Ask a Doctor
November 11, 2008
Got health questions? Ask Dr. Tovar in our online chat. Submit your questions now.
Moderator: Our guest today is Dr. Sam Tovar, an Emporia native. He has been practicing medicine for six years at Medical Arts Clinic. His specialty is family practice and he his particularly interested in obstetrics and pediatrics. People have been sending in a lot of health-related questions. We'll start with a complex question that may or may not have a complex answer.
Dr. Sam Tovar: This chat is intended solely for informational purposes and is not a substitute for routine or urgent medical evaluation, treatment or consultation. Individuals with medical or personal problems are requested to seek advice from their own physician or mental health professional. Dr. Tovar's responses should not be construed as medical opinions aimed at establishing a diagnosis or course of treatment. Information found here may serve as a topic of discussion between patients and their individual clinicians. Individuals who are being treated should not construe information here as replacing or superseding recommendations of their own clinician. Clinicians should appreciate that suggestions made here, without benefit of direct assessment, are not intended as direct consultative recommendations.
jeneswift: I am a 29 year old female, 5'4, and I currently weigh 185. I had a hysterectomy at the age of 23. I have gained 70lbs since then. I have also had numerous problems with foot pain,stomach pain, IBS,beginnings of skin cancer removed and high liver enzymes WITH PAIN. even though they keep telling me I don't have pain receptors in my liver I keep telling them it hurts. I have also had my gall bladder removed. I have noticed that my circulation is getting very poor and my veins on the surface of my arm(around elbow) have disappeared. I have also noticed the veins on top of my hands are getting smaller. Is this a sign of a disease? Or is it because I am overweight? I started weight watchers 4 weeks ago and have lost 13.8lbs so far. The only change I have noticed is my heartburn is better. Is there a way to improve my circulation and get my veins back to the way they were? Thank you.
Dr. Sam Tovar: Ideally, when a person comes in with multiple concerns, I would love to tell them the solution is a simple one or two step process, easily accomplished and then move on. In actual practice, health is multi-factorial. Generally speaking, I find that a person’s health is influenced by the unique interaction of that person’s current age, their sex, their genetic makeup, their current level of fitness, their diet selection, their perception of themselves, and personal habits (alcohol, smoking, etc..). Some of the above items mentioned are things we can influence and other items are unchangeable. With that in mind, even the most “clean-living” young healthy individual can suffer from an incurable, chronic disease process. But, once again generally speaking, a person should work to optimize those aspects of their health that they can. Age has a way of slowly breaking our bodies down, but healthy living habits serve to slow the aging process and delay the onset of certain medical conditions. I congratulate you on your weight loss. I expect that continued weight loss will improve some of the symptoms you are ailing from. In addition to weight loss, I would recommend incorporating regular aerobic exercise into your daily life. Increased blood flow to your arms and legs (from exercise) will help improve your circulation
DJrocksthemic: I have chronic pnuemonia problems because my body has trouble expelling mucus. I'm a young guy who works out, but I've been getting sidelined by colds that turn into something worse because I can't get it out, any suggestions?
Dr. Sam Tovar: With chronic pneumonia I would wonder about conditions that cause your lungs to produce excess amounts of mucus. Do you suffer from asthma or allergies that are untreated? Are you a smoker? Are you frequently around areas that are smoky, dusty, or moldy? Do you have a condition that has stiffened your lungs and has made it more difficult to move secretions? In regards to your colds, do you eat healthy? Good nutrition is key to a fully functional immune system. Are you involved in activities that may weaken your body's ability to fight disease (too much alcohol, under too much stress, not enough sleep)? So for starters, I would recommend keeping hydrated (to prevent mucus from thickening) and making sure you are keeping as healthy as can be. Certainly, you should consider the possibility of asthma or allergies as contributing to your problem.
latenighttips: My family has had problems with reoccuring boils. What can we do for that and is there a nose swab that can be done to check for MRSA?
Dr. Sam Tovar: Your skin is your first line of defense to protect your precious innards from the filth of the outside world. All individuals carry bacteria such as Staphylococcus aureus with no problems, that is, until their skin is punctured or cut. Friction and scratching can cause this type of skin injury. This may allow bacteria to enter into the skin causing folliculitis or deeper boils. Most cases of folliculitis or boils will clear with good hygiene. At times, antibiotics may be used, or in the case of isolated large boils, they may be lanced (cut open to drain). MRSA is a type of staph infection that is resistant to certain antibiotics that have commonly been used to treat skin infections. Because MRSA is more prevalent in today, I typically culture a wound whenever I lance a large boil to ensure proper antibiotic selection. In your particular household, since boils seen to be reoccurring, it may be useful to swab each individual member of the family. I would discuss this with your physician.
birch: What are the lifelong consequences in discomfort and health costs for sports related injury? Any national figures for the proportion of health costs related to sports injury compared to, say, smoking?
Dr. Sam Tovar: Dammit Jim, I’m a doctor, not a statistician. (Trek fans will understand)
quarterback: Since you are around sick people all day long what are some tips that you and your family use for staying healthy?
Dr. Sam Tovar: I would like to think I practice what I preach. In my personal health, I exercise regularly, I eat an orange or grapefruit daily, I don’t smoke. In working with sick people, I am diligent with washing my hands as well as my stethoscope inbetween patient visits. I avoid inhaling germs by moving out of the way of a direct sneeze. I have rarely use antibiotics in my entire life and instead depend on my own immune system to clear illnesses. I feel these actions have allowed my body to develop a healthy, active, immune system. In addition, I feel that since my occupation positions me next to illness I have built up my immune system in some sort of homeopathic manner. (Teachers, nurses, and pastors probably would identify with this) Certainly, there are days when I don’t feel quite well, but I hesitate to call it sickness. My old high school coach used to say something like, “If you feel a bit of a cold coming on, go out and run 4-miles. It will elevate your temperature and help you fight viruses.” (My coach was a cross-country coach.) My wife would say, our kids are healthy because they have already been sick enough with being exposed to everything I take home from work.
quarterback: How long do flu shots last and when is the best time to get them? Do people get them to early?
Dr. Sam Tovar: According to the CDC (Center for Disease Control), the flu season will typically peak between December and March, and most often peaks in February. It takes about 2 weeks after your vaccination to produce protective antibodies. I would vaccinate in the fall because if you wait too long, sometimes the vaccines become unavailable. I personally received my flu shot last week. The flu shot will last the season. Repeat shots are not indicated during the same season. Due to the mutagenicity of the flu virus, a new flu shot is developed yearly.
murmusic: I take Toporol for high blood pressure, and it interferes with my workout at the gym. Since I want to lose enough weight to stop needing medication, is there an equally effective medication I might try that doesn't suppress my heart rate?
Dr. Sam Tovar: That's a great question. The best blood pressure medication is the one you are willing to take. Certainly, there are different categories of high blood pressure medications, each with different potential side-effects. Toprol belongs to a category called “beta-blockers” which is known to slow the heart rate in a favorable manner. This is usually not a problem for most people, but if you feel this is affecting you, ask your physician about other options.
murmusic: My partner snores heavily, and often stops breathing for ten to twenty seconds at a time. Sometimes he springs awake and appears to be having trouble inhaling, until for some unknown reason he suddenly starts breathing again. I worry about how this affects his health, and wonder how best to convince him to see his GP about it.
Dr. Sam Tovar: The manner of sleep you are describing sounds a lot like a condition called “obstructive sleep apnea”. Individuals with this condition actually do, momentarily, stop breathing. It’s a scientifically proven fact that if you are not breathing, you are or soon will be dead. The jolt you see is the body awakening itself to breathe. Having “The Apnea” affects the body in a myriad of ways. Imagine yourself, trying to sleep, and as you drift into your deepest levels of sleep you are suddenly jarred groggily awake. You then spend the remainder of the night bouncing between near awake and suffocation. You finally awaken, unrefreshed and tired. Your body responds to this lack of good sleep by causing you excessive daytime sleepiness, morning headaches, memory or learning problems, irritability, and lack of concentration. You may even suffer from high blood pressure and chronic pain. This can be the result of untreated apnea. I not sure why your partner hesitates to see a doctor. I would suggest you start with informing yourself on this condition. Then approach him and heartfully let him know that you have concerns about his health and then educate him about this condition. If that doesn’t work, maybe you can bribe him.
Moderator: We have time for one more question, this one about weight-loss programs.
treetrunk: What is the best weight loss program?
Dr. Sam Tovar: The best weight loss program is one you are willing to live with for the rest of your life. Anyone can lose some weight by following any number of fad diets. In order to keep this weight off, you need to continue on the diet plan. Too often, someone goes on a diet for “x-number” days, then reaches her target weight. Feeling good about reaching her goal, she will stop the diet and return to her usual pattern of eating. The weight will then return -- no surprise. In order to effectively lose weight, I would suggest you change your manner of eating. Don’t go overboard and try to change everything at once. Just look at your diet and make food-substitutions. Substitute high-calorie foods, with a lower calorie substitute. A week-long diet journal is an excellent way to identify problematic foods in your diet. With that in mind, I feel the South Beach diet is a reasonable diet to maintain for your entire life. In addition to food changes, a person needs to incorporate regular exercise into their life. Be fit and lean, not just lean.
Moderator: That's all the time we have for today's chat. Thank you, Dr. Tovar, for giving our readers the benefit of your medical advice. A transcript of this chat will remain here on the Web site and an edited version will be published in Wednesday's Gazette. Thanks to all who participated today.