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Doctor's Diagnosis: A-Z

What do the Three Mile Island and Chernobyl nuclear incidents, the Exxon Valdez oil spill and the Dec. 1 , 2013 Metro-North Railroad derailment have in common? Sleep, or rather lack of sleep, was a major contributing factor to each of these events. 
It used to be thought sleep was passive, that the brain was simply resting. We now know sleep is an active process. During a good night’s sleep, the brain cycles through several stages, each with its own characteristic brain-wave activity. Despite much research, it is still unclear exactly what the brain is accomplishing during these different stages. 
What has been firmly established is that sleep is not a luxury but is essential to good health. Without adequate sleep we cannot function normally, even though people certainly try, often with disastrous consequences. For example, last year alone people drowsy from insufficient sleep were responsible for about 100,000 automobile accidents. 
Most adults need about 7 to 8 hours of sleep and do best with a regular sleep-wake cycle that enables them to be awake during daylight. Unfortunately, there are endless problems that may interfere with this objective. 
An uncomfortable bedroom temperature, excess noise, even a partner who snores can all interfere with sleep. Caffeine, alcohol and tobacco use commonly contribute to sleep difficulties. Many diseases, especially if associated with pain, may also interfere. 
People who work evening and night shifts are especially at risk for sleep problems. Workers who rotate among different shifts can never establish a healthy sleep cycle. Even those who work a regular night shift frequently have difficulty maintaining a normal cycle. 
Teenagers are notoriously sleep deprived; it’s just about impossible to get one to go to sleep at a reasonable hour. Many schools are experimenting with starting later in the morning so that students will have enough time for a good night’s sleep. 
The medical profession has a long history of disregarding the issue of sleep. Until recently, working frequent 24-hour shifts was a rite of passage for doctors-in-training. There are now rules limiting how many hours a doctor-in-training may work and mandating sufficient time off for sleep. Interestingly, there are no rules that limit the number of hours fully trained doctors can work. For example, it is still the norm for anesthesiologists to frequently work 24-hour shifts. 
And of course there is daylight saving time: guaranteed to make sure everyone’s sleep cycle is disrupted at least twice a year. 
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 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Zzzzz, for not enough sleep

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A female patient is given an antibiotic for bronchitis. The bronchitis improves but she returns a short time later complaining of a vaginal discharge. Coincidence? Probably not. 
Each of us has trillions of microbes living in us and on us. Usually these microbes are harmless, and indeed many are helpful. Most of these microbes are bacteria. Some are yeast cells, which are actually a one-celled fungus. These yeast cells usually do not cause any problems, unless something disrupts this microscopic world. 
Antibiotics frequently are the cause of such a disruption. For example, if a patient with bronchitis is given an antibiotic, the antibiotic will hopefully kill the bacteria that are causing the bronchitis. However, it may also kill some of the bacteria that are keeping the yeast cells in check. Since antibiotics have no effect on yeast cells, the yeast cells are free to multiply uncontrollably, often leading to problems such as a vaginal yeast infection. 
The resultant yeast infection will cause vaginal itching, burning and a very characteristic thick white discharge that looks much like cottage cheese. The diagnosis can often be made by examination alone but if necessary can be confirmed by examining the discharge under a microscope or by doing a culture. There are many over-the-counter treatments available that are effective. Prescription medications can be given for resistant cases. 
Other possible disrupting factors include poorly controlled diabetes, pregnancy or problems with one’s immune system. 
“Probiotics,” which are capsules containing live bacteria, and yogurt have been advocated by some for use in vaginal yeast infections, but it is not clear that they are actually helpful. 
Yeast infections can also affect other parts of the body. Moist, warm areas are especially susceptible. Many severe cases of diaper rash are caused by yeast, since the area under the diaper — despite best efforts — is often warm and moist. Likewise, women with large pendulous breasts will often develop yeast infections where the breasts continuously rub against the chest wall. 
The mouth is also a frequent site of yeast infections. This is common in people who wear dentures or who have weakened immune systems due to such problems as cancer, HIV or diabetes. 
Not all yeast cells are harmful. Yeast is used to make bread and cheese and to produce beer and wine. It's almost as if they are paying us back for all the trouble they cause.

Doctor's Diagnosis: Yeast infection

drs diagnosis: yeast infection - crop

My friends who are color blind are males. Every patient I have taken care of with muscular dystrophy or hemophilia was a male. Is this just a coincidence? Not really. 
We often forget that each of us began when a single sperm cell fertilized a single egg. This fertilized egg somehow contained all the information needed to develop into a full-grown organism capable of reading. Where in the fertilized egg was all this information contained? The answer is in the chromosomes. 
Chromosomes are actually just gigantic DNA molecules, very tightly wound around themselves, like a tangled-up piece of spaghetti. Stretched out, all of the DNA from one single human cell would measure about six feet long. 
The DNA in humans is packaged into 23 pairs of chromosomes, with one of each pair coming from the biological mother and one coming from the biological father. 
The so-called “sex” chromosomes make up one of the pairs. Females have two X chromosomes, with one X inherited from the mother and one from the father. Males, who are XY, have inherited an X from the mother and a Y from the father. The Y chromosome ensures the person develops into a male, but otherwise it contains little genetic information — and that’s the problem. 
Diseases such as red-green color blindness, hemophilia and the commonest form of muscular dystrophy are all carried on the X chromosome. If a male inherits an abnormal X chromosome, he will develop the disease. The Y chromosome cannot compensate for the abnormal X chromosome because it does not carry any genetic information pertaining to these problems. Inheriting a single defective chromosome is enough for the male to develop these diseases. 
In contrast, for a female to develop these diseases, she must inherit an abnormal chromosome from both her parents. If she has one abnormal and one normal X chromosome, the normal one prevents her from developing the disease. Since these are relatively uncommon diseases, it is unlikely — but not impossible — for a female to develop these problems. 
Scientists are learning how to manipulate chromosomes. For example, most of the insulin used today is obtained from microbes that have had part of a human chromosome inserted into them so that they produce human insulin. 
Until similar treatments become available for diseases such as muscular dystrophy and hemophilia, females have a decided advantage in terms of avoiding diseases found on the X chromosome. 
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 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: X chromosomes

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Most people I know want nothing to do with the West Nile virus. What few people realize is that West Nile virus wants nothing to do with them, either. 
Birds are the intended victims of West Nile virus. Mosquitoes transmit the virus from bird to bird, enabling the virus to survive, essentially forever. Occasionally mosquitoes will transmit the virus to other mammals such as horses or humans. But people are “dead end” hosts; even if we are infected, we will not pass on the virus if a mosquito bites us. The cycle is broken and the virus dies off, but not before it may have caused considerable harm. 
There’s a reasonable chance that you have been infected with West Nile and do no know it. Most people never develop any symptoms at all. About one in five will develop transient fever, headache, body aches and fatigue. Usually enough to make you feel like you have “the flu,” but not enough to make you seek medical attention. 
Less than 1 percent of infected people develop severe complications. The brain and spinal cord become inflamed, causing such problems as seizures, coma, paralysis and possibly even death. Those that survive may be left with permanent injuries. 
There is no specific treatment available and no vaccine, either. Instead, prevention is aimed at attacking the mosquitoes that spread the disease. 
On a personal level, this can involve proper use of insect repellents, wearing long sleeves and pants, and fixing broken screens. Emptying areas of standing water where mosquitoes can lay their eggs, such as flowerpots, gutters, birdbaths and pool covers, is also essential. 
On a county level, this involves active surveillance of mosquitoes and birds to determine levels of West Nile activity, which can fluctuate considerably from year to year. When significant activity is detected, difficult decisions have to be made. For example, over the summer Suffolk County had to close several parks in the evenings — when mosquitoes are most active — due to increased West Nile activity. Decisions about spraying with insecticides can be especially challenging, having to balance people’s concerns of potential harm from the insecticides against the threat of disease caused by West Nile virus. 
West Nile virus was first detected in this country in New York City in 1999 and has spread throughout the continental United States. Mosquitoes are no longer just annoying; they can be deadly, too.

Doctor's Diagnosis: West Nile Virus

Caribbean Virus Outbreak cropped

How much inconvenience would you put up with in order to avoid dying from colon cancer? Millions of Americans confront this problem and many give a surprising answer: “Not very much.” 
This year about 50,000 Americans are expected to die from cancer of the colon (the large intestine). Routine screening colonoscopy could considerably decrease the number of deaths if more widely used. After passing a colonoscope through the rectum, the colon is visually examined, biopsies are taken of any masses that are found and polyps, if present, are removed. Most colon cancers are detected in their early stages while the prognosis is still excellent.&nbsp; 
The procedure can last up to an hour and requires sedation. Additional time after the procedure is needed to recover from the sedation. Patients should not drive and need to have someone accompany them home. A bowel prep the day before, plus this large investment of time and the “bring a friend” factor are major inconveniences for most people. 
Virtual colonoscopy avoids these problems. It is actually a high-resolution CT scan and only takes 10 or 15 minutes. Some air is injected into the rectum, but there is no colonoscope used and sedation is not needed. Although there may be some bloating or cramping, as soon as the procedure is completed the patient is free to leave and carry on his or her normal activities. Certainly more convenient, but there are issues. 
The procedure requires a bowel prep very similar to that used for regular colonoscopy. This involves fasting and taking laxatives to cleanse the bowel. This is actually the part of the process most people find objectionable and having a virtual colonoscopy does not eliminate the need for it.&nbsp; 
Certain polyps that could have been detected with a colonoscope will be missed on virtual colonoscopy and the significance of this is not clear. Also, virtual colonoscopy can only detect problems, not treat them. If a mass or polyp is found a regular colonoscopy is still needed.&nbsp; 
Virtual colonoscopy results in radiation exposure. Also, while scanning the colon the adjacent structures are visualized and a significant number of exams will detect abnormalities outside the colon. This will lead to anxiety and further testing, which may or may not benefit the patient, depending on what is ultimately found.&nbsp; The role that virtual colonoscopy should play in screening for colon cancer is still controversial.&nbsp; 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Diseases A to Z: Virtual colonoscopy

Doctor's Diagnosis: Virtual colonoscopy

Sometime in their lives, most women — and some men — will find out what it’s like to have bacteria multiplying uncontrollably in their bladder: they will experience a urinary tract infection. 
The kidneys are continuously making urine, which is stored in the bladder, and then&nbsp;eventually eliminated from the body. Normally there are no bacteria present in the urine. Bacteria, however, can sometimes overcome the body’s defenses and infect the urine. Most often these bacteria come from the rectum and work their way up into the bladder. Because of the differences in anatomy, females are much more likely than males to encounter this problem. Being sexually active and using certain forms of birth control, such as a diaphragm, increases the risk.&nbsp; 
The resulting bladder infection often makes the patient feel miserable. A feeling of pelvic pressure, a need to urinate frequently, and burning or painful urination are common. The urine itself may be bloody or cloudy.&nbsp; 
The diagnosis is often made from the patient’s history alone, especially if the history includes previous bladder infections. There are urine tests that can be done in the doctor’s office to help confirm the diagnosis. 
The most reliable and useful test is a culture of the urine. This will not only identify which bacterium is causing the problem, it can also help determine which antibiotics will be most effective. The problem is that the results will take a day or two and the patient does not want to wait to begin treatment. Also, it requires a “clean catch” specimen. The patient must clean their genital area, begin urinating, discard the first flow of urine and “catch” some of the next flow in a sterile cup. 
Easier said than done. 
Usually, the infection responds quickly to the antibiotics. Patients often feel better in a day or two but it is essential that they take all of the medicine they have been prescribed, to make sure the infection is completely eliminated.&nbsp; 
If not treated promptly, the infection can spread to the kidneys. This is a much more serious condition and may require hospitalization for treatment.&nbsp; 
Urinary tract infections are relatively uncommon in males, but those with certain congenital abnormalities and problems such as an enlarged prostate are at risk. 
The discussion would not be complete without mentioning cranberry juice. Although some swear by it, the evidence is very mixed — at best — that it actually prevents bladder infections. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Urinary Tract Infection

Doctor's Diagnosis: Urinary tract infection

I admit it: I’m not as young as I used to be. There’s more fat, less muscle, less energy. My chief concern in the bedroom is making sure I get a good night’s sleep. Question: Would taking testosterone supplements restore my former glory? 
Testosterone is a hormone that peaks in men at about age 30. It helps control masculine characteristics such as muscle mass, sex drive and growth of body hair. Supplements have long been used effectively by men who do not produce enough testosterone. 
What is new is the claim that millions of middle-aged men not currently using testosterone would benefit from taking it to address perceived “low T.’’ 
What’s not to like about turning back the clock a bit with these gels, patches or injections? 
First of all, it’s never been proven that using testosterone in otherwise healthy men will result in increased alertness, muscle mass or sex drive, and it is not FDA approved for such uses. 
Also, there are many possible side effects. Of most concern is recent evidence that has linked testosterone use with increased risk of heart attacks and stroke. It may worsen symptoms in men who have trouble urinating due to enlarged prostates, and it may worsen existing prostate cancers or even cause new ones. Worsening sleep apnea is also a possible side effect. 
Caution must be used to make sure it does not accidentally come in contact with females or pre-adolescent males, because this frequently leads to undesirable side effects. 
Until someone actually shows testosterone is safe and really helps middle-aged men, I’ll settle for trying to get to the gym more often and learning to enjoy my naps. 
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 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Testosterone

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As school gets going into high gear, pediatricians will once again encounter many children complaining of sore throats, often accompanied by adults who are worried the child may have strep throat. Few of the adults realize that the main goal of diagnosing and treating strep throat is to prevent heart disease. Let me explain. 
“Strep throat” means specific bacteria known as Streptococcus are causing the sore throat. There is usually a rapid onset of severe throat pain, high fever and swollen lymph nodes in the neck. On examination, the tonsils appear red and swollen. 
The problem is that viruses cause most sore throats, and even experienced clinicians cannot reliably determine if it is strep just by examining the patient. Traditionally a throat culture is done to determine if strep is causing the problem. Although accurate, the result is not available for a day or two. 
Other tests can now be done right in the office while the patient waits. However, these rapid tests are known to miss many cases of strep. Just to be safe, many pediatricians will do both a rapid test and a culture. 
Treating strep throat is usually straightforward with currently available antibiotics. After beginning treatment, most patients will feel better in a day or two and can then return to school or work. 
The most important reason to treat the strep throat, however, is that if left untreated the body’s reaction to the infection can lead to the development of rheumatic fever. This disease involves a variety of problems such as skin rash and nodules, arthritis, and heart disease that often involves the heart valves. The heart damage is often permanent and may eventually lead to heart failure requiring surgical repair or replacement of the valves. Though it has become less of a problem in the United States, rheumatic fever remains a major cause of heart disease in many parts of the world. 
Treatment also helps prevent strep from spreading and causing infections of the ears or sinuses. Additionally, it helps limit the transmission of this highly contagious disease. 
Unfortunately not all complications are readily preventable. For example, it is not unusual to develop inflammation of the kidneys after a strep throat infection even if it was treated appropriately. 
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 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Strep throat

hsHEALTH

Several years ago my friend Lynne developed increasing difficulty using her hands. This was particularly alarming to her since she relies on them to perform her job as a nurse anesthetist. After some uncertainty, she was eventually diagnosed with rheumatoid arthritis. 
“Arthritis” is a general term meaning inflammation of the joints without specifying the cause. Lupus, gout, Lyme disease, even psoriasis can all cause arthritis. 
Rheumatoid arthritis is a very specific disease. It is an autoimmune disease, where — for unknown reasons — the immune system attacks and destroys healthy tissue. In this case, the linings of various joints are the targets. Like many autoimmune diseases, rheumatoid arthritis most often affects middle-aged females. 
Frequently the hands are involved resulting in very characteristic deformities, such as painful swollen knuckles and fingers deviating to the pinky side. Other joints such as the elbows, knees, ankles and hips are also frequently involved. When advanced, the arthritis can become totally disabling. 
Rheumatoid arthritis does not just affect the joints. Patients often develop fatigue and fever. Skin nodules, anemia, heart disease, lung disease and even eye problems are often present. 
There is no cure for rheumatoid arthritis, and managing the disease is more art than science; there is no simple protocol to follow. 
The disease is treated aggressively as soon as the diagnosis is made, hopefully before there is any permanent damage to the joints. Nonsteroidal medicines and steroids play a role but more potent “disease-modifying” agents are usually needed. 
A new class of drugs has been introduced in the past few years, the so-called "biologic" agents. Modern biotechnology has designed these drugs specifically to alter the body's immune system. Though often extremely effective, they are not without problems. They are very expensive, often must be given by injection, and also make the patient vulnerable to serious infections. 
Surgery is often required to replace or repair joints and tendons. Occupational and physical therapists can be helpful in maximizing the patient’s activities by providing exercises, offering heat and cold therapies, and providing aids such as splints. Assistive devices are available to help with tasks — such as opening jars and using knives — that may be very challenging in patients with advanced disease. 
My friend Lynne continues to struggle with her rheumatoid arthritis but thanks to one of the newer medications is still able to work. In spite of her arthritis, her patients are in good hands. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Rheumatoid arthritis

Since smoking at the beach club is prohibited, my pal Jim has to sneak out to the parking lot when he feels the urge for a cigarette. He knows that due to his smoking he is at high risk for heart and lung disease, stroke and many types of cancer. So why doesn’t he quit? In short: nicotine. 
Nicotine is one of thousands of chemicals inhaled when smoking tobacco. It is absorbed into the blood and then transported to the brain in a matter of seconds, where it triggers feelings of intense pleasure. But the effects wear off very quickly, and without more nicotine, smokers will soon start experiencing withdrawal symptoms. It is this immediate feeling of pleasure when smoking and rapid onset of withdrawal symptoms when not smoking that makes nicotine so addictive. 
Some people are able to break this vicious cycle on their own, but most need help quitting. Many patients find nicotine replacement therapy to be helpful. Nicotine is supplied in such a way that the immediate euphoria is lessened, and the amount of nicotine used can be gradually decreased and eventually eliminated. 
Currently, Nicotine is available in many forms such as patches, lozenges, nasal sprays and gums. 
Various types of counseling and behavioral therapies are also available. Additionally, there are some non-nicotine medications that have been shown to be helpful for those who want to quit. 
The controversial new electronic cigarettes are are battery-powered devices that might look like regular cigarettes but do not that heat up. Instead, nicotine, a solvent and sometimes flavorings into a vapor to be inhaled. (Hence the term “vaping.”) 
Proponents claim that, like other nicotine replacement products, e-cigarettes can helping patients quit smoking. 
Opponents are afraid that this is an attempt to once again make smoking in public socially acceptable. They also worry that e-cigarettes will entice many people who have never smoked to begin the nicotine habit, eventually leading them to smoke tobacco. Also, the long-term health effects of inhaling the vapor and the e-cigarettes’ effectiveness in helping patients quit smoking are unknown. There is also concern that available flavorings such as bubble gum show they are being specifically marketed to teenagers. So far I’ve gotten nowhere in my attempts to get Jim to quit smoking. I haven’t given up yet; there’s too much at stake. &nbsp; 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Quitting smoking

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The oncologist spoke with certainty when she told us that any further attempt to treat my mother-in-law’s cancer was useless. As the family slowly came to understand what the doctor was really telling us, we were left with one overwhelming question: “Now what?” 
In the past, in situations like this, health care providers and family members would often silently agree to not share the unfortunate news with the patient. It was felt that telling them that further treatment was useless would inflict unbearable pain by depriving them of all hope. What was not fully appreciated was that this conspiracy of silence would isolate the patient physically and emotionally just when they were most in need of a helping hand. 
The emergence of palliative care medicine has entirely changed this approach. The basic idea is very simple: tell patients the truth while assuring them they are not being abandoned. The goals may be different, but the patient will have lots of support in achieving their new goals. 
For most patients, the biggest concern is avoiding pain. Palliative care involves juggling whatever pain medications and other treatments are needed to keep the patient as pain free as possible while minimizing the undesirable side effects. 
There are many other issues besides pain management. Common physical problems such as loss of appetite and difficulty breathing are dealt with. Emotional issues such as depression and fear of dying are addressed. Spiritual and religious needs of the patient are attended to, a source of great comfort to many. Family and friends are encouraged to spend as much time with the patient as possible. 
Another important aspect is helping family and friends deal with the impending loss of their loved one. 
Traditionally, palliative care would take place in an inpatient setting. More recently, if there is an appropriate support group, the trend is to let patients receive their care in the familiar surroundings of their own home. 
Palliative care is not limited to patients with end-of-life issues but is appropriate for many patients with chronic incurable diseases. When applied to patients where curative treatment has been stopped and the life expectancy is less than six months, it is often referred to as hospice care. 
Any member of the health care team can help the patient or family begin the palliative care process when appropriate. 
Watching my mother-in-law lose her battle with cancer was not an easy process. The burden was greatly eased knowing she had received such wonderful care when she needed it most. 
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 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Pallative care

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My mom was “old school” and never complained as she experienced the various aches and pains that are a normal part of the aging process. 
So it was very alarming when she started having vague abdominal pains, and complained of feeling bloated after eating small meals. Eventually we discovered the source of her problems: she had ovarian cancer. Despite surgery and chemotherapy, she eventually died from this terrible disease. 
Unfortunately, many women experience similar tragedies. 
The ovaries produce hormones such as estrogen and also generate the “eggs” that may become fertilized to create offspring. They are also a common site for cancer to develop. 
Cancers discovered when still confined to the ovary have the best prognosis. However, at this stage the cancer usually will not cause any symptoms. As was the case with my mother, the cancer is usually found after it has metastasized (meaning it has already spread to other parts of the body). Symptoms are very common once the cancer has spread, so it is much easier to detect, but it is also much more difficult to treat. 
So why don't we recommend screening women for ovarian cancer the way we use mammograms to screen for breast cancer? The answer is that even in women who are diligent about getting regular checkups, there is no reliable screening test available. 
Routine pelvic exams, even with Pap smears, are not effective because Pap smears do not detect ovarian cancer. Screening with transvaginal ultrasound and checking for a blood tumor marker called CA 125 have been studied, but these have not proven useful for routine screening in patients with no symptoms. 
The risk factors for ovarian cancer are not clearly known, and many are beyond the patient’s control, such as being middle aged or older, having previously had certain other types of cancer, having a close family member who has ovarian cancer or having certain inherited genetic mutations. Other risk factors include never having given birth and possibly having used hormone replacement therapy. 
Presently we can only encourage women to seek medical evaluation if they experience warning signs of ovarian cancer such as abnormal vaginal bleeding or discharge, pelvic or abdominal pain, quickly feeling full when eating, frequent bloating or changes in bowel habits. 
I very much miss my mom, and I sure wish an effective screening test is developed before my daughter gets much older. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Ovarian cancer

Doctor stethoscope CROPPED

It’s no secret that Long Island has recently experienced a large increase in deaths from heroin overdoses. Years ago, when my friend Raymond became a police officer in Suffolk County, he underwent extensive training in the traditional techniques law enforcement uses to deal with this type of problem. Recently he got called back for additional training: He needed to learn how to use Narcan. 
Narcan (a brand name for the drug naloxone) blocks virtually all the effects of narcotics. It is not a new drug. For several decades, ER doctors have used it to treat patients who have overdosed on narcotics. 
What is new is the idea of having first responders — such as police officers — carry the medicine with them. When they arrive at the scene of a suspected narcotic overdose, they can give the medicine immediately, instead of having to wait for the paramedics to arrive. To avoid the danger of using needles in an uncontrolled emergency situation, a liquid formulation was developed that can be sprayed into the nose using a special easy-to-use kit. 
When given to a person experiencing a heroin overdose, someone who may be close to dying almost miraculously begins to wake up in a matter of minutes. They still need to be hospitalized because the Narcan may wear off before the narcotic does. Also, it may cause acute withdrawal symptoms in narcotic-dependent patients. 
The drug is very specific, working only in patients who have recently taken narcotics. This includes not only heroin but also other narcotics such as morphine, codeine, fentanyl and OxyContin. 
It is not effective against drugs that aren’t narcotics such as cocaine, alcohol, marijuana, methamphetamine or Ecstasy. 
How is Raymond supposed to know which patients to give the drug to? The answer is simple: If there is any possibility of a narcotic overdose, he should go ahead and give the medicine. Giving Narcan to someone who has not been using narcotics rarely if ever causes problems. 
In an attempt to make the medicine even more widely available, both Nassau and Suffolk Counties have offered programs where any adult can be trained to administer the medication, obtain a two-year certification and receive a Narcan kit to take home. 
Raymond never thought part of his job would be to administer medications to people with heroin overdoses, but now he’s been trained and is ready to use his new skills to help save patients’ lives. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Narcan

Noxolone in Spin Cycle 5.8.14  crop

While enjoying one of Long Island’s great pleasures — sunning myself at the beach — my good friend Greg ruined everything by telling me, “Hey, Steve, that mole on your neck needs to be checked.” Eventually, I did get around to having it examined and it’s a good thing I did: It was a melanoma, the deadliest of all skin cancers. 
Certain skin cells produce a pigment that gives the skin its color. Sometimes these cells start multiplying uncontrollably and develop into a type of cancer known as malignant melanoma (often simply called melanoma.) 
Melanomas result in thousands of deaths each year, and the problem is getting worse. People with fair skin who burn easily are at increased risk, but regardless of your skin type you can develop a melanoma. Although the risk increases with age, melanoma is one of the most common cancers of young adults. 
It is impossible to tell for certain if a mole is a melanoma just by inspection. Be on the lookout for the ABCDEs of melanoma: A = asymmetry (different parts of the mole look different), B = irregular borders, C = different colors, D = diameter (usually greater than the size of the eraser on your pencil), and E = evolving or changing in shape, size or color. 
Any suspicious mole should be brought to the attention of a dermatologist. When diagnosed early, most melanomas can be removed with little or no chance of recurrence. However, if it has already spread, then surgery, chemotherapy, or radiation therapy may be needed. 
Most melanomas are due to exposure to ultraviolet radiation. Steps to minimize problems with melanoma include: Checking your skin regularly, avoiding indoor tanning, wearing dark clothes and hats with large brims when outdoors, avoiding the sun between 10 a.m. and 2 p.m. and possibly routine screening by a dermatologist. 
And use sunscreen. Lots of sunscreen. It should be potent (SPF of at least 15, some say 30), and have broad-spectrum (UVA and UVB) coverage. All exposed areas of your body need to be covered with a generous amount, and it should be reapplied every two hours, especially if you are swimming or perspiring. Most people do not use nearly enough, and are not getting anywhere the amount of protection they need. 
Take precautions now; unlike me you may not be lucky enough to have a friend who is going to make the diagnosis for you while you’re at the beach. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: M is for melanoma

melanoma -- cropped

Virtually everyone either is directly affected by lactose intolerance or knows someone who is. This is because the majority of adults have some degree of lactose intolerance. 
Despite this being so common, most patients have little understanding of what their problem actually is. For example, I’ve heard many people say they are “allergic” to lactose, but lactose intolerance is not an allergy. 
Lactose is a type of sugar. More precisely it is two different sugars bound together. The body cannot directly absorb lactose; it must first split the lactose into its two parts. This is done by an enzyme called lactase, which is produced by the lining of the small intestine. 
As children, we all make lactase, which is very important because lactose is the main sugar found in milk. The problem is that when we become adults, many of us stop making sufficient amounts of lactase. Without it, we can no longer absorb the lactose. Since we don’t absorb it, the bacteria in our intestines use it as an energy source, in the process releasing undesirable products. 
The results can be explosive. Within 30 minutes to two hours of consuming lactose, patients complain of bloating, abdominal pain, diarrhea and passing gas. The problem is usually diagnosed by the history alone or by having patients experiment with a lactose-free diet. If needed, there are tests available to confirm the diagnosis. 
There is no way to make the body produce more lactase. Most often, patients simply learn to avoid lactose-containing foods such as milk, ice cream, yogurt or cheese, especially soft ones such as cottage cheese. 
Typically patients can tolerate small quantities of these products, but the amount varies from person to person, and trial and error is needed to determine individual limits. Especially sensitive patients must use extra caution because small amounts of lactose can also be present in unexpected products such as cereals, salad dressings or even certain medications. 
All is not lost if you are one of the millions of people suffering from this problem. Products are available such as “lactose-free” or “lactose-reduced” milk, which is milk that has lactase added to it. 
Lactase itself is available in pill or liquid form and can be taken immediately before consuming lactose containing foods or added to cartons of milk. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Lactose intolerance

0MHUP1PC.JPG / mg

Jaundice 
"My father’s eyes are turning yellow. I think he’s got that disease you call jaundice. How will they treat it?” asked my friend Brian, who had been caring for his sick father. 
I had to explain to him that, although jaundice is a serious problem, it is not a disease; it is what is called a sign, meaning an abnormality that can be observed on physical examination. Jaundice is a yellowing of the skin, the white part of the eyes and other areas, such as the lips, due to an excess of a substance called bilirubin. 
What is bilirubin? 
Red blood cells, the ones that carry oxygen, are continuously being broken down by the body. One of the breakdown products, bilirubin, is taken up by the liver and then discharged into the bile. Eventually it enters the intestines, ultimately being eliminated from the body in both feces and urine. 
Jaundice develops when there is a problem at any step in this complex sequence that results in the abnormal accumulation of bilirubin. For example, there may be so many red blood cells being broken down that the liver is overwhelmed, such as can happen in sickle-cell disease or after a blood transfusion. Or a liver that has been damaged may be unable to process bilirubin, resulting in jaundice. 
There are many possible causes of such liver damage, including viruses, certain medications or alcohol abuse. Diseases that cause problems with the flow of bile, such as gallstones or cancer of the pancreas, also can result in jaundice. 
There is no treatment as such for jaundice. The physician can only systematically determine the underlying problem and try to correct it. 
There is one exception to this. Newborn babies frequently develop jaundice because their livers are not fully mature and cannot process bilirubin properly. Infants with very high levels often are placed under special lights that break down the bilirubin into harmless products that they’re able to eliminate. 
Although my friend Brian was looking for a simple answer to his question about how they would treat his father's jaundice, he had to settle for my more complicated answer. In adults, there is no direct treatment; the doctors would first have to do some detective work and determine the underlying problem. &nbsp; 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Jaundice

jaundicedeyes

When I first met my brother-in-law, Leo, he was experiencing a personal crisis: He had just been told that he had diabetes and would have to inject himself with insulin for the rest of his life. Initially in a state of shock, he eventually became quite comfortable with the procedure and now doesn’t think twice about injecting himself in front of family and friends. But what exactly is he injecting and why? 
Our bodies try to maintain a constant blood-level of glucose, a type of sugar. The glucose cannot leave the blood and enter most cells of the body unless insulin is present. Insulin is a hormone secreted by the pancreas. If there is an insufficient amount of insulin, such as occurs in patients with diabetes, the blood glucose level climbs even though the cells are being starved of glucose. Some of the glucose will spill out into the urine. The body is then forced to use alternate fuels for energy, which can lead to life-threatening complications. 
Until the 1980s, insulin was obtained from the pancreases of cows and pigs. Presently, most insulin is obtained from microbes such as yeasts whose DNA is altered to produce human insulin. 
Insulin is usually injected because it is a protein, and stomach acid would break it down if swallowed in pill form. The pancreas continuously senses the level of glucose in the blood to determine the body’s insulin needs, automatically increasing its output after meals, for example. Patients on insulin need to check their glucose levels frequently and inject themselves with various combinations of long- and short-acting insulins to try and mimic the pancreas. However this requires multiple needle “sticks” and many patients find it difficult do this, day after day. 
Insulin can also be delivered continuously via a catheter placed under the skin which is attached to a small pump that the patient carries at all times. The pump delivers a continuous baseline infusion and can be programed to deliver extra boluses at mealtimes. Many patients find this more convenient but there is still the need for them to frequently check their glucose levels. 
Newsday recently reported progress on a “bionic pancreas” that can both continuously monitor the glucose level and supply the correct amount of insulin, much like a normal pancreas. For my brother-in-law and millions of others such a device can’t become available too soon. &nbsp; 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Insulin

diabetes cropped

HPV vaccine 
The response from my teenage daughter was pretty much what I expected when I announced that I was making a doctor’s appointment for her to receive yet another vaccination. “I’m not a kid anymore, I’ve had my shots, leave me alone,” she retorted. It certainly didn’t make the conversation any less awkward when I told her that it was crucial that she get the shots now, before she started having sexual relationships. 
I explained that she needed to be vaccinated against human papilloma virus (HPV), one of the most common sexually transmitted infections. After being infected with the virus, most people eliminate it before it does any damage, but in many others significant medical problems develop such as genital warts or cancer of the cervix, vagina, penis or anus. 
In addition there has been an alarming increase in oral and throat cancers caused by the virus, presumably spread by oral sex. The actor Michael Douglas, who has cancer, made headlines when he discussed this issue during an interview last year. 
It is now recommend that both males and females be routinely vaccinated against HPV when 11 to 12 years old. 
If there’s an effective vaccine available, what’s the problem? Actually there are several. 
The vaccine requires three separate injections given over six months and the cost of the vaccines alone is over $400. 
Another problem is that there are actually two vaccines available — Gardasil and Ceravix — which are not identical. The issue is that there are many different “types” of HPV, and the vaccines differ in which of the types they cover, with neither vaccine providing perfect coverage against all relevant types. Gardasil is approved for females and males while Ceravix is only approved for females. Your health care provider should help you determine which is most appropriate for you or your teenagers. 
The thorniest issue for most parents is that the vaccine should be given before any intimate sexual contact occurs. The vaccine is probably of little value if given after the patient already has the virus. 
As I can testify, as a parent it can be more than a bit unsettling to know you are having your child vaccinated in preparation for the day when they will start having sex. On the other hand, I imagine it would be a whole lot more painful to see your child suffer with a disease such as cervical cancer that could have been easily prevented. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: HPV vaccine

Years ago my good friend Tim starting experiencing a significant weight loss when he began having severe abdominal pain after meals. It took several physicians a long time to figure out the problem was that he could not tolerate gluten. At the time, this was a relatively unusual diagnosis for an adult. There was not much information available on the subject, and even the food labels were of no help. Through lots of research and much trial and error, he eventually developed a gluten-free diet that he could follow. 
There are now millions of Americans avoiding gluten and a multibillion-dollar food industry trying to accommodate their needs. 
Why are they avoiding gluten? 
Gluten is not a toxic substance, but rather a combination of proteins commonly found in certain plants, such as wheat, barley and rye. Not only is consuming gluten perfectly healthy for most people, it’s also very useful. For example, when baking bread it enables the dough to rise and helps maintain the bread’s final shape and texture. 
But many individuals who suffer from celiac disease or other related problems, such as "gluten sensitivity," respond negatively to gluten. Gluten damages the lining of their small intestines, interfering with absorption of nutrients. Exposure to gluten may result in immediate problems such as diarrhea, abdominal distention, heartburn and bloating. Long-term problems such as anemia, weight loss and weakening of the bones may also develop. &nbsp; Recently, for unknown reasons, there has been a tremendous increase in the number of people who have been diagnosed with gluten related difficulties. 
In the past, people like my friend Tim were on their own in dealing with their situation. Now there are gluten-free products everywhere, which makes the process easier but still challenging. The list of foods to avoid is lengthy and includes most traditional cereals, pastas, breads, bagels and even beers. Constant vigilance and much label-reading are required. Supplemental vitamins and minerals are often needed. A dietician can help create an appropriate diet plan. 
Interestingly, many people without gluten problems have taken it upon themselves to adapt a gluten-free diet, but there is no real medical evidence showing this is of any benefit. 
Living a gluten-free life may be challenging, but it is certainly possible. Tim’s been doing it a lot longer than most people, and he’s doing just fine. He just never expected so much company. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Gluten intolerance

gluten intolerance

FIBROMYALGIA 
I have always found that one of the most difficult undertakings in all of medicine is to look a patient in the eye and say, “I don’t know.” After years of training, the last thing in the world you want to do is explain to a sick patient that you simply do not have the answers to many of the questions that are so important to them. Patients usually assume that once they are given a diagnosis their doctor has a full understanding of their disease. Unfortunately, a patient given the diagnosis of fibromyalgia may hear their physician say “I don’t know” quite often because. The simple truth is that there are many essential but unanswered questions concerning fibromyalgia. Typically, patients with fibromyalgia complain of chronic incapacitating muscle pain. Additionally, these muscle pains often are associated with multiple other problems, such as easy fatigability, difficulty with sleep, joint pain and depression, all of which make simply getting through the day extremely challenging. Fibromyalgia is a “clinical diagnosis.” This means there are no lab tests or imaging studies, such as X-rays or CT scans, that are useful for diagnosis or guiding treatment. The diagnosis is based on the patient’s description of symptoms. Additionally, fibromyalgia patients often have 9 pairs of “tender points” in very characteristic areas such as the back of the skull and outside part of the elbow. When the examiner presses on these areas, most people experience a simple pressure sensation. Fibromyalgia patients, on the other hand, frequently experience intense pain. The cause of fibromyalgia is poorly understood but may involve some abnormality in the way the nervous system processes pain sensations. Even though much is not known about this disease, much can be done to help these patients. Medications such as Lyrica have been approved for fibromyalgia. Other medications can help with the pain, depression and sleep disturbances. Psychological counseling and support groups can help, along with exercise, physical therapy, massage and tai chi are essential in keeping patients active. Complementary therapies such as message and tai chi help many patients. Most important of all may be accepting the challenge of having both the doctor and patient get past the disappointment of dealing with a disease of which so much is not known and working together using the wealth of information that is available. &nbsp; 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Fibromyalgia

Emphysema 
Growing up in the Bronx, I would frequently visit my friend Mike’s apartment to see if he could come out and play. Invariably, his mom would first make us go to the store and buy her a pack of cigarettes. It was a different era: Smoking was sophisticated, and the man behind the counter wasn’t interested in checking ID cards. 
It wasn’t until years later that I figured out why my friend’s mom didn’t go buy her own cigarettes. She was suffering from emphysema and the short walk to the store was already much more than she could handle. 
The main function of the lungs is air exchange . Lungs have millions of “alveoli”: microscopic balloon-like sacs, where oxygen is extracted from the air, attached to the red blood cells and sent via the blood to the rest of the cells in the body. Emphysema is the destruction of these alveoli. &nbsp; There are many causes: air pollution, industrial exposures, even a congenital form exists, but the vast majority of cases are caused by smoking cigarettes. &nbsp; Consequently these patients cannot get the oxygen they need. Medication and exercise can help them maximize the function of the remaining lung tissue but will never bring back the alveoli that have been destroyed. These patients slowly restrict their activities, often becoming unable to leave their houses. Even just talking or blowing out the candles on a birthday cake may be too challenging for them. Many of these patients require supplemental oxygen to stay alive. &nbsp; Nowadays, there are many effective programs and medications to help people with emphysema to quit smoking that were not previously available. Too bad Mike’s mom had to suffer so. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Emphysema

VITAMIN D 
My wife of over 20 years was not happy when she played back the message the doctor had left on the answering machine: “You need to take vitamin D and calcium and do more weight-bearing exercise.” Being a business executive and not a health-care worker, she turned to me for an explanation. 
Like an ever-increasing number of patients, she had undergone a bone-density test to assess the health of her bones, and it showed she had an early form of osteoporosis. Her bones were not as strong as they should be, and she was at increased risk of experiencing fractures. 
As we age, we are all at risk for osteoporosis, but people who are inactive, smoke, drink too much or take certain medications are especially likely to develop this problem. 
Calcium is a mineral that helps give bones their strength, but calcium is only useful in the presence of vitamin D. This vitamin actually functions as a hormone, acting on cells throughout the body. Its most important effects are increasing the absorption of calcium from the intestines and helping to make sure the calcium is available for the bones to use. 
Vitamin D can be found naturally in some foods, such as oily fish, and in fortified foods such as milk, bread and cereals. Even so, most people consume an insufficient amount of the vitamin. Interestingly, a main source of vitamin D is your skin. When exposed to sunlight, your skin can make a vitamin D precursor that, after being modified by the liver and kidneys, becomes active. The problem is that many variables affect how much vitamin D your skin can generate: your type of skin pigmentation, time spent in the sun, the latitude you live at and use of sunscreen are some examples. Needless to say, if you’ve spent this winter on Long Island, your skin has not generated much vitamin D. 
For the calcium and vitamin D to really strengthen my wife’s bones, she has to do more weight- bearing exercises. Her main form of exercise is swimming, which, like bicycle riding is a great exercise but does not put enough stress on the bones to be helpful for this problem. Brisk walking, jogging, resistance training or tennis would be much more effective at strengthening her bones. 
Persuading my wife to take calcium and vitamin D pills was relatively easy; having her increase her weight bearing exercises is proving to be a whole lot more challenging. 
<img align="left" src="http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Vitamin D

Healthcare

CHLAMYDIA 
Even though chlamydia is relatively easily to diagnose and treat, I always found dealing with chlamydia patients extremely frustrating. Let me explain. 
Chlamydia is a very common bacterial sexually transmitted disease (STD), with more than a million new cases each year in the United States. It can be easily spread by vaginal, oral or anal sex. 
Patients with chlamydia may have a discharge from their penis or vagina and a burning sensation when they urinate, or they may have no symptoms at all. Especially in females, untreated infections can lead to long-term problems, such as chronic pelvic pain, infection of the uterus and fallopian tubes, and possibly even sterility. 
If treatment with antibiotics is simple and effective, what’s the catch? I used to see the same problem over and over again. For the antibiotic treatment to be effective, both the patient and any sex partner(s) need to be treated simultaneously. Otherwise, the patient is cured but eventually will reacquire the infection from the partner. This is known as the “ping-pong effect” as the infection is continuously passed back and forth. Many patients are very reluctant to bring in their partners to be treated for a sexually transmitted disease. When I was treating patients with chlamydia, the law was clear: No antibiotic prescription could be given to a patient unless the patient had been evaluated in person. Hence, we would end up seeing the same patients come in over and over again, with the same problem. 
Now, New York State has addressed this dilemma by adapting an “Expedited Partner Therapy” (EPT) program. If a patient is diagnosed with chlamydia, the health care provider can not only treat the patient but also prescribe an antibiotic for a partner, even though the partner has not been examined. 
It is hoped that this will increase the chances of both partners being treated at the same time, thus eliminating the “ping-pong effect” and eliminating the frustration of both patients and health care providers. 
If any of you have experience with the EPT program, I’d like to hear 
<img align="left" src="http://http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Chlamydia

pills -- istock

BURSITIS 
Last summer, after years of being a terrible golfer, I completely changed my golf swing. The results were certainly surprising: my game improved tremendously but, by the end of August, my left elbow was the size of a baseball. My new golf swing had caused a classic case of bursitis. 
A bursa is a fluid-filled sack found in many joints that helps cushion and aid movement. Normally we don’t even know they are there. They can become inflamed due to a variety of causes, such as infection or trauma, but most often due to overuse of the joint. Shoulders, elbows, hips and knees are frequently involved. For example, people who kneel for prolonged periods while gardening or laying carpet can develop bursitis of the knee. The stress of playing a lot of golf a less-than-perfect golf swing can cause bursitis of the elbow. 
Patients with bursitis will experience tenderness and pain, especially when using the joint. In severe cases such as mine, the swelling can become rather impressive as the inflammation causes increasing amounts of fluid to accumulate in the bursa. 
Treatment consists of trying to rest the joint by avoiding the activities that caused the problem. Icing it, wearing an elastic bandage or brace and taking nonsteroidal anti-inflammatory agents such as Motrin or Aleve also may be helpful. If these conservative measures don’t work, the bursa can be drained, but there is a risk of infection. RarelyIn rare cases, the bursa needs to beis removed surgically. 
In my case, for almost a month, I had to stop playing golf, wear an elastic brace and take a nonsteroidal. By then the season was almost over so I only played one or two more times in the fall. I’ve spent the winter trying to strengthen my elbow by working out at the gym. Now that golf season is here, I hope to get through it without a recurrence. 
<img align="left" src="http://http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

Doctor's Diagnosis: Bursitis

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ANAPHYLAXIS 
I once had an unfortunate encounter with an unfriendly wasp that required me to be treated in the emergency room for a potentially life-threatening allergic reaction. Can a single wasp sting really threaten your life? The answer is yes, if you suffer from a severe form of allergy known as anaphylaxis. 
Usually, allergies cause watery eyes, runny noses, maybe even an asthma attack. In some patients the allergic reaction is much more severe, with skin rash, narrowing of the airways and dangerously low blood pressure developing in a matter of minutes. If not promptly treated these patients can quickly die. In fact it is estimated that almost 2,000 people a year die in the United States from an anaphylactic reaction. 
What type of agents can trigger anaphylaxis? It’s a lengthy list ranging from certain antibiotics (especially penicillin and related drugs) to the latex used in medical gloves to foods such as peanuts to stings from bees and wasps. 
Patients who know they develop severe allergic reactions to certain allergens must work very hard to avoid exposure to these agents. An allergist may be able to help desensitize them to known triggering agents. Regardless, in an emergency these patients must be ready to treat themselves. 
The most useful drug is epinephrine (also known as adrenaline) which comes in an auto-injection device known as an EpiPen, a prescription medication. When patients feel a reaction developing they uncap the needle and inject themselves in the outer part of the leg, directly through their clothes. Then they should call 911. 
After my encounter with the wasp, I was told to carry an EpiPen at all times. Knowing it could save my life made it worthwhile, but it can be rather inconvenient. Recently a new epinephrine auto-injection device was released, known as Auvi-Q, which is smaller and more convenient to carry. Removing the outer case activates an audio voice recording that gives step-by-step instructions to the user. 
If any of you have any experience with this new device, I’d like to hear from you. Contact me at health@newsday.com. 
<img align="left" src="http://http://cdn.newsday.com/polopoly_fs/1.7936453.1399393024!/httpImage/image.JPG_gen/derivatives/mugshot_100/image.JPG" style="padding-bottom: 3px; padding-left: 3px; padding-right: 3px; float: left; font-size: 12px; padding-top: 3px"> 
 Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice.

Doctor's Diagnosis: Anaphylaxis

anaphylaxis - crop

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Health officials said the individual, who lives in Nassau County, is an adult over the age of 50 and he or she was not vaccinated against measles.

Person with measles at Nassau medical offices prompts new questions

Peterson has more than three decades of medical experience.

NUMC names new chair of medicine as hospital turnaround era nears new phase

Lidl has recalled Gelatelli Coffee & Vanilla Gelato with Coffee Sauce & Cookie Pieces, sold in 16-fluid ounce containers.

Grocery chain recalls gelato product

Organizers had raised $1.7 million as of Sunday morning out of a goal of $2.5 million.

'Fight the good fight': Breast cancer walk draws thousands to Jones Beach

The unvaccinated adult over 50 years old represents the second case in the county this year.

Second measles case of the year confirmed in Nassau County

The 91-year-old former pediatrician transferred a home into his wife's name days before a law made assets of accused sexual abusers vulnerable.

'He's still getting away with it': Ex-doc hasn't paid a dime of $1.6B in sex abuse judgments

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In Nassau County, about 4.5% of outlets tested were positive, similar to Suffolk's rate of 4.6%. Newsday Albany reporter Keshia Clukey has more.

'There were a few school districts that stood out'

NewsdayTV's Doug Geed speaks with Newsday reporter David Olson and Stony Brook Children's Hospital's Dr. Sharon Nachman about the issue of vaccine fraud.

'There likely are others'

The verdict is the second $5.5 million judgment against Townhouse Center for Rehabilitation and Nursing this year.

'This has to stop'

He and other childhood survivors will be in Washington, D.C. this weekend to ask lawmakers for more research funds. NewsdayTV's Doug Geed reports.

'I just knew it was something really bad with me'

The Willens now find themselves part of a widening national debate about doctor-assisted end-of-life decisions as they consider whether a new state law offers Kim Willen an option she may want to take when her disease runs its course. NewsdayTV's Virginia Huie has more.

'Walk a day in our shoes before you make a judgment'

The settlement approved in federal court is one of the largest to resolve a local wage theft complaint in recent years. Newsday data reporter Anastasia Valeeva has more.

Hundreds of live-in aides to get millions in unpaid overtime

ScieGen Pharmaceuticals wants to build a 60,000-square-foot factory and warehouse in Hauppauge to meet consumer demand. NewsdayTV's Virginia Huie reports.

'Very important for us'

Northwell's WTC Health Program has seen a jump over three years in certified cancer cases among first responders. NewsdayTV's Virginia Huie reports.

'I would do it again'

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