Staying Alive Q&A

Q. My friend suggested I get Botox injections for my migraines, what do you think?

A. Recent studies abroad have strongly suggested that treatment with Botox can give long-term relief from migraine headaches. The exact mechanism of action is not fully understood but it may be related to the drug’s ability to relax the muscles in the head. The drug appears to modify the course of migraine disease and its progression, even after the series of shots have ended.  Botox has been approved by the U.S. Food and Drug Administration (FDA) to reduce frown lines and to treat certain muscle spasms in the eye, head and neck.  Botox has not been approved to treat migraines, but that may change soon.

Botox injections are a purified form of the botulism toxin that causes food poisoning. Allergan Inc., the manufacturer of Botox, is conducting trials in the United States, which, if successful, will allow for U.S. regulatory approval to use the drug for migraines. Treatment won’t be cheap. It will cost approximately $1,000 for one session of 10-to-35 tiny injections into the head and scalp. And no, the shots won’t help your sagging chin along with your headaches because the injections are directed only at your scalp.  Like any other medication Botox does have side effects which are usually mild, and include pain at the injection site. Symptoms usually last a couple of days. So for now you should seek other cures for your headaches until the drug is further tested and approved.

My Message: Almost all quick fixes are rare and do not last!

Q. My doctor is expensive.  I like her but can’t really afford her fees. Any tips?

A. Negotiate. Ask for a better price! If you find a doctor you respect and who takes good care of you, don’t be driven away without a frank talk. According to a recent Harris Poll, 14% of patients reported asking their doctors for a better price. When money is tight there is little harm in asking. Everyone has a different comfort level in negotiating discounts.  I call it ‘special consideration’.

Q. My physician gives me a break on his fees because I’m a student. He has referred me to a specialist. Can I expect the same discounts from the specialist because of the referral?

A. If your doctor refers you to be examined by a colleague, do not assume this doctor’s fees will be the same. Most often they are not!  I understand that when your doctor says you need to see a specialist you are more concerned about your health than how much the visit is going to cost you.  So before you get a bill that makes you scream “ouch”, be proactive.  What do can you do?  Don’t be shy. When you make the appointment ask about the doctor’s fees.  If the referral appointment is made for you, get the doctor’s phone number. Confirm the appointment and speak frankly to the front office manager about the costs involved and how much insurance will cover. Do not hang up until you are clear on what the visit will cost you. Insurances fees are well established so this should not be brushed off as an unknown. What will happen if we have a universal health plan pass Congress is anyone’s guess!

My Message: Even in healthcare, often ‘you get what you pay for!”

Q. Can I take a vacation when I’m pregnant?

A. Absolutely! You don’t have to put your life on hold until you deliver your baby!  Just follow my suggestions below and double check with your physician to make sure travel is safe for you.  Your doctor knows your exact condition, special needs and any problems that are likely.  First and foremost, carry your health records and your doctor’s phone numbers with you wherever you go. Be flexible and realistic. Listen to your body. Try to plan your trip around when you know you’ll be at your best. Planning a trip during mid-pregnancy (14 to 28 weeks) is probably a safe bet.  Keep in mind that the quickest way is usually the best way to travel when you are pregnant. Save the cross country trip until after the baby is born. Limit yourself to a maximum of five hours a day in the car. And whether you’re in the car, train, bus or plane, get up and walk every hour.  Stretching your legs decreases swelling and reduces the risk of blood clots. And while you’re up, stretch your back as well. Extend your arms upwards and reach for the ceiling.

Flying is safe when you’re pregnant, but keep in mind that most airlines restrict travel for pregnant women to one month before the date the baby is due. Reserve a forward aisle seat for a smoother ride and ask to be near the bathrooms. Or ask for the first row at the wall between cabins so you’ll have extra legroom for stretching and standing. And don’t worry about the metal detectors; they won’t harm your baby.

Remember, good nutrition is especially important for pregnant travelers. Pack your own healthy snacks and drink plenty of water.  And when you sit down for a meal, choose a light nutritious meal that you know is good for you and your baby. Finally, use how you feel as a guide for how much you do.  Pace yourself, don’t overdue the sightseeing. An afternoon siesta is a great way to get reenergized. Have a safe journey!

My Message: Being pregnant means added responsibility

Q. With recent events and fears, along with changing color alerts from the government, how safe are we? I love to travel but I’m afraid.

A. There is a lot of craziness going on in the world today. And you might think staying close to home is best. But the likelihood that you will have a brush with death at home or work is much greater than any real danger from terrorism. Let’s look at the numbers: The risk for an American to develop heart disease is one in 300 and the risk for developing cancer is one in 509.  On the other hand, the chances you will die from a terrorist attack are about one in 9.3 million. That’s about the same as your chances of winning the Powerball jackpot!

My Message: Live your life prudently and to the fullest, many things are beyond your control.

Q. Is there a right way to wear a seat belt when you are pregnant?

A. Great question. When you’re pregnant, you should always wear both the lap and shoulder belts. Wearing both belts properly can avoid broken ribs or injuries to inner organs.  Buckle the lap belt low at your hipbones, below your abdomen. NEVER put the lap belt across your abdomen. Place the shoulder belt across the center of your chest, in the middle of the breasts, making sure the upper part of the belt crosses your shoulder and is not chafing the neck. NEVER put the shoulder belt under your arm.  And before you start the engine, remove all slack, making sure both belts are snug.  Buckle up to protect you and your baby. Remember, serious injuries usually occur when seat belts are not used at all!

My Message: Forget the wrinkled clothes, save your lives!

Q. How can I tell if my neighbor’s daughter has what it takes to babysit my kids?

A. I understand your concern. Handing your children over to a young babysitter is a big decision. You want to make sure she is mature enough to handle any situation. You also want to make sure she is properly trained. So the first thing I’d recommend is for you to find out about babysitting courses in your community. Get the details and be ready to offer assist with this option if you decide the teenager is ready to watch your children.

It’s also important to talk to the parents before you approach the girl about babysitting. Find out if they think she can handle the job and whether or not they would allow it. If they say yes, invite her for a visit. This will give you a chance to observe how she interacts with your children. You know your kids so create likely scenarios and ask how she might handle them.  For instance, say “Jack fell down the other day and scraped his knee. If you were caring for him and this happened what would you do?”  Wait patiently for the answer. It is important, not to fall into the trap of answering your own question.  You need to see if she has the ability to think on her feet.  See if she would allow your child to play with a specific toy, and ask when she thinks it’s okay to play outside.  Talk about basic care, such as feeding and changing dirty diapers. You could also ask her for help when it’s time to feed them. This will give you a good sense as to whether or not she can handle the job. If you think she’s a good match for your children and she wants the job, provide her with information on the babysitting course.

Once hired, continue to discuss and reinforce proper care, especially in regards to medical situations. If administering medication is involved, provide her with simple, easy-to-follow instructions and have her demonstrate until you’re sure she can do it properly.  Share any medical problems, allergies and phobias your children may have.  Please, always leave written instructions, including emergency phone numbers. Make sure she knows how to lock the house and the location of the first aid kit.  Providing your babysitter with the knowledge and tools she needs to take care of your children will give you and her peace of mind when you’re away.

My Message: Best care is when you do not presume any common sense knowledge!

Q. I think it may be time for my dad to stop driving. My sister says I should just take away his keys. I’ve tried but when he says ‘no’ I do not have the heart to insist. After all, he taught me how to drive. I’m agonizing over this, what can I do?

A. This is one of those dilemmas of modern life. Driving is the ultimate measure of our independence. It is hard to trust anyone to self-regulate this activity and to recognize when they no longer feel competent or safe. It is even harder to convince someone that they are placing innocent people at risk if they continue to drive.  There are many medical conditions that develop as we age that can affect our ability to drive. Your dad’s physician may be able to help you. Call and explain your concerns. If the doctor agrees it is time to give up the keys, you could schedule an appointment where you and your father can meet with the doctor to discuss the situation. Together you may be able to convince your father that it would be wise to stop driving.

1. I want to add that older drivers aren’t the only ones who should give up driving because of their medical conditions. There are many drivers who take prescription and over-the-counter medications that effect their concentration and alertness. They, too, should be encouraged to hand over their keys!

My Message: Enlist medical caregivers in difficult tasks that are life altering!

Q. Do I have to worry if my family wants to go outdoors with West Nile virus around?

A. Mosquitoes that feed on birds infected with West Nile can spread the virus to humans. However, about 80 percent of the people infected with the virus don’t know they have it because they show no symptoms. The rest develop flu-like symptoms, such as fever, headache, body aches and swollen glands.  Medical attention should be sought if symptoms develop.

Of course, prevention is the best approach. Remember, when it comes to mosquitoes, it is all about water. They’re attracted to standing water.  So repair leaking faucets and pipes and frequently move A/C drains and hoses. Refresh bird baths and pet bowls frequently. When you’re outside, wear insect repellant and clothing that covers both your arms and legs.

My Message: Check regularly with your state health department hotline or web site

Q. How can I deal with sore nipples since I’m breast-feeding?

A. Tenderness is one of the problems common in the first few weeks of nursing. Follow these tips to avoid or reduce soreness: Make sure the darker skin around the nipple (areola) rather than just the nipple is placed in your baby’s mouth.  Don’t let the baby chew your nipples. Avoid excess washing of your nipples and do not use perfumed soaps or creams.  Don’t use a towel to dry your breasts. Just expose your nipples to air or dry heat instead.  And please no plastic bra liners! Breast feed from the non-tender breast first then limit nursing to 5-10 minutes on an already ’sore’ breast. If the breast is too ‘sore’, I suggest using a pump for 24 hours to allow the irritation to heal.  Always vary positions while nursing so one area of the nipple is not traumatized. Wear breast shells between feedings. If discomfort continues don’t ‘tough it out’, see your doctor.

My Message:  Beast-feeding is a loving, natural, convenient and inexpensive way to feed your baby.

Q. I’m a 51-year-old woman and I do not trust that I’ll get all the cancer screening tests I need from my doctor. I’d like to know what cancer screening tests I should be receiving.

A. The answer depends a lot on your individual risk factors and family history. If you smoke, for example, you are at higher risk for developing lung cancer. If you have a family history of breast cancer, you are at higher risk for contracting the disease. Based on your health history, your doctor will recommend the necessary tests.   I’ll presume you are at average risk. Here’s a list of tests you should be getting on a yearly basis:

1. Pap smear (to detect cervical cancer),

2. Mammogram and yearly breast exam by your physician (to detect breast cancer) (NOTE: You should also be checking your breasts monthly for signs of breast cancer.)

3. Skin inspection exam done by a dermatologist (to detect skin cancer)

4. Blood testing for Cancer Antigen 125 (to detect ovarian cancer)

5. Colon exam (to detect colon cancer) NOTE: Here you have options after age 50: a colonoscopy done every 10 years, an annual testing for blood in your stool, or a ‘flexible sigmoidoscopy or double contrast barium enema every five years. Again this recommendation is for those at average risk.

Early detection of cancer can make a difference. Along with the appropriate tests, pay attention to your family history and adopt a healthy lifestyle.

My Message: Take the test, not the chance!

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