted, sometimes the symptoms are limited to back pain alone. If you experience new and sudden back pain, it is a good idea to see a doctor about it. Many people also have associated symptoms of painful urination, frequent urination, blood in the urine, fever and nausea or vomiting. If you notice these symptoms, see your doctor immediately.
In some cases, people become extremely ill with pyelonephritis and have to be hospitalized. This can occur when the kidney infection spreads to the blood stream. This is called septicemia, and it often begins with rapid breathing, increased heart rate, chills and a sharp spike in fever. Severe pyelonephritis can also cause the kidneys to stop functioning, which is a potentially fatal situation with a number of symptoms, from bloody stools and breath odor to tremors and swelling of the lower body.
When you went to the emergency department, the doctor probably began by tapping on the kidney area to see if it caused you pain. Then, most likely, your blood was drawn to be checked for a high white blood cell count, which would indicate infection. They probably also obtained a urine specimen to examine for bacteria. Once bacteria are cultured and identified, the doctor can prescribe the most effective antibiotic.
Most people respond quickly to antibiotic treatment, and their symptoms resolve without further complication. A thorough follow-up usually calls for x-rays of the entire urinary tract to look for structural problems in the system that may have caused the problem.
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