Question:

Dear Dr. Garcia, You have been very kind to answer many questions for me in recent years. I am writing now with a general medical question that I hope you can help me with. My incredibly sweet, gentle, and unfailingly kind  husband is 81 years old. A retired professor, he is physically active and extremely fit, conitnuing to work 35 hours/week as a grocery clerk. He also volunteers as a literacy tutor in prisons and at a homeless shelter. He has begun to experience understandable cognitive deficits, particularly with short-term memory and sequential tasks. He had an MRI last week and I just received the radiology report. We won't see his physician again for another 5 weeks, following a standard geriatric neuro-psych evaluation in a few weeks. Meanwhile, I am hoping that you can help me to interpret the radiology results. (I know that my husband is not your patient and that you have not assessed him; nor are you a neurologist, a radiologist, or a geriatrician. I would simply appreciate your professional medical opinion on this report.) It seems to me that it confirms the organic changes underlying his symptoms, indicating a decrease in oxygen to his brain due to the ischemic small vessel changes and due to the diffuse atrophy--particularly of his hippocampus, which governs memory. What I am wondering if you can tell me is this: Are these organic changes likely to be the early stages of a progressive dementia like Alzheimers, or are these neurological changes simply typical of/consistent with advanced age, indicating that he might simply retain his current level cognitive deficits without experiencing significant progression of them? The report follows. Thank you ever so much for any insight you can offer us, Dr. Garcia. We appreciate your generosity greatly, especially in the face of the inevitable, heartbreaking an incalculable losses of aging and death.

FINDINGS: There are prominent ventricles and cortical sulci. There is moderate atrophy of the apical Campbell formations--right greater than left. No intracranial mass lesion, hemorrhage, abnormal extra-axial fluid collection or evidence of acute or territorial infarct. No restricted diffusion. Mutiple discrete foci within the deep and subcortical and confluent areas within the preventricular white mattter and of the cerebral hemispheres and brainstem are identified. The pituitary gland, clivus, cervial medullary junction are normal. The calvarium skull base, mastoid air cells and orbits are normal. The visualized paranasal sinuses are unremarkarble.

IMPRESSION: Mild to moderate chronic small vessl ischemic changes. Diffuse atrophy. Moderate atrophy of the hippocampal formations, right greater than left.

Answer:

Treatment for brain atrophy depends on the cause. The outlook or prognosis depends on which condition caused the brain atrophy. Some conditions—like stroke, encephalitis, or multiple sclerosis—are manageable with treatment. Brain atrophy can be slowed or stopped in some situations. Others—like Alzheimer’s and Huntington’s disease—will get progressively worse in terms of both symptoms and brain atrophy over time. What I see on the MRI is more than likely a slow progressive issue. There are treatments for such things. In my regenerative medicine practice, I use certain peptides to help these issues. They are Cerebrolysin, Selank, and Semax. You can email me at my office directly after you meet with the doctors there and we can discuss some options. There are things that can help, The things he is doing now, staying active and using his brain, are very important as well as minimizing additives in his food.  Please stay in touch

Question:

I have a general medical question. For the last several weeks, every time I eat (anything), the pressure in my ears increases markedly, as they would in a plane, and then they begin to pop. This happens all the time but seems to be worse if there is even the slightest bit of salt in my food. What do you think could be causing this? I very much appreciate this generous service you offer to all of us, Dr. Garcia!

Answer:

The most common cause for your problem is blocked eustachian tubes. That can be due to allergies as well as inflammation where the tube empties. The best thing is to get an exam by an Ear/ Nose and Throat specialist. They may be able to open the tube to a larger bore so it drains better. At times they place a small tube temporarily into the ear drum to alleviate the pressure and allow the tube to decompress. I wish you the best

Question:

Do you think that the OTC supplement Liver Rite (Liverite) effective? It claims to make one's liver function more efficiently, decreasing fatigue and "sluggishness."

Answer:

I am sorry, but I think there is no need for that product, the milk thistle will add very little to nothing

Question:

What do you think of the product Lipozene? Snake oil or effective? Thanks for your opinion!

Answer:

Since the active ingredient in Lipozene (fiber) doesn't magically speed up your metabolism or burn fat, you still have to eat less or exercise more to lose weight on the pill. Yep, that means you still have to cut calories for Lipozene to help you lose weight. You may be able to eat your favorite foods (as the website advertises) but you'll probably have to eat far less of them. Save your money

Question:

Can you explain the mechanism by which glucophage works? I was prescribed it last summer for Type 2 diabetes and lost 35 pounds in the first six months, which returned me to my pre-diagnosis weight of 105, something no amount of appropriate diet or exercise had been able to achieve for the previous two years during which I mysteriously gained weight for the first time in my 55 years. (I had never weighed more than 107--always slightly underweight for my height, but not dangerously so.)  How is it that the glucophage finally achieved the weight loss? My weight seems to have leveled off now though I must still be on the glucophage; that is, I still have diabetes. I have always been an amateur competitive cyclist and runner; and I lift weights four days/week and row several times each week as well. I am also a vegan. I'm not sure what else I should be doing to combat this miserable disease, which came on out of nowhere after a lifetime of excellent health (though it runs in my family, so I am genetically predisposed to it). Thank you for any insights you can offer.

Answer:

The Glucophage works by increasing insulin sensitivity so the insulin in your body will work uninhibited. That allows fat loss to occur. There is nothing wrong with staying on it to control your diabetes. It is very safe and many people without diabetes use it in a low dose to slow the possibility of losing that sensitivity. Loss of insulin sensitivity can happen in advanced age and with decreasing sex hormones. Resistance exercise will help retain the insulin sensitivity, much more effective for that than aerobic exercise, as it forces the glucose into the muscle where it belongs. There are many supplements that can help increase the insulin sensitivity, you can find them on many websites, I like cinnamon, chromium, alpha lipoic acid, Vit B 1, bitter melon, green tea. Keep working out, avoid the simple carbs and stay on the Glucophage, maybe in time, the need will lessen.

 

Question:

Just a quick follow-up about the biofilm in my face. I agree that the relatively midl heat from the (transcutaneous) ThermiSmooth (not the percutaneous ThermiTight) might have killed the bacteria. But why might that process--i.e., bacterial death--cause such a marked case of pruritis?  Also, it sounds like this treatment might be my answer to killing this infection. Do you think that a Profound treatment (percutaneous) might be more effective in killing this swamp in my face? It can't be cut out because it's deep and throughout my whole cheek, crossing the infraorbital nerve and two branches of the facial nerve.Thanks again for this amazing service you offer, Dr. Garcia. You are extremely generous!

Answer:

I am not sure why the itching came on, it might be related to the bacteria dying off, but no way to know for sure. I cannot say whether a Profound treatment will kill the bacteria. A small trial spot might be worth it

Question:

I have a complicated problem: a hospital-acquired infection (following a J-line 2.5 years ago) that has lodged in my cheek and flares up in an impressive cellulitus presentation every 6-10 weeks and then susbides, but does not resolve, with oral antibiotics. My doc has tried every class of antiobiotics possible with no permanent results. I aappear to have a particularly resistant biofilm. We haven't yet tried vancomycin because it will require a picc line, but I think that's our next move. Meanwhile, I had completely forgotton about (repressed?!) the fact that i am living with this infection and had a ThermiSmooth treatment to my face last week. Immediately after the treatment, that area of my cheek became furiously itchty. I should think that the heat would kill the bacteria, not stiumulate it. What do you think is going on? Is the itchiness from the bacteria dying from the heat or is it from the bacteria multiplying from the heat? (UGH to the latter option.)  By the way, my doctor tells me he can't aspirate and culture the infection because it's solid, not liquid; and he rightly doesn't want to excise a chunk of my cheek, making this probrlem even more disastrous. What do you think of all that/ Thank you for your time and opinion.

Answer:

I do think the Thermi treatment should either kill or do nothing to the bacteria. I do not think it should make it worse. As to aspirating a solid lump, I have to agree, that cannot be done, although the nodule can be cut out if it is somewhere where the access is straightforward and not over anything that could get inured. Sorry to hear about your problem

Question:

Good day, Dr. Garcia. I have a general medical question for you. For about 8 years, I've had nerve damage in one foot -- either  morton's neuroma from a life of ballet (it's visible as a bundle of scarring  on MRI) or peripheral nerve damage from diabetes, which was just diagnosed two years ago. (If it were from diabetes though, wouldn't it be in both feet?) The pain is well managed with gabapentin, but sometimes, that foot swells significantly; over time, that that foot needs a shoe size that is about a 1/2 size larger the other foot. Why is that? If this is caused by diabetes, is the nerve damage reversible now that my glucose is controlled? Thank you for your help.

Answer:

As to the diabetes, yes, you are correct, it would happen in both feet. As to the shoe size, most likely that is due to the scar tissue changing the contour and even size of the. It can cause the arch to be affected as well as the width. It is uncommon for diabetes related pain to be reversed but good control will usually keep the neuropathy from progressing. Hope that helps

Question:

Two years ago I was in an intensive care unit and needed an IJ line placed. Within 48 hours, I developed an aggressive, nasty case of cellulitis in my cheek, on the same side of my body where the central line was placed. I was put on keflex, and the infection ostensibly resolved within 10 days. Unfortunately, it flared up again four months later, five months after that, and then again six months later, each time treated with courses of keflex. Three months later, it erupted again, and I then was put on clindamycin qid x14 days and qd for 3 months thereafter. I just stopped that course of treatment  a few weeks ago, and once again, I awoke this morning with an extremely impressive recurrence of the cellulitis. In addition to be unsightly, it is remarkably painful; it feels like a hot screwdriver is being driven into my cheekbone. My dermatologist initially wondered if it might have been a biofilm that developed from years of injections of HA's, independent of a central line infection (a possibility that he considered a secondary and unlikely culprit because the infection presented above, not below, the IJ line).  While I don't dispute the standard medical logic of his thesis,  I have always believed that this is a frank, hospital-acquired infection, since its initial presentation followed so shortly after the line's placement. What do you think might be the cause? And now, what might you suggest as a course of treatment? Vancomycin? IV? I'm at my wit's end. Thanks for any guidance you might be able to offer.

Answer:

I believe that is is likely some low level infection from the original infection that has not be totally cleared. What might be happening is that the filler is being contaminated from the low level bacterial count and makes it all worse. Before undergoing blanket antibiotic coverage, a diagnosis of the true pathogen should be done. I thing a culture, possibly requiring a needle aspiration of the the tissue is a starting point. A CT scan of the area might help direct attention to a particular area that appears to have a walled-off region compared to the non-affected side. Once that culture comes back, then appropriate treatment can be started. They also need to do culture for not only aerobic and anaerobic bacteria, but also look for strange contaminants like acid-fast bacteria and water-borne pathogens. I would also recommend a look at your facial bones to make sure there is no abscess in the dental region seeding the infection. I wish you the best.

Question:
Answer:

sorry but I do not see anything posted

Question:

Do garlic supplements actually help to manage cholesterol? If so, how much of a difference can they generally make? Thank you very much for sharing your professional opinion.

Answer:

I think the effectiveness of garlic for lowering cholesterol is small. I prefer using plant sterols to control cholesterol, my favorite is Nature Made CholestOff

Question:

Hi, Dr. Garcia. My endocrinologist just added glucophage to my insulin to see if we can reduce my insulin resistance. I'm a type 1 diabetic, so this is an off label prescription. One of hte problems is that the insulin has caused me a 35 pound weight gain since I was diagnosed last year. I eat like an anorexic devotee of Atkins, but the constant injections of insulin have simply blown up my fat cells. I am 58 and never weighed more than 103 pounds in my entire life. Now I'm at 142 (5'6"), and no matter how strictly I follow this diet and exercises (i'm a Cross Fit instructor in addition to my day job), I cannot lose any weight. I'm writing to ask if in your experience, you think the glucophage will help with the weight loss and, if so, about what percentage of theis $%#@ weight I can hope to lose. Thank you for your help. My endocrinollogist is just mostly interested in my kidney function and A1C (which has also been stubbornly high at 8.4 despite all my attempts at tight glucose control) and couldn't care less about my weight, which has totally changed my life. I really appreciate your insight and wisdom.

Answer:

the glucophage does help by increasing muscle sensitivity to insulin. I am unsure why you have gained that much weight if you are a type 1 diabetic, that is very unusual. I think there is low risk with taking the glucophage and it is worth a try. I would be curious as to what type insulin they have you on.

Question:

PS: This is the lobectomy woman again. I have a question about the scar. It's a thin, red horizontal  line across a natural, small crease in my neck; currently covered in Dermabond (for the next 2 weeks). But here's the problem: that thin red line is in the middle of what looks like a pink log, about the size of my little finger. It looks like a hypertrophic scar -- at just 48 hours post op!  (How could it become hypertrophic so quickly?) I've never seen a scar like this before. I''ve had a facelift with a running subcutaneous suture under my chin, but that was absolutely flat from the very first hours after surgery. Does my description of this current scar sound familiar to you? If so, what's up with this?  Is it a common technique for closure? Why is it raised? Will I be left with a pink log on my neck forever?  My surgeon (at a major teaching hospital in CA)  assured me he has worked with colleagues in plastics to ensure the best possible result, but I'm beginning to panic about this. It doesn't look right to me. (I don't have an appointment with mysurgeon again for four more weeks.)  I was speaking with someone last month who had one of these "pink logs" in her suprasternal notch. When I asked if she'd had a thyroidectomy, she said sh e had -- 3 years previously! That nearly casued me to cancel my surgery; but then, my surgeon assured me I wouldn't even notice the scar after a month or so. I'm not so sure. Thank you for offering me any insights you are able, Dr. Garcia.

Answer:

At the 2 day point it is likely the deeper sutures that are everting the skin so that the scar in time heals flat rather than depressed. A hypertrophic or keloid scar cannot form that fast, it would not start to be seen for a minimum of 4-6 weeks. Just follow your surgeons recommendations and if in the highly unlikely event it does turn thicker, injections can be done to flatten it out.

Question:

Just weighing in as a patient for your readers: I completely concur with you about SculpSure. Incredibly painful (and I have such high pain tolerance that I've had several surgeries just under local anesthesia) and unimpressive/next-to-no results. I've used CoolSculpting and found it quite tolerable with predictable, if mild/moderate, results.

Answer:

Thank you so much for providing your experience. It is always good for patients to hear from an actual recipient of the treatment rather than just a doctor. Glad you got good results from the CoolSculpting 

Question:

Do noses really grow/widen with pregnancy? If so, why? And if so, do they return to normal size after delivery?

Answer:

there can be some small amount of swelling or edema during a pregnancy, but they do not actually grow. Once the regency is done, the swelling will go away.

Question:

I see that you've answered a question like this for someone else, but I wasn't fully clear on your answer. Please forgive me for asking you a version of a question you've already answered! I  take statins. I know you say Cholestoff might be able to replace them if one eats well and exercises. But I'd like to know if taking Cholestoff  as well as the statins might increase their effect of lowering my LDL. That is, can I drop my LDL even more if I add Cholestoff to the 20 mg of atorvostatin that I'm already taking? Thank you for taking the time to share your medical knowledge with us!

Answer:

The two work by different pathways so it is possible that you can lower your LDL using both. That is safer than adding red rice yeast as that has essentially statin-like properties and that I would not mix those two

Question:
Answer:

I personally think SeroVital is a waste of money. As to the frequency of the shots, they are done daily. You can go to http://www.worldhealth.net/  to find a doctor that can test you for the hgh deficiency and then start treatment if indicated.

Question:

What do you think about Glucomannan as a supplement for weight loss?

Answer:

I think Metamucil in a generic form is as effective at a fraction of the price. Any weight loss you get from either is mild at best as its only function is to push your food through your intestines faster to limit absorption.

Question:

Do white kidney bean extract supplements effectively block carbs? For instance, this product: https://supplementpolice.com/carb-block-ultra/ If that isn't a good product, what supplement do you recommend to help block the absorption of carbohydrates? Thank you, Dr. Garcia.

Answer:

I am sorry to say that it does not work. Plenty of claims, actually the claims have been out there for over 20 years. No true unbiased research on proving it effective. All the 'studies' are sponsored by the company that makes the product. Acarbose and miglitol are prescription drugs that do work but have some side effects.

Question:

Thanks for your reply about the hyperglycemia. Just a quick follow-up: I wasn't at all distressed by the surgery with the local anesthesia; in fact, i was so relaxed I even fell asleep for most of it. Why would I have heightened levels of cortisol from such an experience-- which I had actually been looking forward to and not at all fearing? 

Answer:

Cortisol release is not typically something you would feel, it is not like adrenalin where that makes your heart rate elevate and you can get shaky. A good example of that is how diabetics that are given steroids for pain and swelling have elevated blood glucose levels. Even the epinephrine in the local anesthetic can raise your cortisol level. People are taught to lower their cortisol level by relaxation techniques many times, but it is not always effective and feeling calm does not mean your cortisol level has dropped. Adrenalin, on the other hand is commonly felt if released in the body, like when you have to slam on your brakes in a car to avoid hitting another car; that is adrenalin, not cortisol that is released. I cannot say why it has remained that way for so long  and at that high level after your surgery though. I think you need to get an evaluation by your primary care physician to rule out other sources or problems

Question:

I am a type 1.5 diabetic, taking humalog and lantus only. No oral meds. Diagnosed just 2 years ago. I manage my glucose fairly well, but the underlying insulin resistance (the ".5" part of the 1.5), makes it occasionally difficult. I usually can keep it between 90 and 120.  Last Friday, I had a mini-facelift (out-patient, local anesthesia only) with no aesthetic problems at all. It was a breeze;...but since then, my glucose has been between 435 and 590, and it's not responding to the insulin. My doctors know about this, but I'm writing to you to ask if you've ever seen this before in your own practice.. What on earth causes this? And in your experience, does it resolve with time? If not, what steps have you seen your colleagues (endocrinologists, primary care folks, etc.) take to manage this extremely worrisome side effect of surgery? Thank you so much for your help.

Answer:

I have not seen it be as high after a surgery procedure, but it is common for it to be a little higher. The main cause is usually excess cortisol release from your adrenal glands that makes managing the glucose level a bigger challenge. I will say that in my experience, I have seen it more in cases of straight local anesthesia compared to general anesthesia because the cortisol release is higher when you are aware of things and your cortisol release is larger. It usually settles down in time and taking your pain pills and getting some rest/ sleep does reduce the stress and lowers your cortisol level

Question:

Good day to you, Dr. Garcia. I have developed for the first time in my life what I am assuming is minor fungal infection in one inframammary crease. My breasts do not sag but are full. I have used Tinactin spray, which seems to have aggravated it. Of course, I am keeping the area clean and dry and wearing soft cotton bras with no underwires. Any other suggestions for handling this? It has gone from itchy and red to painful and red, but there is no discharge. Thank you. What an unpleasant  question to thrwo at you throuugh cyberspace, by the way. Happy Holidays....I have a fungal infection!!! Yuck. But do have pleasant and restful holidays. And thank you for all you do for us.

Answer:

I would suggest trying some differnet over the counter medications before seeing a dermatologist in person. Naftifine (Naftin),terbinafine (Lamisil),clotrimazole (Lotrimin), econazole (Spectazole), ketoconazole (Nizoral). Best of luck and wishhing you a Happy Holiday Season.

Question:

I forgot to ask: If you take more than one Choestoff/day, is it beneficial to take them at different times -- e.g., morning and evening?

Answer:

I suggest one in the morning and one at night

Question:

I read here that you take Cholestoff and successfully control your cholesterol. That's great! Congratulations! How many do you take/day? I'd like to give that a try!

Answer:

it take the product by Nature Made. I take one capsule in the AM and another at night. I take it with my other vitamins
 

Question:

I just saw your posting about LDL and wanted to ask a slightly different question. I have the same issue -- a moderate dosage of atorvatstatin -- and when I've asked my PCP if adding something like red yeast rice or Cholestoff might increase the degree to which I can reduce my LDL, he has said that would be like adding gas to an already full tank in your car, that it won't do any good because I've already got the atorvastatin onboard and that it would just be a waste of money, that is, that the supplements can't extend or override the prescription.  Also I've read that niacin can increase insulin resistance. Since I'm officially in the "pre-diabetic" category, I don't want to aggravate that in the pursuit of lower LDL cholestorol. Is there any truth to those claims? Thanks so much.

Answer:

The issue with taking red rice yeast is that it might be enough to get you off the statin. Red rice yeast is a combination of cholesterol lowering compounds. The drug companies isolated a few and made them prescription drugs. You may likely be able to either reduce the statin dose or entirely go off of it. My preference is the Cholestoff over red rice yeast. With that alone I have been off the statin for years and controlled my cholesterol better with less muscle aches than I did with the statin. Niacin can cause a change in insulin sensitivity, so you might want to skip that one. All the best.

Question:

I am on atorvastatin (20 mg qd) and CoQ10. I would like to lower my LDL (and raise my HDL) even more. I take 4,000 IU of omega 3. Would adding Cholestoff (or red yeast rice) as well as niacin (about 500 mg qd) be helpful in your opinion? Anything else I should do? (I eat very well and am a Cross Fit instructor, so I get great deal of exercise.)  Thank you for your assistance, Dr. Garcia.

Answer:

I think your plan is a good one. I think all of the supplements you have listed have a good effect on lowering total cholesterol as well as LDL. As to HDL, that is much more controlled by genetics and harder to modify. There are studies that have shown a high intensity interval training (HIIT) method does assist in elevating HDL. HIIT is short burst of intense exercise, short rest and then a high level effort again. A mixture of exercises is performed  These need to be relatively short sessions of 30-45 mins max but it needs to be low to medium weights gone at a high level of effort. Slow methodical aerobic training will not do it. Best of luck with the journey.

Question:

PS  Sorry, I mistyped! My daughter has gained 8 pounds in 12 weeks, and weighs 143 now, not 148.

Answer:

Understood, my comments still stand

Question:

Dear, Dr. Garcia. I'm sorry to ask you another general medical question outside of your specialty, but you've been very kind to answer another such question for me several weeks ago. My daughter was diagnosed recently as a Type 1 diabetic. We are not clear about one issue in particular. We know full well that endocronoligists rightly fight to defeat the story that "insulin makes you fat" by making clear that once insulin is restored to one's system, it simply enables the body to use the glucose produced by food intake. That's clear enough.  And we understand why they need to emphasize that: to get their patients to take their insulin! But I don't think that's the whole story, and it's hard to get anyone to admit that the insulin itself, even with signifnicantly reduced caloric intake, can cause weight gain.

In the past three months, my daughter, who is an athlete  (5'6", 135  pounds at diagnosis), has been trying to drop 10-15 pounds to return to her normal weight, which might also promote greater health in light of her diabtes. She had reached 135, for the first time in her life, in thred three months prior to her diagnosis (inconsistent with Type 1 diabetes, by the way, which typically causes weight loss) due to a knee injury, surgery, and extended immobility.  Since her diagnosis, she has been eating 1,000-1,200 calories/day (lean protein, water-based vegetables, and one small fruit/day -- no processed carbs, no dairy, no gluten), and she has strictly followed her sliding insulin regimen, needing approximately 4-5 units of Humalog and 3-4 units of Lantus daily. She continues her track and field training  2-3 hours/day with her professional trainers and coashes. And inthe past twelve weeks, she has gained 13 pounds and now weighs 148! To say the least, she is incredibly discouraged and concerned about what the weight gain implies for her diabetes.

Her endocronoligst and nutritionist insist that she simply must be eating more (and differently) than she is reporting, that "insulin does not make anyone fat," and repeating the reasonable old addage "calorie in, calories out";  but I can attest that this is one highly disciplined and determined young woman and that she is being completely truthful with her medical team. In fact, to offer solidarity, I started eating her diet with her, especially since I was preparing most of her food anyway, and I have lost 19 pounds in the past 12 weeks. At 102 now, I need to change my diet to start gaining weight, pronto.  So all of this is to ask you, what do you think is happening? Can insulin itself cause weight gain?  Any suggestions on what she can do/try to lose these extra pounds? Thank you very, very much for reading this long question and for sharing your medical opinion with us.

Answer:

It is hard to say without seeing her blood glucose monitor readings, but let me start with the issue about insulin and weight gain. I believe that is can cause weight gain. When insulin is in the blood stream at the appropriate time, it will assist in glucose metabolism, but when it is around at other times it can point to weight gain. Insulin products that are long-acting such as Lantus are more convenient, as they avoid the more frequent injections, but that have their limitations with their long periods of effects. I also have to say that when type I diabetes is uncontrolled, that is when you have weight loss, and when it is controlled, it is not uncommon to have a rebound weight gain. Calories in and calories out is not accurate as it depends greatly on activity level and time of eating, as well as time of insulin administration. It might help her to take the Humalog at multiple times, depending on her sugar reading rather than using a long-lasting insulin. You might want to discuss that option with her physician.

Question:

I've had surgery 4 times in my life. Each time, every anesthesiologist has given me an inhaled substance via a mask and told me "This is just oxygen," which it clearly is not. Three questions: 1) What is the name of gaseous substance(s) that they give patients at that point? 2) Why on earth do they lie? Why don't they simply say, "I now need you to inhale ________ which induces unconsciousness"? 3) After three of my four surgeries, my hair fell out and though most of it eventually grew back, with each successive surgery, it thinned more and more, permanently. I'm now facing a fifth surgery. Is there any anesthesia I can request that will reduce the likelihood of this happening again? Thank you, I hope you'll have a beautiful and restful holiday weekend, Dr. Garcia!

Answer:

I cannot say exactly what happened on the prior exposures you had to general anesthesia. In some cases the anesthesiologist does use gases for the anesthesia. These can can be variations of Forane. At times it is only oxygen and they give you a medication like propofol to put you to sleep. Sometimes they continue to use propofol to keep you asleep and other times they use one of the newer shorter acting gases to keep you asleep. It varies from doctor to doctor and their preference. Speak with the new anesthesiologist about your issue before your surgery. As to hair loss with anesthesia, it can happen, some people are more susceptible than others. It is caused by the stress of the whole experience. I think having them use propofol to keep you asleep is the best option, rather than the gases. Also taking things after surgery like licorice root, ashwaganda and rhodiola help you handle the stress better. I wish you the best

Question:

Sent this question to you a few days ago but it must not have gone through. How many mg CoQ10 should one take daily when on a statin? I'm on Lipitor 20 mg  qd.  Is that a moderate or low dose statin? Should most people be on more for it to be effective? Thank you.

Answer:

I suggest taking at least 400mg of CoQ 10, preferably in a gel cap, when one is on a statin. If you have no access to gel caps then some peanut butter or almond butter at the same time as the pill is acceptable. As to the dose of Lipitor, that is a pretty average dose. Most people get started at 10mg and are increased depending on the response.

Question:

My daughter has Type 1 diabetes. I've read that cinnamon can help regulate glucose. Do you think it's worht adding a cinnamon supplement to her insulin regimen, or is the imporvement so negligible as to be useless?

Answer:

I have seen it help in people that are type II diabetics, those that are diet controlled or take oral medications. I have not seen it help in those that take insulin shots. There is an effect, maybe enough to reduce the dose of the medication, but it is not anything as strong as the prescription drugs

Question:

Quick general medical question for you today, Dr. Garcia: I had a brief critical illness last month, after which my blood chemistries were all messed up for the first time in my life. Most alarmingly to me, my cholesterol kevels had completely flipped. Previously, my HDL was about 140 and my LDL was about 40. When they tested it upon my discharge, my LDL was 140 and my HDL was 40! Of course, I was put on statins instantly and told to be careful with my diet (which I always am) and vigilant about rigorous exercise (which I also always am). My question for you is how long do you think it will take for me to get back to my previous levels? I am seeing my doctor at 6 weeks post discharge. Do you think it will be corrected by then? Or will it take longer? I'm both horrified and, weirdly, embarrassed by this development. I know it's not my fault, but the reigning medical culture makes me feel that it is -- like I'm not eating correctly or exercising enough.. (I am 5'6", 108 pounds, marathon runner, 30 years old, non smoker, vegan, no-processed carbs of any kind, female.) Thank you for your opinion.

Answer:

There are many reasons why blood tests like that can change. I will say that the LDL is likely going back to normal once your acute issue is over and that is usually between 4-6 weeks. HDL is more tightly genetically controlled, so that might take a bit longer but a low HDL in the short term is of no big concern. Get back to all you activities and diet/ supplements and they should all flip back soon.

Question:

How many Cholestoff do you yourself take each day to achieve the level of clinical effectivness you think necessary to lower your LDL? And do you take them all in one dose or spread them out?

Answer:

I take Cholestoff one pill twice per day and it has kept my total cholesterol and LDL in great shape.

Question:

Just saw that you answered a question about statins. Do you think it's safe/helfpful to take plant sterols like Cholestoff to supplement the effects of Lipitor? I'd like to continue to lower my LDL. Thank you for taking the time to reply to this and to all the questions that are posed to you.

Answer:

I personally have found plant sterols, specifically Cholestoff, to be as effective as an statin drug. I also take Omega 3 and Omega 7 fish oils and found they also work well in conjunction with the sterols. You can take them in conjunction but you might just need to sterols/ fish oils alone. I also suggest you take at least 400mg of CoQ 10 in a gel cap formulation if you are taking a statin as they deplete your CoQ 10 severely and you need that in your supplement plan

Question:

Does grapefruit potentiate some statins, like Lipitor, making them more powerful, or does it diminish their effectiveness?

Answer:

Grapefruit juice increases the effects of statins, in particular Lipitor and Zocor and can give you excessively high levels of the medication. This can lead to more side effects. You should avoid grapefruit when taking statins, especially these two medications.

Question:

I was diagnosed with adult onset Type 1 diabetes last year. It's well managed with insulin. I was scheduled for a facelift, but when the surgeon learned of my diabetes, she canceled the surgery. I consulted wiht another surgeon and he said it's fine to proceed. What do you think? I've never had any evidence of poor wound healing, I don't smoke, and I'm a competitive cyclist. Would you perform a facelift on someone like me? If so, what extra precautions would you take? And what extra precautions would you advise the patient to take? Thank you. 

Answer:

As long as your diabetes is well-controlled, there is no problem, The morning dose of insulin should be half of normal the day of surgery and then the nurses in the recovery area will check you glucose to see if you need more. It is only a problem if the diabetes is not well-controlled. I have performed facelifts on many patients such as you.Nothing else special to be done.

Question:

Is 50 mg HCTZ qd  considered an average dose? A high dose? A low dose? Thank you!

 

Answer:

that is a pretty standard dose, sometimes use a little lower if used in combination with another anti-hyptertensive

Question:

post-op clicking

Answer:

The clicking is usually due to a piece of the miniscus that is stil haning just like  a hangnail. It might need to be clicked again. The orthopedist tries to be as conservative as they can be because clipping the minuscus off removes cartilage from the kneee, so it relieves the pain but alse decreases the surface area covered by cartilage.

Question:

Happy New Year, Dr. Garcia! I know you’re a big proponent of supplements. As the calendar turns again, and as I get older with it, I thought I’d check in with you to see if you think my daily supplements are sufficient and, if not, what I should add. I also thought I’d ask about my skin care regimen.  I’m a white 51 year old woman with vegan, gluten-free diet. Non smoker, daily exerciser, sun block user. Good health except for mild hypertension (controlled by HCTZ) and some osteoarthritis, which seems only to be getting worse with every year. So here are my daily supplements: multivitamin, calcium, vitamin D, vitamin C, vitamin E, vitamin B complex vitamin A (low dose), probiotics,,Co-Q 10, red yeast rice, plant sterols, fish oil, biotin, turmeric, tart cherry, garlic,  low dose aspirin. Anything you’d suggest I add? Remove?  Also, here’s my skin care regimen: Retin-A .1% 10 months/year, daily sunblock, squalene oil by day, a peptide complex followed by aquaphor at night,  gentle exfoliation each morning, chemical peels 3-4x/year. I tend to have mild rosacea which is made significantly worse by microdermabrasion, so I can’t use that, though I wish I could. Anything you’d suggest adding? Deleting? Thanks so much! A peaceful and healthy new year to you and to your family, Dr. Garcia!

Answer:

I would add some turmeric, glucosamine and chondroitin, magnesium, Vit D3, possibly some MSM, make sure the Vit E is all isomers and not just alpha-tocopherol. Might see a dermatologist for a prescription for some topical antibiotics for the Rosacea. Avoid hot water on your facial skin. Otherwise you are on target. Happy New Year.

Question:

I see that you occasionally offer general medical opinions here, Dr. Garcia, so I’m asking for your impression of an MRI result. My husband is a 40-year-old runner and amateur athlete, never prone to complaint and quite physically rigorous. In the past year, his left knee has been excruciatingly painful. X-rays have had non-specific results. He’s had two steroid injections, which haven’t been especially helpful. His lifetime limit on that is 3. PT only aggravates the pain. (Four different physical therapists have told him that he’s in far too much pain for them to work with him and, in fact, that it’s like asking someone with fractures to do physical therapy on unhealed bones.)  Last month, his orthopedic surgeon ordered an MRI and, based on those findings, told him simply to follow the standard RICE protocol and use  NSAIDs–which he can’t tolerate–because he just has “arthritis” and will have to get used to it, advice which pushed my husband into clinical depression for the first time in his life because he is unable to ambulate, use stairs, or complete most ADL’s without my assistance. I had to leave my job simply so I can drive him door-to-door for anything he needs to do, including getting to and from his job, a move that has put us in financial peril. He’s now using a walker. This is a man who used to run every day, lift weights, or row 18 months ago.  He consulted another orthopedic surgeon who told him to “man up, this is what happens when you get old, buddy.” Here is the radiologist’s report from the MRI. Would you please tell us what you think? What would you do if this were you?  Thank you very much for your insights.“1. Relatively large focal area of marrow  edema in the inferior lateral patella, with suspected  overlying focal full-thickness cartilage loss. This is  not fully characterized, but most likely represents sequela from a remote injury. Doubt acute fracture. ? stress fractures. 2. Blunting of the posterior horn of the lateral  meniscus, with area full-thickness cartilage loss along the posterior lateral tibia, deep to the posterior horn of  the meniscus. 3. Somewhat distorted appearance to the body of the  lateral meniscus, possibly a transient appearance due to  interposition between the femur and tibia. No definite  surfacing tear. Does the patient have lateral-sided  symptoms in this location? “

Answer:

sounds like patellar-femoral syndrome. The initial treatment as described is RICE, which is effective in a certain percentage of people. The problem is the patella floating over the knee when it is bent, obviously a runner will do this repeatedly and cause continued irritation. I have never seen steroid injections work to tell you the truth. PT might help but that is not a cure. Wearing a patellar brace to keep the patella tracking properly helps many. I also think avoiding gluten-containing foods also help decease the inflammation. Taking turmeric, apple cider vinegar and ginger also are good for deceasing the inflammation on the patella. As to more aggressive options you can consider PRP injections into the joint, they do help with pain but it will take 4-6 weeks to have its maximum effect. In a subsection of patients a slight shaving down of the patella can help so it does not get aggravated when bending the knee joint. I know he likes running but he might consider pushing and pulling a sled to keep his conditioning up. It helps as there is only a concentric motion and the eccentric portion, which is the most problematic is eliminated. Keeping the thigh quadriceps muscle strong is a key as the muscle will atrophy from disuse. He can do that with body weight squats and leg extension machines, just do not let the knee go to 180 degrees, knee a slight bend.  Many athletes swear by something called cryotherapy where you stand for a short period of time in a liquid nitrogen chamber and it helps decrease swelling. Have him try all or some of those options and see how it goes.

Question:

I've been following the information you've been sending to the person with the hair loss following surgery because I'm having the same problem. My nails grow extremely quickly. My doctor tells me that this is an indicator that my hair will grow just as fast. Is that true or is he just trying to console me? Thank you for your advice to all of us, Dr. Garcia.

Answer:

they are related but not in a direct fashion. The growth of your nails does not translate to speed of hair growth I am afraid. They are both dead protein but shedding hair is different than growing nails. Sorry. Hang in there though, your issue should turn around in the next few months, although it seems like forever.

Question:

Thanks. I'll give them a try. I've seen an orthopedic surgeon and he just tells me it's patella-femoral pain ("runner's knee") because I'm 53. He's only ordered X-Rays, not any soft tissue studies because he feels they aren't necessary. Ah, managed care! So there you go. I'll keep pushing him. Thanks for the encouragement.

Answer:

your name does nto show when the question is posed, that is why I did not know you were the patient with the Runner's Knee. There will come a opint where the surgeon needs to do an arthroscopy if it does not get better with conservative treatment. Sorry to hear about the slow movement on that.

Question:

Two general medical questions for you on this lovely summer Friday, Dr. Garcia: 1) After menopause, I became hypertensive, though I am a non-smoker and triathlete (also, I'm vegan and eat low-salt diet)  5'6", 105 lbs.  I tried ACE inhibitors before learning that they cause angioedema for me, so I switched to relatively high-dose HCTZ (50 mg/qd)   My blood pressure now hovers around 138/85, which my pcp thinks is OK but about which I'm not happy. Would you agree with my pcp that this is OK? If not, what else might you suggest?  2) I am very fair-skinned and for the past 30 years have been militant about sun-avoidance and full sunblock coverage all the time; but for the first 20 years of my life, I was in the sun constantly, so I have ancient solar damage to my skin. In the past year, little dark, dark red-black superficial bruise-like lesion have been appearing on my arms and around my neck for no apparent reason. The tend to resolve on their own after about 4 or  weeks. My dermatologist thinks I they are simply from scratches (though the skin isn't abraded at all) or bruises, but this makes no sense to me, since I'm not banging my clavicle  or tiny spots on my forearms. What causes these?  Thanks so much. Have a great and relaxing weekend!

Answer:

The blood pressure is OK, can try an additional medication like a Calcium channel blocker or a beta blocker.As to the skin, it is due to the skin getting thinner and there are like small bruises underneath the skin from small blood vessels tearing. Not much you can do about it I am afraid. Thanks for the kind words and the same to you.

Question:

My daughter got a superficial burn on her arm four weeks ago from an oven. It didn't blister but it did turn red and a thin film of skin, in a circle around the burn, peeled off within a week. We iced the burn when it happened, cleaned it, and kept it covered. It's now flat and reddish-brown. (She's white. We're German-American.) Is it likely to stay this color and become a permanent scar or will it fade over time? If it will fade, how long do you think it will take  to go back to normal? Thank you.

Answer:

Sounds like a medium depth burn. The color will likely come back but it can take a few months. I would use sunblock in the meantime to avoid the new skin from getting sun burned and make the healing take longer. Also some good moisturizer is need as well. I wish you the best.

Question:

Dear Dr. Garcia: a general medical question for you: I was diagnosed with that generic catch-all "patello-femoral pain" last year, the ubiquitous "runner's knee." X-rays showed nothing significant, not even arthritis. My docs didn't do an MRI to look for soft-tissue damage. I was told by two different orthopedic surgeons that I simply had "non-detectable generalized inflammatiion in the joint." The pain was indescribably debilitating, like a sharp metal vise with nail spikes clamping over my patella with every step. I went from running 7-8 miles/day to needing to sit on my butt going down stairs and to using a walker on flat surfaces. I couldn't even transfer from sitting to standing without assistance. Nothing worked -- PT, acupunture, massage, OT,  ultrasound, NSAIDs, etc.  I finally did a steroid injection, which I now see from scanning you site your never, ever recommend. Oops! So I won't be doing that again. Here's the thing: the injection seems to have taken down the pain by about 80%, so that would lead me to think that it worked and reduced the "non-detectable inflammation in the joint." BUT I now have new and incredibly loud crepitus in that joint -- so loud that every step I take can actually be heard anout 8-10 feet away from me, especially when descending stairs, but even when I sit or stand from a chair. If I understand things correctly, crepitus is a classic indication of inflammation. So what do you think is going on? I'm really, really relieved to be out of agony, if not out of all pain, but I'm worried that the crepitus is portending further damage and an imminent return of the pain. Sorry to be asking all this of a plastic surgeon, but the ortho guys (who all seem a bit cavalier to me) just say, "Aw don't worry about it." Easy to say when it isn't your own complete im/mobility on the line! Thank you for your advice, well beyond your own field, I know.

Answer:

The crepitus can be from a small amount of air from the injection or a little bit of the steroid that has congealed and makes that sound. It should go away over a few weeks if it is that. I think an MRI would help in order to see that posterior surface of the patella. At times there are little sharp points that can be shave down in a minimally invasive arthroscopic method that might alleviate the offending piece causing the patello-femoral pain. I also would start taking turmeric 500mg twice daily, a great natural anti-inflammatory with no bad side effects. Might also want to decrease gluten consumption even if you do not have a gluten sensitivity as it has been shown to increase inflammation as well. Best of luck.

Question:

Hi, Dr. Garcia. I asked this question a few days ago but it seems that you didn't see it. I always take probiotics every day. I'm scheduled for surgery and will be on the necessary course of antibiotics. May I continue to take the probiotics during that time, or will they render ineffective the antibiotics? Thank youi.

Answer:

Taking them together is a waste of the probiotics. Stop taking the probiotics when you are on the antibiotics and then resume the probiotics as soon as the anti-biotic course has finished. Sorry for the delay not sure what happened to the question earlier. The antibiotics will over-ride the probiotics

Question:

I know this isn't your field, but I see that you answer other general medical questions. My son has diabetes and has developed a severe sensory neuropathy in his foot. He is in agony, claiming that his foot feels like it is on fire and that someone is repeatedly stabbing him with a long knife. His doctor is trying to manage the pain with meds. Meanwhile, we can't seem to get a straight answer. His diabetes seems to be under control -- we monitor his glucose levels all the time and the insulin is working -- but this pain appeared in March and won't go away. One doc says it will subside once his "glucose is evened out"  (though it IS stable); another says that once nerve damage has been done in diabetics, they are never out of pain for the rest of their lives. He is a teenager, and of all the things that he has been through with this diseases, this seems to be the worst. He is as depressed as he is tortured. What do you say? Is this nerve damage--and subsequent pain--likely to be a life sentence? That is, is this damage permanent? Or is it reversible? If so, how to reverse it? Thank you for reaching well beyond your expertise to proffer an opinion. We really appreciate your help.

Answer:

I am afraid that without medications, the pain will persist for the rest of his life, at least with the technology we have at present. There are hopes that stem cell therapy might help revers some of the damage. We perform adipose-derived cell therapy but we cannot guarantee the degree of improvement.

Question:

For the past month, I have been awakened at about 4:15 AM, shortly before I usually rise, with agonizing  foot and calf cramps in both legs. The muscles become flexed and completely rigid, literally "as stiff as a board." Usually, one can resolve cramps by walking, but the cramps are so fierce that it is honestly difficult even to stand. I have a high tolerance for pain, but this is so painful that I end up shrieking and waking my family. It takes a good hour to resolve each morning. What on earth could be causing this? I  am 54, female, post-menopausal, a non-smoker, in very good health otherwise. No changes of any kind in my health or diet in the past month. Thank you for helping me to solve this puzzle.

Answer:

Most of the time, night leg cramps occur for no known reason, and they're usually harmless. In general, night leg cramps are likely to be related to muscle fatigue and nerve problems.
The risk of having night leg cramps increases with age. Pregnant women also have a higher likelihood of experiencing night leg cramps.
In rare situations, night leg cramps can be associated with an underlying disorder, such as peripheral artery disease — in which narrowed arteries reduce blood flow to your limbs — diabetes or spinal stenosis.
Some drugs, particularly intravenous iron, estrogens and naproxen, have been linked to night leg cramps.
Restless legs syndrome (RLS) is sometimes confused with night leg cramps, but it's a separate condition. In general, pain is not a main feature of RLS, but RLS could be the cause of night leg cramps.
Other conditions that may sometimes be associated with night leg cramps may include:
Peripheral artery disease, Spinal stenosis , Blood pressure drugs, Diuretics, Oral contraceptives, Cholesterol-lowering drugs (statins)Other conditions: Dehydration, Diarrhea, Muscle fatigue, Nerve damage, as from cancer treatments, Osteoarthritis, Parkinson's disease
Activities that might help prevent night leg cramps include: Drinking plenty of fluids to avoid dehydration, Stretching your leg muscles or riding a stationary bicycle for a few minutes before you go to bed. Untucking the bed covers at the foot of your bed
Activities that might help relieve night leg cramps include: Flexing your foot up toward your head, Massaging the cramped muscle with your hands or with ice, Walking or jiggling the leg, Taking a hot shower or warm bath. Although once widely used, the medication quinine is no longer recommended, as its effectiveness has not been demonstrated in carefully performed studies of people with night leg cramps.

Question:

Dear Dr. Garcia. I have a Morton's Neuorma which has become completely debilitating. I am unable to walk and am constant agony. It feels like I have a blazing hot knife stabbing into my foot 24/7. This has nothing to do with standing, walking, or footwear. I am in constant, unremitting pain. I've done steroird injections, which have done nothing, cryotherapy, which did nothing, RF ablation, which did nothing, alcohol sclerosing (6 rounds), which have done nothing. I will never elect to do a neurectomy for fear of the development of a stump neuroma, which would make my situation far worse, though it's hard to imagine this situation getting any worse than it is. My doctor (an anesthesiologist at a pain clinic) has now prescribed Neurotin/Gabapentin. I do not usually take medications if I can avoid them but I can no longer avoid them. I can barely make it to work and once there, I sit at my desk and weep in pain all day. I can get nothing done, I can barely sleep, and my life is coming unravelled. (By the way, I cannot tolerate any narcotics because they make me violently nauseous, which is a good thing! I can absolutely understand  how so many suffering people get addicted to those terrible drugs in circumstances like mine. I recently learned that my disorder, along with entrapped trigeminal nerves, are officially considered "suicide diagnoses," which I understand.) My physician claims there is no risk of addiction with Neurontin. I've been on it for a week, and it has truly helped a little bit without any apparent side effects. I'm writing to ask if this seems like a long-term and sustainable plan to you. Many of the patients I have met at this clinic have been on Neurontin for 10+ years with no problems, but I'm really afraid of all medications and the specter of addiction. I appreciate your assistance.

Answer:

There are no cases of addiction to Neurontin to my knowledge but there are two or three cases where the patient had been on a high dose of that medication as well as others and was taken off for a medical reason and they had physical withdrawal symptoms until there medication could be switched to something else. In your case I think it is certainly wise to use it for your physical and mental health. There are new medicines being developed all of the time and likely in the suture there will be something else for you to take as an option. Best of luck.

Question:

Distinctly itchy elbows for the past week. No change in laundry detergent, diet, etc. Never had this before. No sign of plaques, but I'm wondering if this is a hallmark sign of the onset of psoriasis or eczema.

Answer:

Usually those issues are associated with a distinct texture and color change. I would use some over-the-counter steroid cream  or Bendryl cream for 5 days and if not better, then go see a dermatologist to see what is the cause.

Question:

My incredibly active 77 year old husband has asymptomatic COPD (smoked for 10 years in his youth), mild carotid stenosis bilaterally, and resultant mild hypertension controlled successfully with a low dose of HCTZ. He also may have developed PAD, evidenced by skin plaques at the end of the medial, distal points of four adjacent toes this past winter which we think may have been frostbite because he was outside in subzero temperatures one day for two hours. The necrotic tissue shed on its own and healed six weeks after it appeared -- but of course, his PCP is rightly suspicious of a cardiac connection and has ordered some tests, which are pending, and more consults with a cardiologist, which are coming soon. Meanwhile, he saw his PCP yesterday for his annual physical. Normal BP and otherwise no unusual findings. (We're awaiting, of course, all the usual blood panel results --CBC, etc.) Today, out of nowhere, the right carotid's pulses are grossly visible, causing all the skin from his clavicle mid-way up his neck to rise and fall dramatically. It is quite startling and entirely new. After that long introduction, my question for you at last: Is this new symptom emergent, indicating an imminent stroke? I don't want to panic and drag him off to the ER for a symptom that might be expected with his condition. His physician's office doesn't open again until tomorrow morning, so we can't reach them; and he has no other symptoms that would cause us to think a hospital is presently warranted. (If it were, I would call 911!)  Thank you for any advice you can give us tonight if you happen to see this. I know you don't -- and shouldn't-- offer emergency advice in an online forum, but perhaps you can offer us some reassurance IF that is properly warranted. Of course, we'll be at his physician's office first thing in the morning. We appreciate your help and guidance.

Answer:

Sorry the message came in after I had left the office. I do not think it is an impending stoke at this point but taking a preventative baby aspirin is a wise thing and then follow up with your PCP as soon as you can.I wish him the best.

Question:

Hi, Dr. Garcia. A general medical question for you: about how long should it take for a cortisone injection to take effect? I received one six days ago for a Morton's Neuroma, and it appears to have done absolutely nothing to reduce the pain. I'm suspecting that if it hasn't worked in a week's time, it means that it probably won't work at all. Is that likely correct? Thank you for your help.

Answer:

If it is going to work it should have had some effect by now, usually it is 2-7 days. Sorry.

Question:

I was diagnosed with bilateral patellofemoral pain 8 weeks ago, via with X-Rays only, no MRI. (No evidence of arthritis or joint damage on X-Rays.)  8 weeks of PT 4x/week and I'm no better at all. In fact, I'm far worse. I've seen another orthopedic surgeon for a second opinion and he concurs with the first diagnosis, but again, he didn't order an MRI. He just gave me the generic diagnosis of "runner's knees."  Both diagnoses came from major sports ortho centers at Boston teaching hospitals. This has been has been life-changing. Overnight, I went from from an incredibly active, athletic life (cyclist, yoga, weight training, rowing, running) to being unable even to use stairs or walk on flat surfaces without a walker. I'm wondering if I may have miniscal tears. My knees have weakened so much that last week, I tore one of my achilles tendon just trying to get down the stairs, so now I'm in an orthopedic boot and have been pulled off PT. The "good" ankle is now acting up too, feeling like it's been "short-sheeted," evincing signs that the achilles tendon in that leg may pop soon too. If the surgeons I saw were correct, then I need strength conditioning not only to get better but also to prevent this from happening again. I'm coming up on three months of inactivity, which is making things worse and putting me at greater risk, but I'm too injured to engage in strength training. I'm going from bad to worse with every passing week. I'm young, so this shouldn't be happening. I'm  so discouraged that I'm growing clinically depressed. I know you're a believer in supplements. What do you think of joint supplements. Worth it or a waste of money? What would you do if you were in my position?  I know you're not an orthopedic surgeon but you are obviously  a truly competent physician who very generously offers your sound clinical advice. Thank you for any guidance you might be able to offer me.

Answer:

I would use MSM, and turmeric supplements, nothing wrong with some glucosamine and chondroitin too. As to exercise and rehab, got to start with body weight stuff for now. Do not do leg extension on a machine as they cause more harm than good. Stick with compound exercise like body squats. If that hurts then do the eccentric motion only. I doubt you have a meniscal tear though from what you describe. I would certainly stay away from cortisone shots though. I know some orthos will scrape the back side of the patellas  to incite cartilage growth. wish I had more for you.

Question:

Dr. Garcia, would you please share with your readers the list of supplements you yourself take and why you take them? You seem to be one of the most knowledgeable--and realistic--physicians in the public eye, and it's always helpful to know how such people take care of themselves. Thanks for considering this! And thanks for all you do for all of us strangers!

Answer:

a general multivitamin, B6, B12 and folate for proper hormone metabolism, Vit D as a defense against bone loss and as anti-inflammatory. As anti-inflammatories I take turmeric, NAC and alpha lipoic acid. For cholesterol management I take garlic, omega 3 fish oils and plant sterols. For heart disease prevention I take Vitamin K2, arginine, baby aspirin and CoQ 10. Magnesium and melatonin for sleep. Daily probiotics. That's about it, I know, its a lot but I think of it as prevention.

Question:

What is the optimal dosage you recommend for a plant sterol (like Nature Made's Cholestoff) and for red yeast rice to lower cholesterol to make them clinically equivalent to statins in results? Of course, I also take Co-Q 10. Thank you.

Answer:

2 capsules per day is enough

Question:

I know you're not an orthopedic surgeon, but perhaps you can help me discern what's happening with my hip. I have developed over the past several months chronic pain in one hip. It feels like a spongy rubber band in in the center of the joint -- so perhaps it's a ligament? -- and the pain is a dull, constant ache, which occasionally become acute, especially (strangely) when I'm sleeping and off my feet.  It radiates down my lateral thigh and sometimes causes numbness in my groin, which makes me think a nerve may be involved. My PC can't figure it out -- thinks is "just a soft tissue problem" -- but it's not going away. Care to venture any diagnostic guesses? Thanks for your help!

Answer:

might suggest you see and orthopedist and have them check you our for a piriformis syndrome, it might be the problem. Best of luck with it, usually just some physical therapy will correct it.

Question:

What does splinting of the ribs when bending over or holding the chest mean? The word splinting.

Answer:

splinting is  a process where you attempt to limit moiton in an area so that it hurts less. like when they put a splint on a broken bone.

Question:

What do you make of this week's research on the potentially deleterious effects of daily aspirin for women over 50--who otherwise have no clotting disorders. At the advice of my PCP (and a dear friend who is a cardiologist), I have been taking 150 mg of aspirin daily for years for its protective effects, but now I wonder. What do you do? And what do you advise your own patients?

Answer:

I think the dose can vary from patient to patient, I think it is incorrect to assume that 81 mg for an adult is adequate in all people. It can be checked by measuring fibrinogen levels in the blood. High fibrinogen levels are indicators of higher risk of stroke and heart attacks. I start at 81mg and then test the patient and increase the dose if needed, slowly. Taking aspirin has also been associated with the finding of colon tumor much earlier too. I find that post-menopausal women need a lower dose than they did while still menstruating.