I suffer from persistent acne problems?




Question: I suffer from persistent acne problems. I am a male 34 years old and have had acne problems since I was 16 years old. My acne is mostly on my face and a lot is found on my upper back. To the point I am ashamed of it. What can I do to make it go away?

Answer: Hi. I have received and read your question. You are suffering from acne vulgaris but since it is now showing up on your upper back and has become a problem you need to deal with this. Proper hygiene and washing is the first step that needs to be taken.

  1. Use a mild soap and avoid scented, medicated soap.
  2. While washing the face, the skin of the face must not be scrubbed roughly. It should be sponged gently.
  3. Wash your face three or four times a day with plain water – soap is to be used only twice a day.
  4. Avoid exposure to dust, dirt or oily cosmetics.
  5. I would also recommend to avoid fatty foods.
  6. Do not squeeze the acne as it may leave a scar permanently.

As far as treatment is concerned you should consult a dermatologist. Possible medication that will be recommended by your doctor may include:

Doxycycline 100 mg two times a day. Ibuprofen 400 mg two times for five days. Isotretinoin once a day for 15 days. Retino-A (Tretinoin) locally at night.

Regards

Dr. Deepak Patel

 

I have had ovulation induction but no pregnancy?

Question: I am trying to have a baby for 3 years now. I’m 26 years of age and in good health except for a Polycystic Ovarian Disease – pcod –  issue. I had Clomid and hCG injections twice. Both were unsuccessful. My  doctor said egg growth is OK. I have uploaded my hormonal test report and ultrasound . Please help.

Answer: Hi. I have received and read your question. In my opinion the hormone reports submitted are normal and the ultrasound seems fine. But, as there is no detail about the sizes of follicles reached during both cycles of ovulation induction it is difficult to make a comment here. There are some points that need to be clarified: Other hormone levels like serum testosterone, serum estradiol, DHEAS (dehydroepiandrosterone), 17-OHP (hydroxyprogesterone) levels also need to be done. If you have been forming adequate size follicles 222 x 22mm by midcycle then hCG (human chorionic gonadotropin) can help you ovulate but if hCG fails at this size then it is likely that your androgenic hormone levels are higher. You should upload the ultrasound pelvis report to assess the size of the ovaries. An anti-mullerian hormone level report is needed for evaluation. Based on the info provided I believe pregnancy is possible however I strongly recommend you consult with a reproductive endocrinologist (fertility doctor). This is your best avenue forward.

Regards,

Dr. John Claude

 

My body wants to keep moving to the right?

Question:  I HAVE BEEN RUNNING FOR PAST 60 YEARS, I’M 75 NOW. MOSTLY LONG DISTANCE HAVE COMPLETED 56 MARATHONS, MANY HALF AND 5K RUNS. LATELY, AFTER RUNNING THREE MILES HAVE LOWER SPINAL PAIN, BODY WANTS TO KEEP MOVING TO THE RIGHT, UNABLE TO CONTROL BALANCE. HAVE TO HOLD ONTO OBJECTS AFRAID OF FALLING OVER. I TEND TO GO OFF TO THE RIGHT?
THANK YOU

Answer: Hi. I have received and read your question. In my opinion, your history of marathon running and heavy use has led to a condition of excess Foot Supination/Pronation – an imbalance of the foot. This can be treated by consulting a specialist (sports physical therapist) who will recommend specific exercises. Also you should reevaluate your foot wear with a orthopedic shoe specialist and find a shoe that can correct the problem.

Regards,

Dr. John Claude

Excessive supination (underpronation) and excessive pronation (overpronation) can cause problems with the body’s alignment and lead to pain in the feet, knees, hips, and back.

  • Too much supination can cause problems, such as pain and soreness.
  • Most people with excessive supination have structural issues in their feet.
  • Ways to treat or prevent excessive supination include wearing proper shoes.

People who pronate excessively roll their foot inward, causing the outer part of the heel to make contact with the ground and the feet to flatten too much.

Those who supinate do not roll their foot inward enough. This puts a strain on the ankle and can cause the ankle to roll outward, which leads to injury.

Excessive supination is less common than excessive pronation.

Causes of supination : The structural problems of the feet causing supination are usually inherited. However, external factors can also play a role in the condition.

Common causes of excessive supination include:Traits that affect the mechanics of the feet and legs are often inherited, such as:

  • leg length (including differences between the length of the legs)
  • width of the foot
  • ankle stability

The shape of the foot’s arch may also increase the risk of supination, with runners with high arches being more prone to supination than other people.Good shoes support the arch and soft tissues of the foot, which help protect the foot from injury. This is especially true when walking on hard and flat surfaces.

The wrong type of shoe — such as rigid or tight shoes — can lead to supination and other foot problems. Also, wearing shoes that are worn out or have no arch support causes supination.

Can I add DHEA and Pregnenolone to improve my hormone levels?

Question: Hello, I suffered a stroke 30 years ago both my adrenal glands were removed and I now rely on 20 mg Hydrocortisone and 0.1 mg fludrocortisone a day Can I add DHEA and Pregnenolone 25/100 mg to improve my hormone levels i.e. Reduce my psa levels

Answer: Hi. I have received and read your question. Based on the information you have provided and considering the medications you are taking, I would not recommend taking DHEA or Pregnenolene. Both have questionable results with insufficient evidence of effectiveness. In addition, they are banned in some countries for certain activities. I hope this answers your question.  Below is some background additional info for you.

Serum levels of the adrenal androgen, dehydroepiandrosterone (DHEA) and its sulfated conjugation product DHEAS, peak in men and women in the 3rd decade and decrease progressively with age. Increasing numbers of middle-aged and older individuals consume over-the-counter preparations of DHEA in the hope that it will retard aging by increasing muscle and bone mass and strength, decreasing fat, and improving immunologic and neurobehavioral functions. To date, however, the benefits and risks of DHEA administration for “anti-aging” purposes have not been defined. Because DHEA can serve as a precursor to testosterone (T) and estrogen, supplemental DHEA use may pose a cancer risk in patients with nascent or occult cancer of the prostate and/or breast.

Regards,

Dr. Deepak Patel

I am really worried about developing anaphylaxis to an anesthetic?

Question: I am about to undergo a hemorrhoidectomy surgery to remove hemorrhoids. I was told I would need a local anesthetic. But I am really, really worried about developing anaphylaxis to the anesthetic. Even though I have had anesthesia in the past without any problems. Do you think I need to be concerned of having a reaction?

Answer: Anaphylaxis is a serious, life-threatening allergic reaction. Anaphylaxis may last a lifetime. But if you have not experienced a severe reaction in the past, you are unlikely to develop the same in future. Do not worry. Just be aware and, to be reassured and feel safe, keep rescue medicine always with you as standby.

Regards,

Dr. Javez Ernesto

Should I take a vaccine to improve my immunity?

Question: I went to hospital 2 weeks ago and now have received the results of my immunity test. I don’t understand what these mean. Is there a problem that I should know about? I was prepared for the test – no meds etc. Should I consider to take a vaccine in the future? Please help.

1. HAV-IgG to Hep A – 11.48 (reactive).

2. Mumps – 47 (positive).

3. Rubella – 46.2 (reactive).

4. Measles – >300 (positive).

Thank you very much for you assistance.

Answer: Hello. Thank you for your question. Immunity concerns have been more in the forefront today what with the corona virus situation and more. Based on the info you have provided it is my opinion that you have no need to worry despite the results turning positive. For instance, for hepatitis, the virus that is considered to be dangerous is hepatitis B, all the same, you may need to take hepatitis immunization. For the MMR (measles, mumps, and rubella) mostly a large number of people that are tested tend to have traits of it not unless you are symptomatic, there is no need for alarm, but again I would highly recommend you take the vaccine for the same.

Regards.

Dr. Deepak Patel

I went to ER, strep test was negative but doctor said it must be strep?

Question:

I am 21-year-old female. I am pretty healthy and have an average weight. I had a sore throat for two days and it is extremely hard to swallow due to swelling to the point I can barely eat solid food. It is not scratchy, and I do not have a cough or fever.

I went to the urgent care, strep was negative but the doctor said it must be strep and would not listen to any of my symptoms. He spent about 30 seconds with me and is treating me with Biaxin. Pain is killing me, and my stomach is having a hard time with these antibiotics even with food. I am attaching a photo.

Answer:

From the picture we received, you seem to be suffering from acute follicular tonsillitis. Usually, this is caused by strep, other bacteria responsible for this condition are Hemophilus and Moraxella. A course of antibiotic at this stage helps in early recovery. As you have been started on macrolide antibiotic, I believe it is the best course of action at this stage – you need to follow the whole course for it to be effective.

Antibiotics are known to cause gastric upset, which usually disappears once the course stops. If this is too difficult to endure ask your Doctor for  Zantac (Ranitidine) 150 mg and take before food twice daily and use warm salt water gargles at least three times a day. If situation continues, please follow up with your Doctor after seven days.

Regards,

I had a root canal done now I am in pain?

Question: I had a root canal done about a month ago. I was supposed to return to the dentist 2 weeks later but because of covid-19, they cancelled. I started getting a bit of pain in the area where the root canal was done and a bad taste in my mouth. I called my dentist and they called in a prescription for amoxicillin. One week later, nothing had changed. I called the dentist and they had me come in. The dentist prescribed me Clindamycin 4 times a day for 10 days. I’m currently on day 4 of taking this. The taste has gone away. The pain is not fully gone but better. My tongue still has a light film on it. I have spina bifida and while showering yesterday, I noticed I have 2 hive like welts near where the spina bifida cyst is.  (picture attached) Also the lymph node near my groin area is tender. I don’t feel sick or have a fever so I’m wondering if these things could be side effects of the Clindamycin?

Answer: Hi. I have received and read your question. Based on the information you have provided I believe this may be be caused by the Clindamyci. I would recommend you speak to your Dentist once more and discuss with him/her the possibility of using an alternative such as cephalexin, azithromycin or clarithromycin. If situation persists you should consult with your primary care physician.

Here Is some more information:

Common Clindamycin side effects may include:

  • nausea, vomiting, stomach pain;
  • mild skin rash; or
  • vaginal itching or discharge;

Side effects requiring medical assistance:

– any change in bowel habits;

– severe stomach pain, diarrhea that is watery or bloody;

– little or no urination; or

– a metallic taste in your mouth (after clindamycin injection).

Dr. Deepak Patel

I hit my head on a wall.

Question: I hit my head on a wall. I am feeling pressing sensations in my left temple. Just recently I feel much smaller sensations in my right temple. Not painful just pressing. What is going on?

Answer: A blow such as the one you have received may have no consequences whatsoever. Using pain relief medication such as Acetaminophen (Tylenol) may help with the pain. Please avoid using ibuprofen (advil) for such an injury. You will need to consult if you have subsequent symptoms. Immediate medical attention is required if you experience symptoms such as bruising behind the ears or around the eyes (raccoon eyes). These can potentially indicate a severe or life-threatening injury. If you experience these symptoms, a CT scan will be required to further evaluate the situation. Sometimes a blow to the head may produce a concussion. These are difficult to diagnose. And the consequences vary. Most concussions or mild traumatic brain injuries (MTBI) symptoms will go away without treatment. So please continue to monitor your situation and should symptoms worsen please consult for more investigation.

Additional Information:

Head injury can be either closed or open (penetrating).

  • A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull.
  • An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This is more likely to happen when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.

Head injuries include:

  • Concussion, in which the brain is shaken, is the most common type of traumatic brain injury.
  • Scalp wounds.
  • Skull fractures.

Head injuries may cause bleeding:

  • In the brain tissue
  • In the layers that surround the brain

Common causes of head injury include:

  • Accidents at home, work, outdoors, or while playing sports
  • Falls
  • Physical assault
  • Traffic accidents

Most of these injuries are minor because the skull protects the brain. Some injuries are severe enough to require a stay in the hospital.

I woke up this morning with sudden back pain?

Question:

I woke up this morning with sudden back pain and a low grade fever?

Answer:

If the fever does persist for more than 2 or 3 days, this may be due to a more serious infection or underlying condition which will require a doctor consultation. An imaging test will then be required as well as further testing after examination. In the meantime if symptoms worsen today or tomorrow, I recommend you visit an ER just to be on the safe side.

Below is a more comprehensive answer:

Causes of back pain and shortness of breath include:

Muscle strain

Muscle strains respond well to rest, ice or heat, and over-the-counter pain relievers, such as ibuprofen or acetaminophen.

A muscle strain typically goes away after a few days, but if it lasts longer, the doctor can prescribe stronger medications, such as a muscle relaxant, to help relieve the discomfort.

Pneumonia

Either a virus or bacteria can cause pneumonia. If the pneumonia is bacterial, a person may need antibiotics to clear up the infection completely. Some people may require hospitalization and supportive care to prevent further complications.

Excess Weight

Being overweight means the muscles of the back have to work harder to support the basic activities of daily life. Having extra fat around the chest or back can also make it harder to breathe or take a deep breath.

GERD

Gastroesophageal reflux disease occurs when stomach acid backs up into the esophagus and causes chest pain, heartburn, or a sour taste in the mouth.

Simple home remedies, such as not eating before lying down and avoiding common triggers can also help prevent GERD. Potential triggers include acidic foods, citrus, chocolate, coffee, and alcohol.

Gallbladder Disease

If a person has gallbladder stones, they may need surgery to remove the stones or the entire gallbladder. Someone who is susceptible to developing stones should avoid eating fatty foods, which can worsen bile production and increase the likelihood of developing stones.

Aortic Dissection

An aortic dissection occurs when there is a tear in the aorta, causing blood to leak into the vessel walls. This is a very rare condition but causes severe back pain, shortness of breath, chest pain, weakness, and sweating.

An aortic dissection is a life-threatening event that requires immediate treatment. Depending on where the dissection is, emergency surgery may be necessary.

Other Causes Include:

  • Cancer of the spine: A  tumor on the spine may press against a nerve, resulting in back pain.
  • Infection of the spine: A  fever and a tender, warm area on the back could be due to an infection of the spine.
  • Other infections: Pelvic inflammatory disease, bladder, or kidney infections may also lead to back pain.
  • Sleep disorders: Individuals with sleep disorders are more likely to experience back pain, compared with others.
  • Shingles: An infection that can affect the nerves may lead to back pain. This depends on which nerves are affected.
  • Cauda equina syndrome: The cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. Symptoms include a dull pain in the lower back and upper buttocks, as well as numbness in the buttocks, genitalia, and thighs. There are sometimes bowel and bladder function disturbances.

All Americans must start wearing masks right now!

What are Americans waiting for?

People in Asian countries have adopted the use of masks for years now. During the corona virus covid-19 outbreaks in Asia, everyone was obliged to wear a mask (and in some areas still are obliged to do so). That’s how they beat it! The use of a mask is NOT necessarily to protect the user from the virus but to PREVENT the user from spreading the virus to others! It is a very simple and intelligent thing to do. Common sense.

I don’t want to get into the reasons why North American and European governments do not promote the use of masks – that is a political issue – probably due to the fact that too much money is spent on military hardware and little to nothing spent on biological warfare or pandemic protection. Maybe it is because there is no available mass production of masks in America or not an integral part of the American culture – but that’s another issue altogether. So my advice is – WEAR A MASK, WEAR A MASK, WEAR A MASK.

Dr. D. Zluf

Dr. D. Zluf

Pain on lower right side?

Question:

Wife has a pin that’s tender to the touch under right side of belly button, feels like a knot or something under there

Answer:

Hi,

I have received and read your question. Several conditions can cause an abdominal mass. If your wife is also experiencing pain, vomiting, fever or discoloration, to be on the safe side , it would be preferable you seek out immediate attention such as an ER or emergency clinic. But if that is not the case then the type of mass you are describing may just require a visit to your Doctor. A Right-lower quadrant mass can be a caused by a number of conditions:  hernia, hematoma, cyst, tumour.

Generally speaking a mass needs to be examined by your Doctor. An imaging test will be required – CT scan, Ultrasound, or X ray – depending on symptoms, and where the mass is located and how it feels, your Doctor will recommend the appropriate  imaging test. The results will indicate further course of action.

Below is a more comprehensive answer:

Located on the right lower abdomen are – Bowel, Kidney, Ovary.

Abdominal masses can be the result of a number of factors, including an injury, cyst, benign tumor, cancer, or other disease.

A cyst is an abnormal mass in the body that’s filled with fluid or infected matter. It is sometimes to blame for an abdominal mass.

Cysts that commonly cause abdominal masses include ovarian cysts, which are cysts that form in or around the ovaries.

Cancers that often cause abdominal masses include: colon cancer, kidney cancer, liver cancer, stomach cancer

Certain diseases may also cause abdominal masses. These diseases include:

  •  pancreatic abscess a pus-filled hollow in the pancreas
  • diverticulitis inflammation or infection of the diverticula, common pouches that form in weak places in the intestines and colon
  • hydronephrosis an enlarged kidney due to the backup of urine
  • enlarged liver
  • splenic enlargement
  • IBD Inlammatory bowel disease that causes inflammation of your digestive track lining,
  • abdominal aortic aneurysm, enlargement or protrusion of the large blood vessel that supplies blood to the abdomen, pelvis, and legs

Regards,

Dr. John Claude

I have been diagnosed with peripheral neuropathy

Question:

I have been diagnosed with peripheral neuropathy and my neurologist ordered some blood work to see if there is any cause for my neuropathy. He said there is nothing in my test that shows the cause of my neuropathy. However I see that a couple of my white blood cell counts are high. Is this any cause for concern? Thanks.

Answer:

Hi,

High white blood cell count is of course a matter of concern. This indicates there is some other underlying problem. Although the problem may NOT be related to the peripheral neuropathy or causing it.  High white cell count usually indicates your immune system is working to fight off an infection. This could be one of many things. On the other hand, finding the cause of the high count may establish some kind of link to your condition.

It would be a good idea you send us your lab results (your pdf attachment was empty). You should also consult with your primary care physician for a complete check up to try to identify the problem causing the high count.

Below is a more comprehensive answer.

There are many causes of peripheral neuropathy, including diabetes, chemo-induced neuropathy, hereditary disorders, inflammatory infections, auto-immune diseases, protein abnormalities, exposure to toxic chemicals (toxic neuropathy), poor nutrition, kidney failure, chronic alcoholism, and certain medications – especially those used to treat cancer and HIV/AIDS. In some cases, however, even with extensive evaluation, the causes of peripheral neuropathy in some people remain unknown – this is called idiopathic neuropathy.

Other test that can be done to determine the cause of your high white blood cell count are:

  • Bacterial infection: a culture of the affected area (e.g.,urine culture, sputum culture, blood culture), strep test
  • Viral infection: tests for mononucleosis, Epstein-Barr virus
  • Inflammation: CRP (preferred),ESR
  • Autoimmune diseases: ANA
  • Allergies: Alllergy tests
  • Leukemia: B

Dr. John Claude

Do Miracles Exist?

The Miracle Collection

From time immemorial, the human being has woven stories that give account of real facts, but are at the same time extraordinary. These are stories that are generally spread by different religions. They narrate unlikely situations, which are almost always related to miracles of healing.

All religions, including the most reflexive ones such as Buddhism, have such stories. Some of these stories include  teleportation, apparitions, disappearances, prophetic messages, apocalyptic announcements and a long etcetera.

“For me, every hour of the day and night, it is an indescribable and perfect miracle”

-Walt Whitman-

For believers, all these “miracles” acquire the value of evidence or proof of the existence of a divinity. Religion is a matter of faith, and faith is precisely to believe when there is no evidence. However, believers often take these types of narratives to be foundational and factual.

Philosophers and scientists are skeptical of such manifestations. Their main criticism is that believers systematically refuse to practice true verification methods for such phenomena. Those who certify them, almost always, are the same religious people or believers and they do so through methods that are in a strict sense not scientific.

Miracles and Marian apparitions

Within the stories of miracles that are spread through different media, the so-called “Marian apparitions” stand out. Regardless of the sacred value that the Virgin Mary may have for believers, the nature and the messages that spread through these apparitions are always striking.

There are patterns that are common in stories of Marian apparitions. They almost always occur to very humble people with little education and never to ecclesiastical or scientific authorities. Believers will say that the Virgin chooses the simplest people because they are more virtuous. But this fact should not be overlooked.

On the other hand, if we take into account the messages of these apparitions, we should conclude that the Virgin has a clearly political attitude. We are talking about a politicized virgin, who left a clear position in 1917 against the Soviet Union, or in favor of peace in Bosnia-Herzegovina (Medjugorje). Mexicans have also indicated that the appearance of the Virgin of Guadalupe coincides with a great effort of catechization of the Spanish colonizers in Mexico.

The fact remains that the Virgin Mary makes appearances only in America and Europe, never in Africa, Asia or Oceania. Neither is the fact that the Marian messages are basically threats. They announce terrible events for the world, and urge them change through religious conversion and prayer. There are even priests who question the validity of these phenomena and qualify them as situations that are closer to paganism than to religion itself.

Miracles and the desire to believe

Religious beliefs are an intimate subject that deserves the highest respect and that is part of the freedom of conscience that every human being has. There are hundreds of cases of people who are cured of illness thanks to their beliefs.

The religious will say that they are miracles, where the intervention of God is verified. Non-believers will argue that these are psychosomatic diseases, which directly involve the nervous system. In other words, the “cure” is actually autosuggestion.

Most people who report these “miracles” do not lie. They really experience what they claim to experience. However, there is reason to think that all this occurs in the mind, rather than in reality itself. There are, for example, hysterical blindnesses that can indeed be cured in the same way as they originate: through a strong psychological experience.

There are also cases where some sort of fraud is evident or, at any rate, a desire to believe that it goes beyond the evidence. There are numerous episodes in which religion has had to admit that it made a mistake that science points out. For example, it had to admit that the theories of Copernicus, Galileo, or Darwin were true. In turn, science has never had to retract in favor of religious beliefs.

Everyone must be a believer or an atheist, according to what one’s conscience dictates. However, true faith does not need prodigies to be firm. And much less requires the fear to stay. The same goes for atheists.

Perhaps we must all understand that there are daily miracles that are much stronger and more valuable than extraordinary events. To live, to breathe, to love, to laugh, to suffer and to be able to succeed in spite of everything are the great miracles that we should all celebrate every day.

Will a person suffering from Crohn’s disease be more pre disposed to get MND?

Question:

Hi I have become paranoid that my boyfriend is going to develop MND at some point In his life and it’s not that rare and I think because he has crohn’s disease that it will make him more pre disposed to get MND. But if he has a disease already will it make it less likely to happen?

Answer:

There is no reason to believe that because your boyfriend has Crohn’s disease that there is necessarily a greater chance of developing MND. There is a 1 in 300 risk of getting MND across a lifetime. It can affect adults of any age, but is more likely to affect people over 50. MND often begins with weakness of the muscles in the hands, feet or voice, although it can start in different areas of the body and progress in different ways. It is in hereditary in about 10% of the cases as far as the remaining 90% due to a number of factors including auto immune response issues, exposure to viruses, toxins and ageing of motor neurons. Unless there are existing symptoms which may lead you to believe your boyfriend may suffer from MND, I would not focus on that and stop thinking about it.

Here are some additional factors for your information:

The physical effects of motor neurone disease can include:

  • muscle aches, cramps, twitching
  • clumsiness, stumbling
  • weakness or changes in hands, arms, legs and voice
  • slurred speech, swallowing or chewing difficulty
  • fatigue
  • muscle wasting, weight loss
  • emotional excess – for example, where a slight upset can cause an exaggerated response, such as crying or laughing
  • cognitive change (changes in thought processes)
  • respiratory changes.

Doctors often find it difficult to diagnose MND in the early stages as it can resemble other conditions, such as mutiple sclerosis  (MS). If a doctor suspects someone has MND, they will refer them to a neurologist, who will take a medical history, do a thorough examination, and may suggest other tests, such as:

1. Blood and urine tests: These can help a doctor rule out other conditions and detect any rise in creatinine kinase, a substance that muscles produce when they break down.

2. MRI brain scan: An MRI cannot detect an MND, but it can help rule out other conditions, such as stroke , brain tumour, or unusual brain structures.

3. Electromyography (EMG) and nerve conduction study (NCS): An EMG tests the amount of electrical activity within muscles, while a NCS tests the speed at which electricity moves through muscles.

4. Spinal tap, or lumbar puncture: A doctor will look for changes in the cerebrospinal fluid, which surrounds the brain and spinal cord. It can help rule out other conditions.

5. Muscle biopsy: This can help detect or rule out a muscle disease.

The doctor will normally monitor the individual for some time after the tests before confirming that they have MND.

Dr. Javez Ernesto