Vagus nerve stimulation for depression

Recently my doctor recommended a vagus nerve stimulation procedure to reverse depression. Does this work? Part 2

While the procedure is easy to perform, it does have side effects that range from neck pain, infection, damage to the vague nerve, difficulty breathing, nausea and slowing of heart rate. In rare cases, one may develop vocal cord paralysis, voice changes, persistent cough and throat pain. While most side effects are tolerable, many people find the side effects annoying in the long run. However, of more concern is that in a few cases, vagal nerve stimulation may also lead to worsening of depression, suicidal thoughts and anxiety.

The surgery for implantation of the device is done as an outpatient and done under local anesthesia. After implantation, the device is programmed to deliver electrical impulses at various frequencies. Most people are started at low electrical current, which is gradually increased to get the desired result. Each stimulation lasts 30 seconds and occurs every 5 minutes. During this period, the side effects are most common. All individuals are given a small hand-held magnet to control the device. The machine has to be turned off while eating or speaking.

The results of vagus nerve stimulation are not immediate and often take months before the desired electrical impulse is obtained. As soon as the stimulation stopped, the depressive symptoms return. The decision to undergo vagal nerve stimulation is difficult. The procedure is very costly and there is no guarantee it will work. So before you decide to get the procedure, speak to people who have had it done. Remember even after vagal stimulation, you may still need to take anti depressant medications and continue with psychotherapy.

Itchy nipples

I am 25 year old and have developed very itchy nipples. Can I apply something on them?

In young people, itchy nipples are nothing to worry about. The itching may be due to tight clothes or your nipple rubbing against your bra or under shirt. This can happen if you exercise without a bra. However, chronic itching can also be a sign of eczema. If the itching is bothersome, obtain hydrocortisone cream over the counter and apply it 3-4 times day. If this problem persists after application of hydrocortisone, it is wise to see your doctor. Another common cause of itching around the nipples is a fungal infection, which can also be easily treated with an anti fungal cream. If the itch is limited only to your nipples, perhaps a change of fabric or bra may be warranted

Erect nipples

Can you tell me why my nipples are erect all the time?

In most cases, nipple erection is associated with sexual arousal but in some women, nipples may remain erect without any sexual stimulation. Why this happens is not well known. Sometimes, nipples can be erect when they are excessively irritated like when you start to pluck hairs or wear tight clothing. Some women love to show of their erect nipples but for those who are shy, then there are a variety of padded bras which can be worn. If you constantly plucking your hair around the nipples, stop the habit and see what happens. If it is the clothes that cause erection of your nipples, start to wear a bra, change the fabric or wear loose clothing. In any case, erect nipples are treated conservatively and there is ZERO need for surgery- unless you love pain and have money to waste.

Stage 4 colon cancer and surgery

 My mother is 77 and very ill. She is barely able to walk and has been a heavy smoker all her life. Recently she was diagnosed with colon cancer that has spread to the liver. Her surgeon recommends surgery. I am not sure what to do.

The first thing is you need to get is a second opinion. Any surgeon who wants to operate on stage 4-colon cancer sick frail patient has very little clinical judgment. Colon cancer surgery in older age groups has its benefits but surgery is also of high risk. The general rule of surgery is that patients who are deemed to be at high risk for surgery need surgical clearance from other specialists. Finally, surgery for stage 4-colon cancer is never done as life expectancy is very poor and there is no chance of cure. Removing a mass from the liver is no piece of cake. With the quality of some surgeons we have, death is a high probability.

The best advice is to seek another medical opinion and still not undergo surgery – as surgery will not benefit your mother. Please dump this stupid doctor-there is something known as palliative care and this is what your mother needs.

PIP Breast Implants

Women who live in Europe, South and Central America continue to get confusing messages from their respective governments about their breast implants. The implants made by Poly Implant Prosthesis (PIP) were manufactured by a French medical company, which is now non-operational. The company made poor quality, cheap grade implants of silicone, but luckily, these implants never made it in the US.

In France alone, data indicate that at least 30,000 French patients (mostly women) will need to have the implants taken out and the government will pay for the cost of removal.

However, response from other governments is not consistent. In other European and South American countries, some women have been advised to have the implants removed but only at their own expense. In other cases, the government has offered to pay for the cost of removal if only the implant shows signs of leakage or is obviously defective. In most Central American countries, patients have simply been told to have their implant checked at their own expense.

In Brazil and Mexico the governments have advised women to have the implants evaluated but have not recommended removal. In Colombia, the government has promised to pay for the removal if there is an indication. In Britain, the National Health Service has advised against routine removal and only those which are found to be defective will be eligible for free removal. In Holland, the government has advised women to have their PIP implant removed. The cost of removal is enormous but for women, it is the disfigurement and emotional torment that also has caries a heavy burden.

Latest estimates indicate that PIP sold close to 400,000 implants worldwide before going out of business several years ago. For those American patients who had PIP breast implants done abroad because the price was cheap, they should be aware that they are at great risk and should see a plastic surgeon.

In the last few years, complaints about these implants had been rising and include breast pain, inflammation, irritation and asymmetry of the breast. Many other implants had leaked or burst because of the inferior grade silicone. Several patients have also died of cancer in France.

Recently the FDA indicated that a type of lymphoma was a cause of death in some of these women with silicone breast implants. Fortunately, the number of cancers has been very few and no definite link has yet been established to the silicone.

For women, breast implants can improve their body image, personality and enhance their sex life.  However, consumers have to know that every prosthesis, like an implant, only lasts for 10-15 years. There is no implant that lasts a lifetime. At some point in time, the implant has to be removed because like any mechanical item, the wear and tear will cause deterioration.

Therefore, while plastic surgery is a great way to enhance self-esteem and confidence, it also carries some unknown risk, especially when cheap quality materials are used. This alone should be one reason not to seek any type of healthcare abroad. Outside of North America, cutting corners in healthcare to make money is the name of the game. Trust me-i have worked in over 27 countries.

Vitamins for glaucoma

I have had glaucoma for years. I just saw an ad for eye vitamins. Can these vitamins improve my vision or protect me from further vision loss?

No, that is all BS. These vitamin ads are bogus. There is no vitamin that can reverse or cure glaucoma. We have a health supplement industry that is unregulated and continues to make unsubstantiated claims. The sad part is that it is supported by unscrupulous healthcare workers who are simply interested in scamming desperate patients. 

Unfortunately, we also have a lot of gullible, stupid and/or desperate people who believe this type of crap. If you have glaucoma, go and see a bona fide eye doctor.  If you muck around with glaucoma at home with this vitamin BS, you will end up blind.

New onset Asthma in middle age

Can I develop asthma at the age of 67? I have never smoked and worked in an office all my life. I only have high blood pressure, which is well controlled. On a recent visit to my doctor, he told me I had developed asthma because of the chronic cough that I have had.

The majority of asthma cases are diagnosed in childhood or in the early teenager years. When one develops new onset asthma and a cough, this is a cause for concern. It is unlikely that one can have asthma out of the blue in the later years of life if the past medical history has been uneventful. Moreover, if you do not smoke or have no chemical related work history, then you definitely need more work up. The first thing to do is ask your doctor to get a chest x-ray and a referral to a lung specialist. Asthma may be related to the heart but this can easily be ruled out by obtaining an x-ray. If your doctor does not intend to work you up more thoroughly, you need a new doctor. At your age, something more ominous should always be ruled out first.

Generic statin

Can I take generic statin?

All statins currently available work in the same way. These medications inhibit a certain enzyme in the body, which prevents cholesterol build up in the body. However, the major difference between the statins is not their effectiveness but cost. Stains are expensive medications. The most expensive are rosuvastatin and atorvastatin. Individuals who have been prescribed these expensive medications should speak to their doctor about the generic statins. At the moment, mevacor, pravachol and zocor are available in generic form and for 1/3^rd the price. 

Many insurance companies may require that you try a generic statin before they will pay for a brand name statin. Some insurance cover all types of statins, after you pay a certain deductible. Statins bring a lot of money to the pharmaceutical industry, and usually doctors have little idea what generic brands are available.   

Remember statins have to be taken for life and can cost a fortune. If you really want to lower your cholesterol cheaply, then eat right and walk regularly. There is absolute no reason why generic statin will not work as effectively as the expensive brands. So, do not believe the hype that the more expensive statins are better than the cheaper brands. I personally believe that these medications are a rip off and instead recommend life style changes for my patients.

Chemotherapeutic drugs and numbness

Why do I have numbness, tingling and painful sensations in my leg after undergoing chemotherapy

Unfortunately, some chemotherapeutic drugs can affect nerves and induce peripheral neuropathy. Common chemotherapeutic drugs that have been linked to neuropathy include vincristine, docetaxel, cisplatin and paclitaxel. In general, these drugs affect the nerves in the hands and feet. Some patients may complain of pain or paresthesias in the fingertips. In rare cases, there may be muscle weakness of the finger, toe of foot.

In most people, the numbness or tingling pain sensation is not severe and does not affect daily living activities. However, if the symptoms are severe, your doctor may decide to discontinue the medications.

Most cases of peripheral neuropathy, which occur with chemotherapeutic drugs generally, improve once the medication has been stopped. This recovery may take anywhere from a few months to a few years. Unfortunately in some people with severe neuropathy, the symptoms may not completely recover

If you continue to have neuropathy symptoms, speak to your doctor. The decision to continue your medications will be made on the severity of the symptoms and the impairment that you have.

Bed wetting and DDAVP

I am a 28-year-old female and often wet my bed at night. Is there anything I can take to correct this problem? Is DDAVP effective?

I think what you have is nocturnal enuresis. It is not a rare problem by any means but because people do not brag about it, the exact incidence is not known. In any case, you have several options when it comes to medications. You may want to ask your doctor for DDAVP, which is available as an inhaler. In some people, it does reduce nighttime urine production. However, it does not work in everyone and it is also an expensive medication. I would say try it for a week and see what happens, if it fails to work in 7-14 days, it is unlikely to work at all. DDAVP seems to work much better in children compared to adults. You should know that as soon as the medication is stopped, the enuresis will return. Good luck.

Lost condom in the butt

 I recently had anal sex with my boyfriend and it appears that the condom came loose and is lost in my rectum. Should I do something?

No, I would not worry at all. In most cases, the condom will just pass out with the feces. It is very unlikely that it will remain in your rectum. During my younger days as a surgeon, we used condoms as tubes when doing colonic surgery. The condoms were stitched on the inside of the bowel so that the fecal material would not come into contact with the bowel lumen, giving the sutures time to heal. After 5-8 days, the condoms then spontaneously fell out. There were never any problems. However, I should warn you- losing a condom in the butt is one thing, but if you were to loose a sex toy or a dildo, that will require removal either with a scope or surgery.

Incomplete colonoscopy

I has just underwent a colonoscopy and the doctor tell me it was incomplete and now recommends a barium enema

Polyps can occur anywhere in the colon but are most common in the left or sigmoid colon. Some polyps tend to grow and eventually turn cancerous. Thus, colonoscopy is a useful tool to screen for polyps and remove them if possible. However, all consumers should understand that in nearly 30% of patients, colonoscopy cannot assess the whole colon. The reason for this failure may be technical (incompetent doctor) or poor bowel preparation. When the doctor is unable to visualize the entire colon, the options are to repeat the colonoscopy or undergo a barium enema. Barium enema is an imaging study whereby contrast is inserted into the rectum and picture of the colon are obtained. Barium enema unlike colonoscopy does not always visualize polyps less than 5 mm. Moreover, during a barium enema one cannot even do a biopsy or remove the polyp. Therefore, if your colonoscopy is unsuccessful, you should discuss the topic with your doctor and find out why it was unsuccessful and perhaps be referred to another doctor who is more proficient at the technique

Arm Acne

I have severe acne on my upper arms. What is the best way to treat it?

Upper arm acne is just as common as acne on the face. Many people have upper arm acne but often do not notice it. The only difference between arm and facial acne, is that the former is usually concealed with garments. Arm acne is common in young people and tends to be slightly more common in men than women.

The treatment of arm acne is the same as for facial acne. There are non prescription and prescription medications that can be used to treat arm acne. The best advice is to first try an over the counter product. If that fails you can see a doctor for a prescription medication.  Unfortunately over the counter products like salicylic acid, clindamycin or benzyl peroxide suck.

In addition, you need to know that arm acne is often made worse by excess sweating, tight clothing and wearing damp sweaty clothes (eg after exercise) 

The first object should be to maintain good skin hygiene. Shower regularly, wear loose cotton garments and change clothes if they are damp after exercise. When showering do not scrub the acne lesions- Scrubbing is not a treatment of acne and can cause scarring. If you have long hair that falls on your arms, trim your hair.

There are 100s of herbs, lotions, potions, solutions, creams, ointments, enemas, solutions, etc etc for acne- the only thing they have in common is none of them work-so avoid wasting your money on BS products. If you have acne, go and see a decent skin doctor. Avoid GPs because they know very little about the skin and will probably prescribe an antibiotic without even examining you.

The good thing about arm acne is that unlike the face, it can be concealed by clothing.

Renova for Acne

Recently my doctor gave me a prescription of Refissa (Renova) for my acne. Is this a good medication?

If you look at all my posts, I provide honest opinions without any bias. I do not work for any drug company, i do not own any shares in any pharmaceutical products and i never associate myself with pharmaceutical reps. I provide information for patients which is useful, practical and honest.

Renova is a great medication for mild to moderate acne. Refissa (Tretinoin emollient) also known as Renova is used for the treatment of severe acne. The drug is also known as accutane, claravis and amnesteem. Refissa is usually prescribed when other treatments have failed.

Refissa belongs to a class of drugs known as retinoids. The drug works by decreasing skin oil production and increasing the peeling action. This leads to thinning action of skin and resolving of acne. If acne is untreated, it can lead to scar formation. The drug is also used to erase fine line and wrinkles.

Trust me, you will not be disappointed. However, it is relatively expensive. Most general practitioners do not prescribe this drug because they are clueless about skin disorders. You need to speak to a skin doctor, but it is worth the money.

Refissa for acne

I am a 23-year-old female and have terrible acne, but my doctor will not prescribe me Refissa. Why?

Refissa is known to cause damage to the fetus and all women of childbearing age should not take this drug. One has to sign a consent before approval can be given to use of Tretin in young women. Once you take Refissa, you should not get pregnant at least one year after stopping the drug. Most doctors are afraid to prescribe this medication to women, because if anything happens during the pregnancy, the doctor is most likely going to be sued. Instead of the pill, you may want to try the topical ointment. However. it also comes with similar restrictions.

Birth defects and pregnancy

Are birth defects common? This is my first pregnancy and I am worried? 

Birth defects continue to occur despite good prenatal care. It is estimated that one in every 33 infants born in North America has some type of birth defect. Birth defects can affect almost any part of the body. Birth defects also vary in severity. Some infants may have a simple cleft lip but others may have serious heart and limb defects. Birth defects of the heart can often be life threatening but most of these can be corrected with surgery within the first year of life. Unfortunately, in other parts of the world the majority of babies born with even the most simplest of heart defects die because of lack of surgeons. If you eat right, do not smoke, do not drink, and do not ingest medications during pregnancy, i would not worry about it. Most things in medicine happen because of bad luck rather than any specific factor.

Neural tube defect

What exactly is a neural tube defect in a baby?

Birth defects can affect the spinal cord. They are also known as neural tube defects or spinal bifida. In simple, there is a hole in the spinal cord and some of the nerves pop out through the skin in the back. These defects vary in severity. Neural tube birth defects affect about 1 in every 1,000 pregnancies. The mildest form of spinal cord defects are only of cosmetic concern, but other spinal cord defects can be life threatening. Even though spinal cord defects are rare, they account for a high number of newborn deaths. One of the ways to prevent spinal cord birth defects is to make sure that you take folic acid supplements during pregnancy.

Assess my PIP breast implant

How do I know if my PIP breast implant is okay?

The best test to check for leaks from breast implants is an MRI. It will cost you about $1,500 at minimum. I am sure the plastic surgeons are going to jack up the consultation fee and recommend removal- so they can make more money. Then if you still want big boobs, you will have to fork out a minimum of $5,000.

Problem with PIP breast implants

What is the major problem with PIP breast implants?

Well, it looks like this French company cut corners and used low quality, cheap grade silicone. It is believed that there are over 400,000 women with these implants and countless more because many women have no idea what the surgeon did. In the last few years, women with these breast implants have been complaining of severe pain, hardening of the breast, leakage of silicone and breast asymmetry. There are some women who have even died from an unusual cancer, but so far there does not appear to be any link between the silicone and the cancer. I recommend that if you have had a PIP breast implant, first go online and see if there is any sincere surgeon who will have anything to do with issue. Most US surgeons are unwilling to help out unless you pay.

PIP Breast implants

If I had my PIP breast implant in Mexico, who will pay for its removal?

Well, you are in big shit. There is a lot of confusion as to who is going to pay for the removal of PIP breast implants done outside the USA. Each country has made their own policy. If you are an American and went abroad for this breast implant, it looks like you will be forced to pay for the removal. However, no one even knows if all the PIP breast implants needs to be removed. Some countries say only women with symptoms should have their PIP implants removed- others like Venezuela and Holland say all women should have these implants removed. Best advice- speak to a plastic surgeon in America. 

I am 100% sure, you will be out of lots of money at the end of all this. Plastic surgeons in the USA will make up some bogus story that you need the implants out. They will then charge you for removal and if you want new silicone implants, you will have to fork out extra. This is usually what happens when you seek healthcare or surgery outside the country-you get ripped out by both sides.

Is binge eating disorder short lived?

Besides the binge eating, individuals also tend to have depression, anxiety and frequently eat alone. The overwhelming feeling is one of disgust and a vow to lose weight. Unfortunately, any attempt to limit food intake often leads to more eating. Most people have no obvious signs or symptoms of binge eating and this behavior is often first noticed by the family indirectly- due to the lack of food in the home. Most individuals with binge eating syndrome are afraid to go to the doctor for fear of embarrassment. 

Most times, it is the family who encourages the individual to seek help. It is vital to seek help because binge eating can seriously affect the quality of life. Like most things in psychiatry, the cause of binge eating is a mystery. Besides some chemical abnormality in the brain, this eating disorder is felt to occur because of some type of emotional trauma. Other contributing factors to this disorder include living in a society which promotes excessive thinness and bad genes.

How is diagnosis of binge eating disorder made?

In order for someone to be diagnosed with the disorder, certain criteria must be fulfilled and include 1) Eating much more faster than others 2) Eating until one feels extremely uncomfortable 3) Eating large amounts of food even though one does not have hunger 4) Eating alone because of feeling self-conscious by how much one is eating and 5) Feeling sickened with oneself, unhappy, or very guilty afterwards.

People who have binge eating may develop these episodes at least once a week for several months. Unlike bulimia, binge eating is not associated with use of laxatives or self-induced vomiting.

What is Binge eating disorder?

Food eating disorders are very common in our society and one of them is binge eating disorder. In this disorder one frequently consumes an unusually large amount of food. While this may sound innocuous, binge eating disorder is a serious malady. Most of us tend to overeat during the festive season, during a holiday or celebration of an event. But for people with binge eating disorder, the overeating is pathological and is a regular occurrence. Most often, binge eating episodes are done in secrecy. People who tend to binge eat, always feel guilty about the excess food consumption and are too embarrassed to tell anyone about it. 

Despite making promises to stop this type of eating, the behavior is usually out of control. Binge eating disorder is like a strong compulsion that cannot be resisted and thus the cycle continues. Binge eating disorder is more common than anorexia and bulimia but has only recently been classified as a distinct mental health disorder.

How do doctors treat people who have factitious disorder?

The first goal of treatment is stop the person from abusing medical resources. Next, the aim is to ensure safety and protection of any real victims like children. The treatment for the individual resolves round stabilizing the psychosocial issues that are causing the problem. Psychotherapy may help change thinking and behavior. Medications are only used to treat secondary depression or anxiety. 

The prognosis of people with factitious depends on the duration of the illness. For those with short term problems, the prognosis is good but those with long term problem, the prognosis is poor. 

Most people continue their behavior and deny that they are faking symptoms. Some eventually end up with real medical problems which are never taken seriously.  Because the cause of factitious disorder is not known, prevention is not possible.

Why does one develop factitious disorder?

No one knows the origin of factitious disorder but both the environment and genetic factors play a role. There are no reliable statistics on this disorder because most people visit many doctors and are also habitual liars. The diagnosis of factitious disorder is difficult and is only made after exhaustive work up reveals no real medical problem.

How can one know if someone is faking a medical illness?

Warning signs of a factitious disorder include:

- Inconsistent medical history with unclear symptoms

- Dramatic medical tales with predictable relapses

- Extensive medical knowledge and well read on the topic

- Have evidence of many scars

- Continue to complain of symptoms despite negative tests

- Very willing to undergo tests and surgery for minimal indications

- Seeking doctors in different cities and never willing to take family members to meet health professionals or vice versa

Do people who feign medical illness have any other mental health disorder?

Most people with factitious disorder also suffer from other mental disorders and in particular personally disorders. These people often have different thoughts, behavior and clearly stand apart from the norm. They also tend to have labile moods, be impulsive, angry and passive. They also have a lack of ability to cope with problems and most have had very poor interpersonal relationships.

There are a variety of factitious disorders- some may mimic a mental illness and others may mimic a physical disorder like a heart attack. There is also factitious disorder by-proxy where the individual fabricates symptoms of an illness in another person, especially a child.