I had a feeling on the left of my Adam’s apple as if someone was placing their thumb on it.

Question: I am a 51 year old male. I have had heart burn from July 2018. Then July 2019 the acid went to my throat and just sits there. Even if i clear it it still sits there. From December 2020 i had a feeling on the left of my Adam’s apple as if someone was placing their thumb on it. Not with pressure but just placing it on my throat. But also at the same time December 2020 my throat became very itchy and dry. Then 28th of April i got a burning sensation in the exact same spot. Left of my Adam’s apple. I would not say it was painful but very uncomfortable and very conscious of it. Also my heart burn did clear from when i first got it in July 2018. Can’t remember when but it has come back and it seems higher up like just below my neck not my chest. Also from December 2020 along with my other symptoms i would say i had a voluntary cough. It is actually when i eat or drink that it makes me feel the urge to cough. I think also my burning pain i have now fluctuates to just a burning that i can feel to something bordering on quite painful. I think thats all and i dont think i have missed anything out.

Answer: Hello. Thanks for your question. Looks like you had (and still have) a serious GERD –
Gastroesophageal Reflux – problem. The pressure you describe in your throat -feeling of pressure or what some patients descibe as a lump like sensation is probably caused by LPR (Laryngopharyngeal reflux disease) – a result of your history and battle with acid reflux. As a result of acid reflux in your throat, your body is reacting through excess mucus and inflammation. In my opinion you need to get your acid reflux problem under control. First: Watch your diet – cut out coffee, acidic drinks, spice, fats, alcohol. Eat small meals. Don’t lie horizontal after your eat. 2. Other treatments you can use involves the use of antiacids, H-2-receptor blockers, proton pump inhibitors. If problem persists or worsens, you may also want to consult an ENT/Gastroenterologist for prescription strength medications as well as possible x-ray, acid (pH) probe test and upper endoscopy.

Let us know how it goes.

Dr. D. Zluf
Dr. D. Zluf

I have pain not only in my hand but from my leg up to my neck.

Question: Hello. I am a 39 year old. Male. I do some activities like dancing and recently I think I pulled a muscle or maybe twisted a nerve in my arm and right hand while dancing. But the result was pain not only in my hand but from my leg up to my neck. Pain is precisely in neck, shoulder, arm and hand.  And I am quite worried about this. A week ago I  had an MRI scan taken and I would like to have an opinion from you, I guess  a second opinion. I uploaded the results. Please provide best possible answer. Thanking you in advance.

Answer: Hi. Thanks for contacting QuestionDoctors.com. Based on the information you have provided and uploaded, I can see your MRI indicates:

  1. Disc bulge indenting the theca at c4/c5
  2. Disc protrusion indenting the theca – left lateral recess at c5/c6
  3. Degenerative cervical disc disease.

In  my opinion, development of the degenerative cervical disc disease results from the cervical spine fractures.

Sensory pain radiates in the direction of the cushioning discs and nerve roots involvement. The pain you feel along your neck, shoulder, arm is probably caused by c4/c5 involvement. The pain you feel specifically in hand is probably caused by the  c5/c6 involvement.

Naproxen can be used to help alleviate degenerative cervical disc disease.  Tens machine can also be used to help with the pain. Your doctor may recommend the use of Baclofen and calcium. I would also recommend you consult with a Physio Therapist who may suggest further treatment and the use of a cervical collar and hot/cold compress treatments.

Regards,

Dr. Javez Ernesto
Dr. Javez Ernesto

Bleeding from vagina. Is this normal or caused by blood clotting?

Question: Hello. I am suffering from vaginal bleeding. I gave birth about a month and a half ago by C-Section. I had bleeding for about a week afterwards. Then it stopped for about 2 weeks and then it started again daily about 2 weeks ago. Can this be due to blood clotting or is this normal after a c-section? I have uploaded CBC, PT, INR/PTT results for you. Thanks again ahead of time for your answer or help.

Answer: Based on the information you have provided you seem to be suffering from postpartum hemorrhage and from the docs you sent they do indicate some type of blood clotting disorder  raised prothrombin time (PT) and international normalized ratio (INR). This needs to be examined and treated immediately. I recommend you go to an ER or hospital. The following tests need to completed: blood, liver function tests (LFT), urea, creatinine, platelet count, bleeding time (BT), clotting time (CT) prothrombin time (PT) and activated partial thromboplastin (APTT) as well as an USG (ultrasonography) . Administration of IV antibiotic as well as FFP transfusion and blood reserve will probably be required.

Regards,

Dr. John Claude

I have been having headaches for about 4 to 5 years?

Question: I have been having headaches for about 4 to 5 years. The headaches will last sometimes all day and sometimes 2 to 3 hours. I don’t have any other symptoms when I have these headaches. But a few days ago while having a headache I vomited as well. I take a flexon tablet when I get a headache. What should I do?  And is Flexon good for headaches?

Answer: Hello. I suggest you get an an MRI brain scan done and also get an ophthalmic examination to identify intraocular pressure and fundus examination to rule out papilledema. As far as taking Flexon is concerned, Naproxen can also be a good choice.

Regards,

Dr. Beverly Lewis

Doctor Beverly Lewis

 

Can I stop my epilepsy medication? Haven’t had a seizure in over 6 years.

Question: Can I stop my epilepsy medication? I have been diagnosed with epilepsy 8 years ago and been put on Lamictal for awhile and then Epilim. But the meds are making me miserable feeling anger,anxiety and depression. I haven’t had a seizure in over 6 years. Can I stop the meds?

Answer: Hi. I understand that the medication may be affecting you. However you will need to consult with your Doctor before doing any modification whatsoever. You will need to undergo MRI Brain (plain and contrast) with MRA, MRV, MRS and whole spine screening and EEG. If results are normal, the drugs can be tapered and eventually eliminated. Until then I recommend you continue as is.

Regards,
Dr. Deepak Patel

I want to take the best possible Covid 19 vaccine. Which one is the best?

Question: I want to take the best possible Covid 19 vaccine. Between the Pfizer-BioNTech, Moderna, AstraZeneca and Johnson vaccines. Which one is the best? I am a 54 year old woman with no health problems.

Answer: Hi. There has been a lot of talk about the efficacy of the different vaccines and talk about some folks preferring one to the other because of its efficacy % rate, etc. But I would recommend you take whichever vaccine is offered to you first.  All these vaccines are highly effective against severe illness caused by covid 19 and that is what really counts. Just to give you an idea, when it comes to flu shot vaccines the average efficacy is between 40 to 60%. But all covid 19 vaccines are efficacious 70% plus! And when it comes to severe illness they all range near the 80-95% range. That is really impressive for any kind of vaccine! So getting any one of these vaccines will do what it takes to protect you.

Regards,

Dr. D. Zluf

Dr. D. Zluf

I am having heartburn and stomach pain. Is it due to GERD or peptic ulcer?

Question: I am a 52 year old woman, suffered from allergies and was prescribed antihistamine, omeprazole sometime ago.  and after about 10 weeks began experiencing heartburn, regurgitation, difficulty in swallowing, and sleep disorder. So I consulted a doctor and I was diagnosed with malaria and acidity. I did an ultrasound and it showed excess gas present in my stomach but no ulcer. I was prescribed Spasmodigestin for 10 days and Rabeprazole for a month. Felt better. I now am feeling more acidic with heartburn and having stomach pain occasionally. Is it due to GERD or peptic ulcer?

Answer: Ulcer in the stomach is not shown as a diagnosis in the ultrasound. Some antibiotics that you are taking can cause side effects with an erosion of the stomach wall. I am not sure whether you are taking medications to reduce the secretion of acid in the stomach. Based on the info you have provided, your stomach burn seems to be mostly antibiotic-induced. If you have heartburn with an acid taste in the mouth after sleeping for few hours, then it is likely due to regurgitation. Consult your Doctor who may recommend you take Omeprazole. It is used to treat certain stomach and esophagus problems (such as acid reflux, ulcers). It works by decreasing the amount of acid your stomach makes. It relieves symptoms such as heartburn, difficulty swallowing, and persistent cough. This medication helps heal acid damage to the stomach and esophagus, helps prevent ulcers, and may help prevent cancer of the esophagus. Omeprazole belongs to a class of drugs known as proton pump inhibitors (PPIs).  Drink plenty of fluids. Avoid taking excess coffee or tea and spicy foods. Avoid smoking and drinking alcohol. Take a break of ninety minutes between your dinner and sleep. Do not sleep immediately after taking food. Keep your head end raised by placing pillows between your shoulder blades. Your Doctor may recommend you can take an upper GI (gastrointestinal) endoscopy if the severity persists or if the symptoms reappear after a month to know what is happening.

Regards,

Dr. Javez Ernesto
Dr. Javez Ernesto

Are my home EKG results good? Or is there a problem?

Question: Are my home EKG results good? Or is there a problem? I have very mild mitral valve regurgitation. Before I did the EKG, I just ate and I was very concerned about the chest pain. I have attached my two EKG reports here. Are they normal? They were taken consecutively, 1 minute apart, the one with 106 heart rate was taken first and the second one with 93 heart rate was taken later). I see some broad peak in the second one. I am not sure if it is an error or something else.

Answer: Hello. I have received, read your question and have taken a look at the info you uploaded. The EKG (electrocardiogram) mainly seems to be of a normal heart. There is no obvious sign of ischemic heart disease or any other issues of rhythm and electrical conduction of heart. The peak you are most concerned about is a simply nothing. It is an artifact and is a recording error of the stylus.

Regards,

Dr. Deepak Patel

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,