"Hey doc, no matter how much I exercise, I still keep gaining weight. I feel cold all the time, and I'm so super tired all day. Is something wrong with me?" "Mr. W, I have a suspicion what it may be, but I will need to check you more carefully first. Here, come into my office and let's talk about it."

Sometimes, having a hard time tolerating the cold, gaining weight for no reason, and being tired all the time could signal a problem with your thyroid gland. A common condition that strikes many people is something called hypothyroidism. This is a condition that affects the ability of your thyroid gland to produce thyroid hormone. So where is your thyroid gland? It is located on both sides in the front of your throat, near the base of your neck. They are normally very hard to feel or even find.

In general, the thyroid is in charge of controlling the overall speed or rate of our body's metabolism. When someone has hypothyroidism, their metabolism is being slowed down. So we can imagine looking at a very tired, dragging person. In hypothyroidism, the hormone thyroxine (T4) and/or triiodothyronine (T3) production or release is below normal. There is another condition called hyperthyroidism--which is just the exact opposite. We will talk about that one at another time.

Here are some signs and symptoms that can signal a hypothyroid condition:

• Depression
• Cold intolerance or sensitivity
• Persistent fatigue
• Weight gain or water retention that is unexplained
• Weakness of muscles or lack of muscle tone
• Nails and hair become brittle, or hair loss
• Osteoporosis
• Paleness
• Goiter--swelling of the base of the neck in front
• A slow heart rate in someone who is not athletic
• Persistent constipation
• Puffy, dry skin
• Speech becomes slow and deliberate
• Memory impairment and difficulty learning new tasks
• Lower than normal body temperature
• Menstrual cycles become abnormal
• Slow reflexes on exam
• Anemia
• Persistent need for sleep
• Mood instability
• Decreased sex drive
• Increased cholesterol and lipid levels
• Acute psychosis--not a common first presentation
• Decreased sense of smell and taste
• Difficulty swallowing

If you suspect you may have thyroid problems and have some of these symptoms, you should see your doctor and get evaluated. The diagnosis can usually be made by a blood test that checks your hormone levels, along with a careful physical exam. If it does turn out to be hypothyroidism, there are several methods of treating the condition. The most common being replacement with a synthetic thyroid hormone taken as an oral medication. There are several possible causes of this condition, however, they all need careful medical evaluation by a health care professional to be discovered.

So until next time...take care of each other...and Stay Healthy Hawaii!

FYI: Things are getting a little bit hectic right now, so this blog will go offline for a short time to allow me to catch up and take care of a few pressing issues. One Doctor's Opinion will be back online on 3/23/10 with more new and interesting topics.

Mahalo for all your support!

GW

What an interesting saying huh? But when it happens to you, it is neither interesting nor funny...

What is back pain? It is exactly that. A pain that happens somewhere along your back. It can be very sharp, sudden, and incapacitating. Or it can be dull, slow developing, and irritating. To make things even more confusing--the characteristics can run the whole range in between. It can also be acute and short-lived, or chronic and unending.

Back ailments are an increasingly more common condition these days and are often very debilitating to the person who suffers from them. In fact, according to the National Institutes of Health, it is so common that in any given 3 month period, over one-fourth of adults suffer from at least 1 day of back pain during that time frame. Wow...Imagine that!

Are there actually risk factors for back pain? Yes!

• Back pain becomes more common as we age--most common age at first episode is in the 30's to 40's
• People who are not physically fit are more likely to suffer back pain--weak core muscles cannot support the spine adequately to prevent injury
• People who suddenly try to do physical activities when they are normally sedentary are more likely to sustain a back injury
• Genetics is sometimes a factor for certain inherited joint conditions--these will also affect the spine
• Obesity increases the risk of back injury--more weight the spine has to support increases the chance of injury
• Ethnicity can sometimes be a factor that predisposes certain groups of people to specific back conditions
• Certain systemic diseases can increase the chances of back pain--arthritis, auto-immune diseases, cancer (can spread to the spine to cause pain)
• Occupation--jobs with heavy labor involved increase the chance of back injury
• Recreational activities--sports or hobbies with high amounts of physical contact can also increase the chances of a back injury
• Smoking--via multiple possible avenues. Many of the above can apply. Usually overweight and physically unfit. Also, smoking increases chances of osteoporosis (weakened bones) and subsequent back bone fractures

What are the common causes of back pain?

• Mechanical or structural--where issues like discs wearing out or scoliosis would become factors. Even how the spine moves mechanically would be factors in injury or pain
• Systemic conditions--arthritis, lupus, osteoporosis, kidney stones, pregnancy
• Infections--referred pain from kidney infections, meningitis, osteomyelitis of the spine (bone infection)
• Tumors--less common cause of back pain. Sometimes cancer in other parts of the body can spread to the spine and cause pain. Less commonly, a tumor can actually begin in the spine.
• Injury--actual injury to the spine due to mechanical forces from lifting improperly or twisting motions

The chances of back injury and pain can be reduced by several general measures. Increasing the strength of the core muscles (abdominal and back musculature) that supports the spine will help to decrease chances of injury. Eating a healthy diet and maintaining proper weight and bone health also helps. Regular exercise and general physical fitness is also very important. Activities that improve your balance and coordination will help you to prevent falls that can injury your back. And finally, good posture and good lifting habits of using your legs instead of your back are crucial in protecting your spine.

Most people have some kind of back pain at one time or another. Here are some warning signs that signal the need for further evaluation by your doctor:

• Severe pain--especially after a fall or traumatic injury
• Numbness or tingling in the arms or legs
• Weakness in the arms or legs
• Unexpected loss of weight in addition to the back pain
• Urinary or bowel problems--burning when you urinate, having problems controlling your bladder or bowels, fever, chills
• Pain that does not get better

Back pain is treated by several different methods. This is best left to the discretion of your doctor as he/she knows your history the best. There are many modalities available to treat back pain today. These include: rest, physical therapy, medication, surgery, spinal manipulation (as from a chiropractor), acupuncture, and massage.

In many instances, the best treatment for a particular patient is a combination of these modalities. For this exact reason, in my own practice, it is not uncommon for us to be working side by side with an orthopedic specialist, as well as a chiropractor at the same time. Each professional bringing their own area of expertise to help the person who is suffering with back pain to heal.

So until next time...be kind to your back...and Stay Healthy Hawaii!

GW

"Doc, I have never had a mammogram, and I don't really bother to go to my gynecologist regularly to get a full breast exam. Too much of a hassle. Should I be worried?" "Well, Mrs. W...yes, you should be worried. Let me tell you why."

One of the main reasons that women should routinely visit their gynecologist is for exactly that reason. A routine and comprehensive breast exam and a mammogram (if their doctor feels they need one) are an important part of a woman's general health maintenance. Even during the best manual breast exam, we often cannot find very small changes in a woman's breast that may actually be cancer. However, with our current technology, early detection of very small breast cancers is often possible by use of mammography. Interestingly, sometimes a good mammogram can detect an irregularity in the breast that could eventually turn out to be cancerous that cannot even be felt as a lump for up to another 2-3 years--had it been left to grow. Imagine that... How's that for early detection?

What is breast cancer? It is a collection of breast tissue cells that decide not to obey the usual rules of cell growth and begin to live by their own rules. More specifically, they grow in a random and out of control, chaotic manner forming what is usually a tumor or a mass. These tumors will grow and often have the ability to spread to other parts of the body (metastasize) and usually or eventually disrupt the normal function of the breast tissue.

Ok, so what is a mammogram? A mammogram is an x-ray of the breast that is taken while it is compressed between two plates so that most of the tissue can be examined. Modern mammograms can be digitally examined for various suspicious patterns by the radiologist. This will greatly enhance the radiologist's ability to find very small changes in the breast tissue being imaged that may signal the very beginnings or a breast tumor.

This is exactly why a mammogram is so important. It can greatly increase your chances of finding a very, very early breast lesion before it becomes a significant problem--so called early detection. This translates into a markedly increased chance of winning the battle should it turn out to actually be a breast cancer. It is a very bad thing to find a breast cancer very late in its progress--as by then, it probably has already spread to other parts of the body.

When should I get a mammogram? This can be discussed more carefully in detail with your gynecologist in regards to when you should get your first screening mammogram. At the time of this blog's writing, the usual recommended starting age is around age 40 years old. However, with new research that is in the works, the starting age may change. The actual baseline screening age is often specific to your own medical situation. If your family has a history of breast cancer, then your doctor may recommend starting with your first mammogram several years earlier than the usual age. He/she may even recommend a more frequent repeat interval than the usual 1 or 2 years.

Here are some signs to watch out for that may signal breast cancer:

• Always keep in mind that cancers that are very small and only detectable by mammogram may not show any signs at all
• A change of your breast shape or size
• A new lump that is found in your breast or a change in a lump that was already there
• Persistent pain in the breast or nipple
• A very tender nipple that starts to turn inward or retract
• Dimpled breast skin or skin that looks like orange peel
• Any type of fluid or blood that is draining from the nipple (that is not milk when nursing)
• Red, swollen, irritated, flaky skin found at any location on the breast

Should you find any of the above, you need to see your primary care provider right away for evaluation.

What are the risk factors for breast cancer?

• Starting menstruation at an early age
• Having a strong family history of breast cancer involving close family relatives--mother, sister, daughter
• Having a late menopause
• Aging in general
• Having children at a late age or no children at all
• Being overweight
• Having used long-term hormone replacement therapy
• Being on birth control pills
• Consuming alcohol
• Living a physically inactive lifestyle
• Being treated in the past with radiation to the chest or breast area
• Having genetic mutations to the BRCA2 or BRCA1 human genes
• Personal history of other breast disease or previous history of breast cancer

What can give me the best chances of preventing breast cancer?

• Routine visits to your gynecologist or primary care provider for comprehensive breast exams
• Determine the risks and benefits of hormone replacement therapy with your doctor and make an educated decision regarding its use for your situation
• Screening mammograms at the recommended intervals as determined by your doctor
• Keep your proper weight
• Do breast self exams regularly--your doctor can teach you to do this properly
• Do regular exercise and remain physically active
• Keep your alcohol consumption to a minimum

If something unusual or suspicious is found on your exam or mammogram, your doctor may do some of the following things:

• Breast ultrasound to evaluate a lump or irregularity seen on screening mammogram--does not hurt, sound waves used to image something
• Biopsy of the area of suspicion
• Diagnostic mammogram--a much more detailed study of the suspicious area
• MRI or Magnetic Resonance Imaging scan of the breast tissue to get a clearer picture of what is going on.

If things don't go as hoped for and your irregularity in the breast turns out to be cancer, there are several options that can be used to help remedy the situation. Your doctor will help you decide what is the best solution for your particular situation. At his/her disposal are several modes of therapy including chemotherapy, radiation therapy, surgery, biologic therapy, and hormonal therapy. It is not uncommon for people to have more than one mode of therapy used on them to improve their chances at a cure.

Whenever we are referring to breast cancer, the key is early detection, diagnosis, and treatment. Hmmm...so a routine mammogram...indeed not the most comfortable procedure...but so much better than the other alternative.

For more information visit: The National Cancer Institute at www.cancer.gov; American Cancer Society at www.cancer.org; or The Centers for Disease Control and Prevention at www.cdc.gov/cancer

So until next time...Stay Healthy Hawaii!

GW

"Doc, I'm kind of confused. I like my job, my wife is great, and my kids make me laugh. I just don't understand why I just feel so blue doc...you know...I'm somehow just not truly happy inside." "Ok Mr. W, let's have you take a seat in my office and let me ask you a few questions to see what is going on with you--ok?"

Feeling depressed, "blue", or sad is a normal reaction to life's unexpected challenges, personal losses, or bashes to our own self esteem. However, having feelings of worthlessness, intense sadness, hopelessness, or helplessness that continues for days, or weeks, or months is not normal.

These bouts of strong emotions usually compromise our ability to function normally. These are often signs and symptoms of clinical depression. There are several types of depression and many other associated physical, mental, and emotional aspects related to it. However, today we will focus on general topics dealing with depression.

Here are some common signs and symptoms of depression:

• Decreased energy or fatigue
• Difficulty making decisions, focusing, or concentrating
• Feelings of helplessness or hopelessness
• Feelings of guilt or worthlessness
• Too little sleeping or too much sleeping
• Early morning waking and restlessness
• Insomnia
• The perception of no joy left in life
• Vague "illness" type of feelings to include stomach complaints, headaches, aches and pains
• Loss of appetite or overeating
• Weight gain or weight loss
• Sad or emptiness type of feelings
• Thinking about suicide or even attempting suicide

These symptoms can be experienced in a combination of components and in varying intensities. If you or someone you know is experiencing these feelings, professional help is needed. A good place to start is to talk to your doctor and let him/her know what you are going through. Your doctor knows you best and can assist you in getting the type of help you need.

The treatment of depression makes use of several different modes of care. Most commonly, psychotherapy and/or anti-depressant medications are used. However, for very severe cases that are unresponsive to the usual modes of therapy, ECT or electroconvulsive therapy (shock therapy) is sometimes considered. The treatment that is best suited to any person's particular situation is best managed by their mental health professional and their physician.

One final word of caution. Unfortunately, clinical depression also carries with it a very high risk of suicide. Therefore, anyone who exhibits suicidal thoughts or behavior that makes attempts at suicide must be assisted into getting help from the local suicide help line or the emergency medical system immediately. Anyone who has suicidal thoughts needs to be taken with the utmost of seriousness. Also, people who have had previous suicide attempts are at an even higher risk for future attempts or even actual success at suicide. A very serious situation that needs immediate intervention.

In a nutshell--persistent and lingering "blues" should always be investigated and not ignored.

So until next time...take care of each other...and Stay Healthy Hawaii!

GW

"Doc...my eyes are very irritated and red. They feel dry like I have sand in them. But what really scares me is that there is some kind of baby slug looking thing growing on my eye!! What is that??" "Relax Mr. W...let me get a good look at this thing. I bet you get lots of sun and don't use sunglasses right?"

Here in Hawaii where we get more than our share of sun and outdoor activities, we often find a common ailment that goes along with our lifestyle...a pterygium on our eyes. This is something that grows from (usually) our nose side of the white part of the eye towards the clear part of the eye or cornea. It is usually fleshy and often has a lot of small blood vessels on it that help it to turn a red, irritated color when it is disturbed or bothering us. The most common symptoms include: dry itchy eyes, persistently red eyes, and the sensation of a foreign body in the eyes. In the worst cases, it can affect vision as the growth invades more of the clear portions of the cornea.

How do we get these interesting looking fleshy accessories? The true cause is not very clear. However, it is highly suspected to be due to our exposure to a lot of ultraviolet radiation in addition to wind, dust, and low humidity. It is most often found on people who have a lot of exposure to these conditions and do not always have proper eye protection. Surfers and other water sport enthusiasts have a fairly high incidence of pterygiums--as it is often difficult to wear proper sunglasses during these types of activities. They are also more likely to occur in areas near the equator. Additionally, they also occur in high numbers in areas that are constantly windy. Interestingly, women tend to suffer from this condition less often vs men.

Prevention is aimed at protection from the sun and wind. Wear sunglasses with side coverage that protects from 100% of UV radiation at all times when in the outdoor environment. Lubricating eye drops also helps to reduce irritation and discomfort. These measures if applied consistently, can help to prevent the formation of or decrease the worsening of a pterygium that is already present.

The first step in treatment is to have your eyes evaluated by your doctor. From there he/she can decide if your condition needs the attention of an ophthalmologist (medical doctor who cares for eyes) or if it is mild enough to be monitored in the primary care setting. More serious cases can be treated by several methods that require the skills of an ophthalmologist. These methods include (most commonly) surgical removal. However, other methods range from beta particle irradiation to membrane grafting.

Here's the bottom line. Most of us who enjoy the outdoors use pretty good sun sense and always slather on lots of good sun block. However, not all of us take the time to protect our eyes--also very important. When in Hawaii, enjoy the outdoors...but give your eyes a break...keep em behind a good pair of shades.

So until next time...Stay Healthy Hawaii!

GW