Umbilical hernia after pregnancy

After I had my first baby, I developed a small umbilical hernia. Eight months later it is still present. Do I need surgery?

Umbilical hernias in adults usually require surgery. These hernias are common after pregnancy and usually resolve after delivery, but if they persist surgery is recommended. Umbilical hernias are notorious for trapping bowel and causing a surgical emergency. I would highly recommend surgery. The surgery is not difficult at all. If the hernia is small, just go with an open procedure. Some surgeons recommend a laparoscopic approach, but this is only because they can make a lot more money. Laparoscopic procedure is ideal if you have a large or a recurrent hernia. The open procedure usually takes an hour. If the hernia is large, some surgeons use a mesh or a net-like cloth to prevent tension and recurrence. Mind you surgery on the umbilicus is painful and you may need prescription strength pills for a few days

Surgery for Achilles tendon tear

I recently injured my left ankle and was found to have a partial tear in my Achilles tendon. The surgeon recommends surgery to repair the tendon. What do you suggest?

The Achilles tendon is very strong but sometimes in athletes or after a traumatic injury it can rupture. This tendon is easy to repair surgically, but the results are not great. Orthopedic surgeons always rush patients with partial Achilles tendon tear to surgery, but now evidence indicates that non-surgical methods may be as effective as surgery. In addition, non-surgical method are cheaper and generally free of complications. Unless it is life threatening or you are a professional athlete, I do not recommend any procedure by orthopedic surgeons. Most have poor surgical skills and are notorious for performing unnecessary surgical procedures. The surgery for Achilles tendon repair will easily costs you several thousand dollars. The non-surgical method will cost you less than $100 but it may take a little longer for the healing process. The choice then is simple- surgery which is expensive with f..kups or no surgery and you go on holiday instead of the surgeon!!!!

Is there a treatment for spitting?

I have a terrible habit of spitting. Is there something I can do to stop this habit?
Yes, go on a one way trip to the moon and you can spit all you want. No one will see you and no one will hassle you. On this planet, spitting is a very common distasteful habit. It is an obnoxious behavior and there is no magical drug to cure the habit. You need to undergo some type of behavior therapy-. I am not much of a fan of chitchat B.S psychotherapy so I can’t advise you on that topic. Just stop spitting and this will cost you nothing; going to professionals is going to cost you a lot of money with no guarantee that these treatments work. Just be aware of what you are doing and resist the urge to spit. In time, you will stop spitting. Some people do benefit from short term use of the latest SSRIs. People who spit also tend to have terrible personalities and for that-there is no cure. People notorious for spitting are indians and chinese.

Suglat for my diabetes

Is the new drug ipragliflozin (suglat) effective for type 2 diabetes?

Suglat is a very new drug approved for the treatment of type 2 diabetes. It is taken once a day and acts by blocking absorption of sugar from the kidneys, which leads to more excretion of blood sugars. The clinical trials showed that it did many wonderful things. Not only did it lower blood sugars but it also reduced body weight. The drug can be used safely even in the presence of mild renal dysfunction. However, I should mention that many of the investigators who conducted the trials on this drug worked for the drug company- and so there is always a conflict of interest. Data can be fudged and adverse reactions may not be reported. 

Do you think any doctor who is paid many thousands of dollars by the pharmaceutical company is ever going to say anything bad about the company's product? Plus, you can bet your life the drug is prohibitively expensive. I highly recommend not taking this drug. 

If you have type 2 diabetes, the first drug of choice should always be metformin or Glucophage. There is no better drug than Glucophage; not only is it cheap, it has minimal adverse reactions and induces weight loss. It has been around for over 70 years and works. If your doctor does not prescribe you metformin, then he or she does not give a crap about your welfare. Only seek treatment from a doctor who is willing to give you metformin. Many new diabetic drugs have been discovered in the past decade and all of them are only mildly effective for diabetes but they all are very expensive.

orthotic shoes and plantar fasciitis

Should i buy orthotic shoes for my plantar fasciitis?
There is ZERO evidence that shoes sold by podiatrists resolve plantar fasciitis any faster. The only thing extra you may need is shoe cushioning; such shoes inserts can be bought from any shoe store. Everything you buy from the podiatrist’s office is a rip off and intended to scam you and/or the insurance company. The pain of plantar fasciitis often takes a few weeks to subside. If your pain is still persistent, a shot of corticosteroids may help. Remember, corticosteroid injections cost hundreds of dollars and only work in a few people- on the other hand, doing nothing is free and will also resolve the condition within a few weeks.
Over the years, many more treatments for plantar fasciitis have been developed but all are simply designed to scam patients off their hard earned money. Shock wave therapy, ultrasound, acupuncture, and other procedures should be considered bogus therapies for plantar fasciitis and you should keep away from people who offer such treatments, unless you have money to waste.

I am on furosemide and each month my potassium is low. Is there any other pill I can take instead?

Drugs like furosemide and thiazides can lower your potassium. Therefore, if you have low potassium, you may ask your doctor to switch you to the potassium sparing diuretic- like spironolactone.  However, you will still need to get your blood work checked regularly because spironolactone can increase body potassium- which can be dangerous. If you have good follow up, spironolactone is an excellent drug and also protects the heart.

Is there a generic version of Flovent?

Flovent is a steroidal inhaler used to treat both asthma and a variety of other allergic disorders. Unfortunately, there is no generic yet. However, there is budesonide, which is the generic version of Pulmicort. It also works in the same way and is a lot cheaper. Speak to your doctor about it.

Is the generic version of Zoloft just as effective for depression?

Yes, you can rest assured it is just as effective. The FDA ensures that generic brands have the same therapeutic effect as the brand name drug. Only the inactive ingredients are different. I would only recommend generics available in America. 

Outside of North America, there is little control on how generic drugs are produced. Some Oriental pharmaceutical companies have a habit of cutting corners to make profit. Therefore, that means do not buy a generic product if you travel to the Orient. Indian and China are two places where there are more fake drugs than the real thing.

Is It true that Zoloft has been associated with breast cancer?

No, to date there are no data to suggest that Zoloft can cause any type of cancer. It is a relatively safe medication.

Can Zoloft cause weight gain?

Yes, all antidepressants cause weight gain. The amount of weight gain varies. The only way to avoid the weight gain with Zoloft is to eat less and walk more. It is the rare individual that does not gain weight on Zoloft. Almost every antidepressant can cause weight gain.

I have a long history of motion sickness. I have been planning a cruise and am wondering if you can recommend something.

There are several things you can do to decrease your risk of developing motion sickness. Avoid smoking and do not eat greasy or spicy foods. Do not over indulge with any type of food.

As far as medications are concerned, you may want to try an over the counter antihistamine. Unfortunately, these medications can cause sedation and ruin you trip. The best medication is scopolamine, which is available and can last for 3 days. You can place it behind your ear and you need to start using it a few hours before the trip. 

Scopolamine is not recommended if you have asthma or have problems with urine retention

Are there any foods that I should avoid when I take Coumadin?

When you take Coumadin, you should avoid certain foods like cauliflower, broccoli, cabbage and spinach. If you are trying to lose weight, check with your doctor first because drastic changes in weight can lead to Coumadin toxicity. Limit the amount of cranberry juice in your diet as it may affect how Coumadin works. If you miss a dose of Coumadin, never double the dose the next time as it may lead to excessive bleeding. It is important that you tell your surgeon or dentist that you are taking Coumadin prior to any surgical procedure. One should also avoid getting injections into the arms or buttocks while taking Coumadin.

What are side effects of Coumadin that I should worry about?

Side effects of Coumadin include nausea, loss of appetite, or mild abdominal cramps. These side effects do not occur in everyone and are well tolerated. Other side effects are more serious and include severe bleeding and easy bruising. If your blood thinning count is too high, you can bleed with even minor trauma. If you see blood in you stools, urine or cough up blood, you must stop the medication and see the doctor. Other side effects of Coumadin include frequent nosebleeds, prolonged bleeding from minor cuts, prolonged menstrual bleeding and black tarry stools. To ensure that these side effects do not occur it is vital that you go and get your blood thinning levels measured regularly.

I have been started on Coumadin for blood clots. I have read the medication can cause many problems. what is the safest way to take it?

When you buy Coumadin, your doctor/pharmacist will tell you exactly how to take the medication. Coumadin can be taken by mouth with a glass of water. It can even be taken with or without food. Coumadin is only supposed to be taken once a day. Never increase the dose or duration of Coumadin without first speaking to your doctor. Do not stop the drug unless you have been told to do so by your doctor. The dose of Coumadin is based on your medical condition and response. All individuals who take Coumadin have to get regular blood work to ensure that the blood thinning levels are right for you.

I have been told that I have a blood clot in my leg and have been given warfarin. How long should I remain on this medicine?

If you have blood clots in your legs, you need to be on a blood thinner –which is warfarin. It is sold as Coumadin and is an excellent drug for people with blood clots. If blood clots are not treated, they may break off and fly off to the lung. In most cases of a first time blood clot in the leg, you need to take the medication for at least 6 -9 months.

My doctor told me that I have C. difficle colitis from over use of an antibiotic. How can I treat this?

C difficile colitis is a nasty illness that commonly occurs after prolonged use of antibiotics. Your doctor will most likely start you on metronidazole or vancomycin. These drugs need to be taken by mouth and within 48 hours you will start to feel better. In the mean time drink ample water, stop use of all other antibiotics and do not take anything like Imodium. Wash hands frequently as this darn infection can easily be passed on to everyone in the family.

I am chronically constipated and have tried all sorts of laxatives, what should I do next?

Well, the one major problem with people who use laxatives all the time is that they will no longer work in future. Chronic constipation is a major problem in the population and I assume you have changed your diet, are drinking ample water and eating fiber. If you have done this, it is time to see a decent colon doctor. There are not many good solutions left for you, but surgery is one of them. Surgery for chronic constipation does work but you should think  about it as it has its own complications. Moreover, surgery is the last resort. Asides from drugs and changes in diet, there are not many more options.

Can Bystolic cause back pain?

Bystolic is a relatively new drug for control of blood pressure. The manufacturers of this drug appear to have been heavily promoting this drug but there is no evidence that it is any better than other older similar drugs. Recently the FDA had to send a cease and desist letter to the company for making unsubstantiated claims. There is also worry that the drug has many side effects. However, back pain is not one of them. The drug is known to cause headaches, dizziness and abnormal sensations in the arms and legs. 

Do not stop the drug but see your doctor first. Perhaps you should get a change in prescription for a more affordable and effective drug. In addition, let the doctor determine the cause of your back pain.