BODY SIGNAL ALERT TESTICLE, HARD LUMP IN: TREATMENT

Anytime a patient notices a suspicious mass in his testicle, I suggest that he visit a urologist, who will do a sonogram of the mass to determine the exact site and whether the mass is hard or filled with fluid. If the urologist has any doubt, he will perform a biopsy. If the testicle is not cancerous—which is usually the case—it will be left in place.

If you have a cyst on the epididymis, your doctor will probably choose to leave it alone. If it continues to grow, however, it will eventually cause pain. At that point, your doctor will probably want to remove it surgically.

If the lump turns out to be cancerous, your doctor will need to treat it immediately by removing the entire testicle. This procedure is called an orchiectomy and is performed if the cancer has not spread beyond the testicle. Again, since only one testicle is usually affected, the other testicle will be left in place, meaning that your fertility will not be impaired. If your doctor feels that the cancer has spread, however, he will recommend that you also be treated with radiation or chemotherapy; this will result in sterility.

One of my patients is a 37-year-old man whom I diagnosed 10 years ago with testicular cancer; he was unmarried at the time. Before he was treated with surgery and radiation, he decided to have his sperm frozen so he would be able to father a child in the future, since the treatments would render him sterile. He also had a small testicular prosthesis placed into his testicular sac for cosmetic reasons.

Today, he’s been cancer free since the surgery; he needs only an annual blood test and physical exam. He hasn’t yet married, but his semen is intact if he needs it to become a father.

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BODY SIGNAL ALERT DIARRHEA, CHRONIC, NONBLOODY: TREATMENT

Changing your diet or your medication will often correct chronic diarrhea.

If you think you have lactose intolerance, try eating some ice cream or drinking a large glass of milk. If you begin to have diarrhea an hour or two later, and you also feel pain and bloating in your abdomen, you probably have a lactose intolerance. You should then eliminate dairy products from your diet as much as you can. This, however, can be a problem, since you still need to get some calcium in your diet, especially if you are a woman. Fortunately, you can take calcium supplements, 1000 milligrams a day for premenopausal women and 1500 milligrams for postmenopausal women daily. You can also buy a lactose-free milk such as Lactaid in the supermarket or add Lactaid drops to your milk or take pills whenever you eat or drink foods that contain lactose.

If you have a gluten intolerance, your doctor will take an X ray of your small intestine to show the typical pattern of gluten malabsorption. An endoscope may also be used to take a biopsy to confirm the diagnosis. One of my patients came to me a few years back complaining of chronic weight loss, and we gave him every test in the book and came up empty-handed. Then I ordered an X ray of his small intestine, which immediately showed all the signs of gluten malabsorption. With the help of a dietitian, we changed his diet to avoid all gluten, and he recovered quickly.

If you have an intolerance to gluten, a gluten-free diet is easy to achieve, even though gluten is found in almost all bread products and cereals. You can eat rice cakes and buy gluten-free products at the health food store.

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BODY SIGNAL ALERT: SHORTNESS OF BREATH WITH COUGH, PINKISH SPUTUM, AND WHEEZING

Description and Possible Medical Problems

If you suddenly become short of breath and simultaneously begin to cough up a pinkish sputum, you need to call 911 for immediate medical attention. You may also be sweating, pale, and wheezing.

These are all signs of acute pulmonary edema, in which the lungs begin to fill with water. Acute pulmonary edema can be caused by a dietary change, a sudden change in or cessation of a medication, a reaction from mixing two or more kinds of medication, or a heart attack or change in heart rhythm. If you have phlebitis, acute pulmonary edema can also be the result of a clot that travels from the veins of the legs into the lung, a condition known as pulmonary embolus.

Treatment

Acute pulmonary edema is a life-and-death situation, and immediate medical attention is necessary. While waiting for medical help, the most important thing to do is to keep a sitting position. If you have any diuretics or water pills at home, there is no harm in taking two of these pills immediately.

Regardless of the cause of acute pulmonary edema, once professional help is on the scene, the treatment for acute pulmonary edema includes the injection of a diuretic, such as Lasix, which will remove excess fluid from your body, meaning the heart has to work less, and nitrates, which reduce the amount of effort the heart has to make. In severe cases, it will be necessary to put you on ventilator support.

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WRINKLES

Description and Possible Medical Problems

Like gray hair, wrinkles are a normal part of aging. However, wrinkles tend to appear earlier than gray hair in most people and so are fought more rabidly and for a longer period of time.

One factor we can’t control when it comes to wrinkles is the fact that skin becomes thinner as it ages, which hastens the appearance of wrinkles. Certain factors can speed up the initial appearance of wrinkles and make them worse once they do appear. Cigarette smoking and sun exposure ate often cited as the two best friends a wrinkle can have. Failing to drink enough water every day is also a significant factor, since adequately hydrated skin tends to wrinkle later and less often.

Most of the expensive skin creams that supposedly “turn back the clock” on wrinkles help keep the skin moist—if you apply the cream to damp skin—but the most important thing you can do is to hydrate your skin from within by drinking 8 to 10 glasses of water a day. It’s never too late to start. You should also stop smoking cigarettes and restrict your exposure to the sun.

Treatment

Wrinkles, of course, are irreversible, unless you decide to opt for cosmetic surgery.

Getting a face-lift has been a popular choice for both women and men for years, but the major drawback, besides the fact that any surgical procedure is dangerous, is the fact that it isn’t permanent, which necessitates a repeat performance in a number of years—and at regular intervals afterward. For some people, however, a face-lift is definitely worth it.

Dermatologists have prescribed the use of certain preparations for years, though the side effects can sometimes be harsh.

Again, more and more people today are deciding to let nature take its course and to age with grace—which includes getting wrinkles.

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HOARSENESS: DESCRIPTION AND POSSIBLE MEDICAL PROBLEMS

We all get hoarse from time to time. Sometimes it’s due to over-enthusiastic cheering at a sporting event; at others it’s due to talking too much. Hoarseness can also result from a cold, perhaps accompanied by a sore throat. Whatever the cause, hoarseness occurs when the larynx— which contains the vocal cords—becomes irritated and inflamed, a condition that is known as laryngitis.

Whenever I hear hoarseness in a patient’s voice, I’ll immediately suspect he or she is a smoker. I always ask, “How many cigarettes do you smoke?” It always amazes my patients that I know they smoke. In turn, I’m surprised that they’re not aware of their smoker’s voice. From then on, at every checkup I’ll know to look for the possibility of polyps— abnormal growths that are common in smokers—on their larynxes.

For people who do not smoke but are frequently hoarse nonetheless, the cause is usually raising the voice or talking loudly. Like smokers, people who talk loudly or who frequently shout or scream are prone to developing polyps on the larynx.

While some folks may joke that the periodic bouts of laryngitis some people have finally allow others to get a word in edgewise, the fact is that persistent hoarseness and/or laryngitis may in fact be an indication of a more serious disease, such as polyps or a tumor on the larynx or in the lung.

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