This is a very interesting question. It is a very difficult question to answer without an exam. I recommend that your daughter have a complete history and physical exam. There are multiple conditions that could result in this unusual physical finding. You should make an appointment with your regular doctor and tell the receptionist that you may need extra time to discuss this with the physician.

Dr. Kimberly Allen DO,FAAP
CCH Pediatric Clinic

I have just been diagnosed with severe osteoporosis with a bmd of -3.4 in L1-L4 and -2.0 in dual femur left and right neck. In addition I have arthritis of the spine and hip. I love to run but am told I should only walk. if I take prescribed meds, do hip exercises to strengthen the area will I ever be able to run?
Richard

Osteoporosis is the most common metabolic bone disease. Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of the people 50 years of age and older. One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime. Osteoporosis is responsible for more than 1.5 million fractures annually, including over 300,000 hip fractures, approximately 700,000 vertebral fractures, 250,000 wrist fractures, and 300,000 fractures at other sites. Osteoporosis is often called a "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse. The rate of hip fractures is two to three times higher in women than men; however, the one year mortality following a hip fracture is nearly twice as high for men as for women. A woman's risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer. An average of 24 percent of hip fracture patients aged 50 and over dies in the year following their fracture. One in five of those who were ambulatory before their hip fracture requires long-term care afterward. At six months after a hip fracture, only 15 percent of hip fracture patients can walk across a room unaided. One in five hip fracture patients ends up in a nursing home, a situation that participants in one study described as less desirable than death.

The most precise technique for evaluating osteoporosis is the Dual X-ray Absorptiometry scan (DXA). Osteoporosis is defined as a  T score of below -2.5 (this number indicates the number of standard deviations by which the patients bone-mineral density differs from a normal mean value). Your values of -3.4 and -2.0 indicate you indeed carry the diagnosis of osteoporosis and are at a higher risk of fracture. The most important task is to rule out hyperparathyroidism because this is the only reversible form of the disease. Once ruled out, if you are over age 50, your doctor should prescribe both Vitamin D (800-1000 units of Vit D3 daily) and calcium (800 to 1500 mg calcium carbonate daily), after it has been determined that your serum calcium is not elevated. A bisphosphonate or other antiresorptive medication may also be prescribed.

There are five steps that can optimize bone health and help prevent osteoporosis. They are: a balanced diet rich in calcium and vitamin D, weight-bearing exercise, a healthy lifestyle with no smoking or excessive alcohol intake, talking to your doctor about bone health, and bone density testing and medication when appropriate.

Just as a muscle gets stronger and bigger the more you use it, a bone becomes stronger and denser when you place demands on it. If your bones are not called upon to work, such as during physical activity, they do not receive any messages that they need to be strong. Thus, a lack of exercise, particularly as you get older, may contribute to lower bone mass or density. Two types of exercises are important for building and maintaining bone mass and density: weight-bearing and resistance exercises. Weight-bearing exercises are those in which your bones and muscles work against gravity. This is any exercise in which your feet and legs are bearing your weight, such as jogging or walking. The second type of exercises are resistance exercises or activities that use muscular strength to improve muscle mass and strengthen bone, such as using the weight machines at a health club, swimming, and bicycling.

Unfortunately, because you have osteoporosis you should take extra caution. Certain movements like twisting of the spine, high impact activities or bending from the waist can be harmful. High-impact exercises, such as jumping, running or jogging increase compression in your spine and lower extremities and can lead to fractures in weakened bones. Avoid jerky, rapid movements in general. Exercises in which you bend forward and twist your waist, such as touching your toes, doing sit-ups or using a rowing machine also compress the bones in your spine. Other activities that may require you to bend or twist forcefully at the waist are golf, tennis, bowling and some yoga poses and care should be given when participating. Once you have lost bone mass, treatment helps prevent further loss but is unlikely to restore bone mass.

Dr. Cody Harlan
Columbus Orthopedic and Sports Medicine

I have just recently moved to China from the United States. Ever since coming to China, I have been having difficulties with my skin. My skin has been excessively dry, rough, and peeling, leaving my skin discolored. I have black and blue marks all over my body. What can I do to treat this?
Anonymous

The skin changes you describe (dry, rough, peeling, discolored, bruising) would make me think of a few specific possibilities, but usually I try to think of the common causes first. When I discuss skin rashes with a patient, I usually ask about the type of soaps the patient is using (laundry detergents, shampoos, etc.) as well as any fabric softeners and whether or not they have soft or hard water. I also ask if they have been exposed to temperature extremes or new/different foods, especially nuts and seafood. (i.e. shellfish or raw/uncooked fish)

Since you describe something that appears to be more generalized, I would ask whether you were taking certain medications, for example aspirin, anti-inflammatory medications like ibuprofen (i.e. Advil, Motrin, etc.). I would also ask if you are taking any vitamins or hormonal products such as birth control pills as well as anything else you might be using.

Beyond that, there are many illnesses that may be associated with some of these conditions. They could include but are not limited to:
* Hypo- or Hyperthyroidism
* Anemia
* Hepatitis
* Vitamin deficiencies

Many of these would take an exam and possibly some tests to determine.

It's unfortunately very difficult to provide a firm diagnosis without the opportunity to actually see the skin changes you describe as they exist. Even then it may well take some testing for the other possibilities I ve described above.
Finally, since you re in China, I might also want to include some other diseases in my Differential.

Dr. Daniel Rosenquist, MD, FAAFP
Columbus Family Practice

A daughter of a co-worker was just diagnosed with the true influenza. I did not get my child vaccinated yet since she has a check up in just a couple of weeks. I was vaccinated through work. Should I be concerned since I has been exposed to a mother of an infected child? Is it too late to vaccinate?
Anonymous

It is not too late to vaccinate. Most area clinics have the vaccine available. Immunity will be active in about 2 weeks after getting the vaccine. As a mother who has been vaccinated you would normally not be able to transmit the virus to your child. Influenza viruses can be either A or B. Usually the Influenza B is more common in children and is less severe with milder symptoms. Children less than 2 years old--even healthy children--are at high risk of ending up in the hospital if they get influenza.
Vaccinating children, their families, and other care givers can help protect them from getting sick. Because influenza viruses change every year, the vaccine is updated annually. So even if you or your children got a flue shot last year, you both still need to get a flu shot this season to be protected. If October and November slip by, and you haven t gotten your children or yourself vaccinated, you should get vaccinated as soon as possible. Flu season can occur anytime from November thru April, so getting the vaccine now will still give you protection.

Sara S. Hough, RN, BSN
Columbus Community Hospital

My daughter just turned 2 and she has been sucking her thumb ever sinceshespit out the pacifyer. I didn't mind because it didn't harm me or myteethand I did it for quite some time. She does it mostly to go to sleep andthen again unconcerned she'll just pop in her mouth. I am now concernedabout the skin around and below her thumb. It is red & raw with patchesofcracked red skin on the tip and a hard corn with dry skin surroundingit. Ineed to be able to put something safe on it to heal the skin in case sheputs it in her mouth. Also, it is advisable to put bandaids on it? Inotice that it seems to swell after having on it.
Anonymous

You have an excellent attitude about your daughter's thumb sucking. Sheis still very young and the fact that the most thumb-sucking activity is at bedtime is not concerning. I would avoid placing bandaids on her thumb because of the risk of hersucking them off and they becoming a choking hazard. I would recommend that you massage Vaseline into the irritated skin ofher thumb a couple of times per day. You could even soak her hand insome warm water then pat dry and apply the Vaseline to the damp skin asthis would help to seal in the moisture.It is important that if the skin looks as if it is infected that youseek the advice of your physician as she may require antibiotics. Good Luck

Dr. Kimberly Allen DO,FAAP
CCH Pediatric Clinic

I have hypothyroidism and take a dosage of .1 Synthroid or Levothyroxine every day. Is it okay for me to donate blood, or would my medication make it not a good idea?
Anonymous

You may donate blood while taking those medications. However, taking some medications can defer you from donating blood temporarily or indefinitely. Anyone who has questions about their eligibility to donate should call 1.800.GIVE.LIFE and speak with a donor health consultant. To schedule an appointment to donate blood you may call 1.800.GIVE.LIFE or go online to www.givebloodgivelife.org.

Erin Behrens
American Red Cross
Marketing Manager
402.492.2149 ext. 3810
C: 402.321.3576


What is bird flu? What are the symptoms?
Anonymous

Bird flu or Avian flu is a type of respiratory influenza that is contagious and spreads rapidly. It is not a condition with nausea and vomiting. Instead it is a respiratory illness that comes on suddenly with symptoms of fever, muscle aches, dry cough and sore throat. Currently it is not in the United States. There is no current vaccine available for this type of influenza. Avian or bird flu is different than the seasonal influenza that occurs every year during the winter months. Most people have some immunity to seasonal influenza but experts say that people have little or no natural immunity to bird flu. Everyone could be at risk of serious illness if the bird flu was discovered in the United States.

The World Health Organization has said that a bird flu pandemic could infect 25-30 percent of the world's population. Vaccine against seasonal flu will not protect against bird flu. However, getting your yearly flu shot is one of several things you can do to keep yourself healthy, and that may help you fight off the bird flu.

Sara S. Hough, RN, BSN
Director of Risk Management and Infection Control
Columbus Community Hospital

What are symptoms of West Nile? What is the best thing to use to prevent bites?
Sara

Sara, this is a good and timely question because West Nile season is underway again. The first cases of West Nile Virus in the U.S. this season have already occurred in Mississippi. As the weather warms it will hit our region. All of our recent rain is likely to increase the mosquito population. Specific to the first part of your question, the symptoms of West Nile Virus come in 3 categories:

Serious Symptoms in a few people: The Centers for Disease Control estimate that about 150 people in the U.S. infected with the virus will develop a serious illness. The serious symptoms include high fever, neck stiffness, confusion or disorientation, tremors, convulsions, muscle weakness, vision loss, numbness, paralysis or coma. These symptoms can last several weeks, and the symptoms involving the nervous system (numbness, weakness, paralysis, mental status changes) may be permanent. Increasing age seems to be a risk factor for severe disease especially those over 50.

Milder Symptoms in Some People: 1 in 5 of the people infected with the virus will have fever, headache, body aches, nausea, vomiting, occasionally swollen lymph glands and at times a skin rash on the chest, abdomen or back. These symptoms usually last just a few days. Rarely the symptoms can last for weeks.

No Symptoms in Most People: 4 out of 5 people infected with the virus will be free of any symptoms at all.

Symptoms, if they occur, develop between 3 and 14 days after being bitten by an infected mosquito. There is no treatment for West Nile Virus and people with mild symptoms usually do not need to seek medical attention. Resting, avoiding the heat, drinking plenty of fluids and use of over the counter medicine for pain and fever are all that is necessary. If the symptoms are more intense or severe, then medical attention is necessary. Pregnant women should consult their physician. Regardless of West Nile suspicions, any infant with a fever that is less than 2 months old should immediately be brought to the attention of their physician.

Prevention of mosquito bites is the key to stopping West Nile disease. Use a mosquito repellent and make sure your repellent has DEET (N,N-diethyl-m-toluamide) or Picaridin (KBR 3023). DEET up to 30% has been approved for children over the age of 2 months. Do not use in the first 60 days of life. It is better to use mosquito netting over infant carriers. The percent on the bottle tells you how long, not how well, the DEET works. 5% lasts 1 hour and 30% lasts 5 hours. Pregnant and nursing mothers may use DEET safely. To use the repellent, apply to exposed skin and clothing. Do not apply to skin that is covered by clothing or to open cuts. Avoid your eyes by spraying or adding lotion to your hands and then applying it to you face. It is better to use a repellent that is only a repellent and not a combination product like sunscreen mixed with repellent. You can use both products in tandem. Apply your sunscreen first and then spray with the repellent.

Finally do not encourage mosquitoes. Make sure that containers with standing water on you property are emptied daily. Drain larger areas of standing water if possible. The goal is to interrupt the breeding of mosquitoes. Do not touch dead birds as they are a common target of West Nile Virus. Seeing a number of dead birds is a red flag suggesting West Nile is in the area.

Go ahead and spray or lotion up and enjoy the summer!

Mark Howerter, MD
Medical Director
Emergency Dept.
Columbus Community Hospital

I completely tore my ACL roughly one month ago. There is still stiffness after long periods of rest, just minimal swelling, and I am starting to gain full ROM. Therefore, I have decided to postpone surgery until the end of summer b/c I don't want to spend it doing rehab. I want to stay active and was wondering if you have any suggestions as to what activities/exercises I could do in the meantime. For instance, is jogging/hiking/climbing ok? If so, is it possible to injur the knee any further?
Anonymous

It is a very good idea to try to rehab your knee prior to undergoing an ACL reconstruction surgery. Straight leg raising exercising can be an effective way to strengthen your leg without causing pain or discomfort. Studies have shown that patients who wait until the swelling is gone and have taken time to rehab their knee and regain full range of motion before surgery have a better outcome after surgery.

It is unlikely that the ACL can be injured further, as it is already torn from your original injury. However, the knee is not as stable as it would be if you had your ACL, and hiking and climbing may increase your risk of tearing the meniscus, or the cushion between the femur and tibia bones. Two options to prevent further injury are:
1) Strengthening the leg by doing exercises, which a Physical Therapist can give you.
2) Obtain a knee brace which may afford you some extra stability until you undergo an ACL reconstruction.

Kelli K. Thomazin, PA-C
Columbus Community Hospital

My daughter is very active in sports and always has been. She has had "athletes foot" which always seems to get worse when in sports. Now, it will not go away at all. We have tried all of the over the counter treatments and nothing seems to work. Is there anything else that we can try at home?
Barb

"Athletes foot" can be a difficult problem to resolve. The primary problem is often moisture. To control the moisture you can use anti-perspirents and even soaking in epsom salts twice a day can help keep the skin dry. Most OTC medications are creams, which moisturize the skin along with the medication. Powders should be used daily as they have drying medications in them along with a topical medication. Sprays are minimally effective for significant cases. If the shoes are damp they should be allowed to dry 100% before wearing again which may mean only wearing them every 2-3 days. There are prescription medication which come in a gel which will also dry the skin along with treating athletes foot. On occasion severe cases may even require a prescription oral medication to resolve the problem along with topical medication. There are other conditions which can mimic athletes foot and a skin culture can be performed to be 100% sure that the diagnosis is correct.

Charles Halverson DPM, Foot Care Center
Columbus Community Hospital

I have a 4 year old daughter that hates to eat at home! She eats great during the day the sitter, but will barely eat dinner at home. Should I be concerned about this? She does get a Flintstone vitamin once a day.
Anonymous

Toddlers and preschoolers will eat when they are hungry. Trust their appetite to look after their caloric needs. If your child is eating well at the sitter's house, then she likely is not hungry for dinner. Make sure your sitter is providing nutritious choices for meals. Snacks should be small and healthy. Meal times are not just for eating; they are times when the family comes together to share and create stronger family bonds. Make meal time pleasant. Avoid punishment or pressure at meal time. If your child is strong-willed, then pressure around eating may escalate into a power struggle and cause your child to develop unpleasant feelings toward meal time. As long as the child has the opportunity to eat nutritious foods during the day, her caloric and nutritional needs will be met. Many times if a child is allowed to help prepare the food, she will be more likely to eat some of it. If she is very picky, then continue to offer her the multivitamin. It is up to the parent to plan and provide healthy meals and snacks, and it is up to the child to decide how much to eat or whether to eat at all.
Dr. Deborah Anderson, CCH Pediatric Clinic
Columbus Community Hospital

My son is 15 months old and sucks his thumb a lot. He sucks his thumb so much it is getting raw. How do I go about breaking this habit and healing his thumb?
Anonymous

Thumbsucking should be considered normal before the age of 4 years of age and basically ignored, especially when your child is tired, sick or stressed. Studies reveal that as many as 15% of 4 year olds still suck their thumbs. That means that a great percentage of children will spontaneously stop sucking their thumbs in the toddler years. In a child that is over one year of age, it is appropriate to try and distract him from thumbsucking. Give him something to do with his hands without mentioning your concern about his thumbsucking. Occasionally praise your child for not thumbsucking. Until your child is old enough to reason with, any pressure you apply to stop thumbsucking will lead to a power struggle that can result in resistance and lack of cooperation.

In regards to the skin of the thumb being sucked raw, the discomfort of the skin irritation may be just the incentive that your little guy needs to halt this habit. If that doesn't seem to be happening, wash hands frequently with antibacterial soap and apply Neosporin or triple antibiotic cream to the area twice per day. If you think that the skin of the thumb appears infected you need to see a health care provider.
Dr. Kimberly Allen, CCH Pediatric Clinic
Columbus Community Hospital