Gastroparesis; Pre-Menopause; Teens & Birth Control Pills; Foot & Ankle Pain
The following is information we discussed on Let's Talk Medical with Doctor Gigi on Friday March 16, 2012. Feel free to refer to the podcast version posted on www.SkipShow.com, & please contact me via DoctorGigi@SkipShow.com if you have comments or questions.
GASTROPARESIS:
Gastroparesis is a slowness of the stomach to digest food, or what I often call a partial paralysis of the stomach. It results in food staying in the stomach for a long time after you eat it. This results in nausea, a sense of fullness which lasts a long time, & sometimes belching (which might be reminiscent of food you ate HOURS ago). The symptoms are sometimes confused with ulcer problems, but they don't get better with typical ulcer medicines. It is most often seen in people with diabetes, but can be associated with many medications, especially medications known as "anti-cholinergic" medications. These are meds that block the neurotransmitter acetylcholine in nerves, & they are commonly used for many different disease processes. They often cause dry mouth & drowsiness. The following is a list of some anti-cholinergic meds:
Anti-histamines = Benadryl, Atarax
Anti-depressants = Elavil, Pamelor, Paxil
Anti-nausea meds = Phenergan, Compazine
Anti-psychotics = Clozaril, Zyprexa, Mellaril
Vertigo meds = Antivert, Scopolamine
Heart meds = Lasix, Digoxin, Procardia
Stomach meds = Bentyl, Lomotil, Levsin, Librium, Tagamet, Zantac
Muscle Relaxants = Flexeril, Norflex
Urinary meds = Ditropan, Detrol, Sanctura
If you have symptoms of gastroparesis, it can be confirmed with a gastric emptying study or perhaps an upper GI series with small bowel follow-through. If you have diabetes, you should aim for good diabetic control, but you will likely need medication such as Reglan or Domperidone. Reglan is an old drug which is cheap, but it has odd side-effects, the strangest of which is a tightening of the neck muscles which causes a person to feel as though his head is stuck turned to the right or left. Of course this is frightening, but resolves when the drug is discontinued. I would suggest trying the Reglan, but start with a low dose & increase according to your tolerance of the med & how well it works for your symptoms. Some people get by with Reglan 10mg with the largest meal of the day, whereas some need the highest dose which is 10mg with each meal & at bedtime. If you are on medications which might be causing the gastroparesis, you should ask your doctor to change them to something else if at all possible.
PRE-MENOPAUSE:
Menopause is an absence of ovarian function, so this occurs when the ovaries are removed during surgery (surgical menopause)or when the ovaries get old & "die" which usually occurs between the ages of 48-52. If you have a natural menopause, meaning that the ovaries die, this will be evidenced by the fact that you will go one year without a period. Before you stop having periods, you get irregular periods. Early on they get closer together... every 2-3 weeks... whereas later they get further apart... every 2-4 months. Once you go one year without a period, we call you "menopausal," & once you are menopausal, you are always menopausal. And if there is anything good about menopause, it is the fact that when the ovaries stop working, they also stop releasing eggs, so menopausal women cannot get pregnant... at least not with their own eggs, though they can carry a pregnancy as a surrogate!
Pre-menopause or peri-menopause is the time BEFORE the menopause when the ovaries are "sputtering" & thus not producing their hormones appropriately. This means that the lady's estrogen, progesterone, & testosterone levels are variable due to the failing health of the ovaries. It is like being on a rollercoaster ride due to the fluctuating hormone levels, & unforunately it can last for 1-5 years! It is during this time that women are most symptomatic with hot flashes, mood swings, & poor sleep. Thin women suffer the most, whereas heavier women are less symptomatic. This is due to the fact that fat cells produce some estrogen... so if you have fat, those cells continue to produce estrogen so you are not entirely without estrogen when your ovaries stop working. It is interesting to note that this is why heavy men have breasts... their fat cells produce estrogen which stimulates breast development!
As the peri-menopause can cause both physical & psychological problems, many women chose to treat this syndrome with birth control pills. These pills basically give the body estrogen & progesterone, which in turn shuts the ovaries off. In doing this, the ovaries do not release an egg, so one cannot get pregnant. Additionally, the rollercoaster ride stops as the hormone levels are predictable & smooth. As you get older, the doctor will change the birth control pills to menopausal hormone replacement, & over time the doses will be decreased. Not everyone wants or needs treatment, but birth control pills are generally considered safe if used at low doses & if used in women who are non-smokers, have no history of blood clots (pulmonary embolus or deep vein thrombosis), & have no history of stroke. If you have miserable peri-menopausal symptoms (or if those around you think you do!) talk with your doctor about options to lessen those symptoms as you really don't have to suffer through it!
BIRTH CONTROL PILLS FOR YOUNG WOMEN WITH PAINFUL PERIODS:
We received a note from a father whose 15 year old daughter was placed on birth control pills due to painful periods. It is not uncommon for young women to have painful & irregular periods for several years, as the ovaries are young & trying to figure out how to do their job properly! This can lead to the young lady having unpredictable periods which can lead to embarassing accidents. Sometimes there is so much discomfort that she will miss school or other functions. As noted above, there is no reason to suffer with period problems when the young lady can take birth control pills which effectively shut the ovaries off & provide predictable, hopefully less painful periods. With proper timing, we can even make the periods begin on weekends so there is less effect on school attendance.
Of course, a parent might fear that this looks as if they've granted permission to their daughter to go out & have sex. Certainly this is not the case, but if you think it, she might think it... so use this as an opportunity to speak with her about sex. And realize that pregnancy is not the worst thing that she can get from sexual activity! Sexually-transmitted diseases such as HIV, Hepatitis B or C, & even HPV (Human Papilloma Virus) are worse than pregnancy as they can be deadly! Even Chlamydia can be a life-altering disease as it can lead to internal scarring which can make her unable to conceive in the future!
So parents, if your daughter suffers with her periods, do not fear putting her on birth control pills, but do seize the opportunity to educate her about sex & reiterate the need for SAFE SEX practices despite her being on birth control! So enlighten her regarding the absolute need for using condoms, & consider getting the Gardasil vaccine series to protect her from HPV (which is the cause of cervical cancer).
FOOT & ANKLE PAIN WITH RUNNING:
One person complained about foot & ankle pain when he runs, as well as afterwards. He wants to keep running as he knows this is great for his cardiovascular system. He has tried orthotics, but has never seen a Podiatrist.
Certainly, running is great for the heart, but if your feet hurt a lot after running, I suggest you should see the Podiatrist so you can run without hurting yourself. The Podiatrist specializes in feet & ankles, & I recommend a Podiatrist instead of an Orthopediast for this reason. The podiatrist can x-ray your feet to look for problems such as arthritis or fractures. This is best done with you standing up on the foot. Note that most x-ray offices do not do foot x-rays in a standing position, but most Podiatrists will do standing x-rays in their offices! The Podiatrist can also look for bunions & flat-footedness, as well as ankle sprains. He might recommend & fit you for orthodics which should align & support your foot so it functions properly & is less prone to pain or injury. If you have orthodics, realize that they do get old & also that your foot does change over time, so they might not fit properly after a while. Be sure to bring them with you to the Podiatry appointment so they too can be checked! And realize that all orthotics are not created equal. If they were purchased over-the-counter or fitted in a shoe store, they might not be as effective as a custom-fitted pair from the Podiatrist.
If you want to delay spending the money on the Podiatrist, you might try running on a soft surface, as concrete & asphalt are hard on the feet & legs. I suggest that you find a running track at a high school or college as these are rubberized & thus absorb some of the pounding. If these are not available, try running in the grass, just to the side of the sidewalk... but watch for holes & sprinkler heads which can trip you or cause ankle sprains! If you live near a park or forest, find a running trail there... & enjoy some nature during your run!
As always, thanks for reading my blog! If you find it interesting or helpful, please share it with your friends & family! And don't forget, you can listen to Let's Talk Medical with Doctor Gigi on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1PM Eastern, or via computer at www.SkipShow.com (live or podcasts). Be a part of the show by calling me at: (727)-441-3000 or toll-free at: (866)-TAN-1340.
Until next week, here's to our health!
Doctor Gigi
GASTROPARESIS:
Gastroparesis is a slowness of the stomach to digest food, or what I often call a partial paralysis of the stomach. It results in food staying in the stomach for a long time after you eat it. This results in nausea, a sense of fullness which lasts a long time, & sometimes belching (which might be reminiscent of food you ate HOURS ago). The symptoms are sometimes confused with ulcer problems, but they don't get better with typical ulcer medicines. It is most often seen in people with diabetes, but can be associated with many medications, especially medications known as "anti-cholinergic" medications. These are meds that block the neurotransmitter acetylcholine in nerves, & they are commonly used for many different disease processes. They often cause dry mouth & drowsiness. The following is a list of some anti-cholinergic meds:
Anti-histamines = Benadryl, Atarax
Anti-depressants = Elavil, Pamelor, Paxil
Anti-nausea meds = Phenergan, Compazine
Anti-psychotics = Clozaril, Zyprexa, Mellaril
Vertigo meds = Antivert, Scopolamine
Heart meds = Lasix, Digoxin, Procardia
Stomach meds = Bentyl, Lomotil, Levsin, Librium, Tagamet, Zantac
Muscle Relaxants = Flexeril, Norflex
Urinary meds = Ditropan, Detrol, Sanctura
If you have symptoms of gastroparesis, it can be confirmed with a gastric emptying study or perhaps an upper GI series with small bowel follow-through. If you have diabetes, you should aim for good diabetic control, but you will likely need medication such as Reglan or Domperidone. Reglan is an old drug which is cheap, but it has odd side-effects, the strangest of which is a tightening of the neck muscles which causes a person to feel as though his head is stuck turned to the right or left. Of course this is frightening, but resolves when the drug is discontinued. I would suggest trying the Reglan, but start with a low dose & increase according to your tolerance of the med & how well it works for your symptoms. Some people get by with Reglan 10mg with the largest meal of the day, whereas some need the highest dose which is 10mg with each meal & at bedtime. If you are on medications which might be causing the gastroparesis, you should ask your doctor to change them to something else if at all possible.
PRE-MENOPAUSE:
Menopause is an absence of ovarian function, so this occurs when the ovaries are removed during surgery (surgical menopause)or when the ovaries get old & "die" which usually occurs between the ages of 48-52. If you have a natural menopause, meaning that the ovaries die, this will be evidenced by the fact that you will go one year without a period. Before you stop having periods, you get irregular periods. Early on they get closer together... every 2-3 weeks... whereas later they get further apart... every 2-4 months. Once you go one year without a period, we call you "menopausal," & once you are menopausal, you are always menopausal. And if there is anything good about menopause, it is the fact that when the ovaries stop working, they also stop releasing eggs, so menopausal women cannot get pregnant... at least not with their own eggs, though they can carry a pregnancy as a surrogate!
Pre-menopause or peri-menopause is the time BEFORE the menopause when the ovaries are "sputtering" & thus not producing their hormones appropriately. This means that the lady's estrogen, progesterone, & testosterone levels are variable due to the failing health of the ovaries. It is like being on a rollercoaster ride due to the fluctuating hormone levels, & unforunately it can last for 1-5 years! It is during this time that women are most symptomatic with hot flashes, mood swings, & poor sleep. Thin women suffer the most, whereas heavier women are less symptomatic. This is due to the fact that fat cells produce some estrogen... so if you have fat, those cells continue to produce estrogen so you are not entirely without estrogen when your ovaries stop working. It is interesting to note that this is why heavy men have breasts... their fat cells produce estrogen which stimulates breast development!
As the peri-menopause can cause both physical & psychological problems, many women chose to treat this syndrome with birth control pills. These pills basically give the body estrogen & progesterone, which in turn shuts the ovaries off. In doing this, the ovaries do not release an egg, so one cannot get pregnant. Additionally, the rollercoaster ride stops as the hormone levels are predictable & smooth. As you get older, the doctor will change the birth control pills to menopausal hormone replacement, & over time the doses will be decreased. Not everyone wants or needs treatment, but birth control pills are generally considered safe if used at low doses & if used in women who are non-smokers, have no history of blood clots (pulmonary embolus or deep vein thrombosis), & have no history of stroke. If you have miserable peri-menopausal symptoms (or if those around you think you do!) talk with your doctor about options to lessen those symptoms as you really don't have to suffer through it!
BIRTH CONTROL PILLS FOR YOUNG WOMEN WITH PAINFUL PERIODS:
We received a note from a father whose 15 year old daughter was placed on birth control pills due to painful periods. It is not uncommon for young women to have painful & irregular periods for several years, as the ovaries are young & trying to figure out how to do their job properly! This can lead to the young lady having unpredictable periods which can lead to embarassing accidents. Sometimes there is so much discomfort that she will miss school or other functions. As noted above, there is no reason to suffer with period problems when the young lady can take birth control pills which effectively shut the ovaries off & provide predictable, hopefully less painful periods. With proper timing, we can even make the periods begin on weekends so there is less effect on school attendance.
Of course, a parent might fear that this looks as if they've granted permission to their daughter to go out & have sex. Certainly this is not the case, but if you think it, she might think it... so use this as an opportunity to speak with her about sex. And realize that pregnancy is not the worst thing that she can get from sexual activity! Sexually-transmitted diseases such as HIV, Hepatitis B or C, & even HPV (Human Papilloma Virus) are worse than pregnancy as they can be deadly! Even Chlamydia can be a life-altering disease as it can lead to internal scarring which can make her unable to conceive in the future!
So parents, if your daughter suffers with her periods, do not fear putting her on birth control pills, but do seize the opportunity to educate her about sex & reiterate the need for SAFE SEX practices despite her being on birth control! So enlighten her regarding the absolute need for using condoms, & consider getting the Gardasil vaccine series to protect her from HPV (which is the cause of cervical cancer).
FOOT & ANKLE PAIN WITH RUNNING:
One person complained about foot & ankle pain when he runs, as well as afterwards. He wants to keep running as he knows this is great for his cardiovascular system. He has tried orthotics, but has never seen a Podiatrist.
Certainly, running is great for the heart, but if your feet hurt a lot after running, I suggest you should see the Podiatrist so you can run without hurting yourself. The Podiatrist specializes in feet & ankles, & I recommend a Podiatrist instead of an Orthopediast for this reason. The podiatrist can x-ray your feet to look for problems such as arthritis or fractures. This is best done with you standing up on the foot. Note that most x-ray offices do not do foot x-rays in a standing position, but most Podiatrists will do standing x-rays in their offices! The Podiatrist can also look for bunions & flat-footedness, as well as ankle sprains. He might recommend & fit you for orthodics which should align & support your foot so it functions properly & is less prone to pain or injury. If you have orthodics, realize that they do get old & also that your foot does change over time, so they might not fit properly after a while. Be sure to bring them with you to the Podiatry appointment so they too can be checked! And realize that all orthotics are not created equal. If they were purchased over-the-counter or fitted in a shoe store, they might not be as effective as a custom-fitted pair from the Podiatrist.
If you want to delay spending the money on the Podiatrist, you might try running on a soft surface, as concrete & asphalt are hard on the feet & legs. I suggest that you find a running track at a high school or college as these are rubberized & thus absorb some of the pounding. If these are not available, try running in the grass, just to the side of the sidewalk... but watch for holes & sprinkler heads which can trip you or cause ankle sprains! If you live near a park or forest, find a running trail there... & enjoy some nature during your run!
As always, thanks for reading my blog! If you find it interesting or helpful, please share it with your friends & family! And don't forget, you can listen to Let's Talk Medical with Doctor Gigi on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1PM Eastern, or via computer at www.SkipShow.com (live or podcasts). Be a part of the show by calling me at: (727)-441-3000 or toll-free at: (866)-TAN-1340.
Until next week, here's to our health!
Doctor Gigi