Body1: Users, we welcome your questions!

bbcr50: Barrett's Esophagus: What is the next step after a failed Nissen fundoplication? What percent of cases fail a second time?

Dr James Whynot: The first step is to definitely determine that prior fundoplication has failed - usually by endoscopic studies. The reason for this is to look at the new anatomy after the surgical procedure. Once the anatomy has been defined, then specific therapy can be planned - using either cytoprotective agents that protect the lining of the esophagus or Proton Pump Inhibitors (PPI's) . Rarely a second surgery is done, either another fundoplication or a Roux-en-Y procedure. I do not know what percentage of cases fail after a second surgery

jill7328: If I have had a hysterectomy and still have ovaries do I need to continue having pelvic exams?

Dr James Whynot: Yes, it is important to continue to have exams. Although the cervix is not present and the uterus is not present, it is important to have pelvic and abdominal exams to detect any enlargement or fullness of the ovaries, which may indicate ovarian cancer.

jump5: Two years ago, I experienced intro-uterine fetal demise. My CBC dropped to 7.4. It took several months to even start feeling normal again. Today, I feel pretty good. I do, however, have several veins that seem to have come to the surface. I have asked to physicians about these veins, and they seem to think it is from my pregnancy ending at 15 weeks and the loss of the weight (25lbs) that I had gained. I am hoping you can give me a better explanation as to what happened to my veins. I had never before had veins so close to the surface before, now, I have them in my arms, my chest, and my legs. Any advice would be greatly appreciated.

Dr James Whynot: I don't know the exact answer but usually when this happens, the veins seem more prominent on the surface due to weight loss. The veins usually are below the surface covered by a layer of fat, and with weight loss this layer lessens, and the veins seem more prominent.

oboynana: I was told this week I have an enlarged heart. What does this mean?

Dr James Whynot: An enlarged heart can mean a number of things. Typically, the heart diameter is bigger than normal. This can result from the build up of muscle in the heart - such as what happens in athletes - or it can be from the heart working harder than normal - such as in high blood pressure or from the heart not working as efficiently - as in heart failure. It is important for your doctor to find out the exact reason for the enlarged heart as each of these conditions has a different treatment.

Anonymous : I have been diagnosed with temporal lobe epilepsy; are these the same symptoms from borderline personality disorder? And would my Major Depression be tied up with any of these two diagnoses?

Dr James Whynot: Temporal lobe epilepsy is of two types - those without loss of consciousness and those with loss of consciousness. Once diagnosed, it is fairly easy to treat. The symptoms of temporal lobe epilepsy vary and can be anything from what is called a 'dream state' to hallucinations both auditory and visual as well as loss of memory. As far as I know there is no association with borderline personality disorder or ties in with major depression.

AJK124A: I recently had sclerotherapy done on my legs. I would like to know how long one is required to wear the compression stockings.

Dr James Whynot: The usual length of time in simple sclerothearpy is 72 hours, but this will vary due to the technique and the number of veins treated. This is a question to ask the performing physician since he or she will know exactly what procedure was performed and how many veins were treated.

monicadaly66 : I am helping my mother while she tries to live with atrial fibrillation. She has had the cardioversion which was unsuccessful for her. She is on a few drugs, keeping the blood thin and a diuretic and some other drugs. The specialist has told her to "learn to live with the condition". The condition gets her down and she's frustrated not being able to be as active as she was. I would appreciate any advice I can pass on to her from people who have found a way to live with AF, anything positive and helpful would be very much appreciated.

Dr James Whynot: If the heart can't be converted back into its normal rhythm, sinus rhythm, then the heart will stay in AF - which is a difficult condition to live with. The heart is not beating as efficiently as it could be, and for that reason, your mother's exercise tolerance will be decreased - and in fact some of the medications used to control atrial fibrillation may make her fatigued. Yes, she has to learn to live with her condition, but it is important to be sure that the cardiologist has evaluated her, made sure that she is on the correct medications in the correct dosages to minimize the side effects of the medication (like fatigue) and to maximize her cardiac output. Her cardiac output is what will control her exercise tolerance. It is also important to know the state of the heart. Is the left atrium enlarged? Is the heart enlarged? These are factors which will also decrease her exercise tolerance - and if they are enlarged, maximizing appropriate medications to maximize cardiac output is important.

Jan13815 : I had a problem with my kneecap. I couldn't move it, and it prevented me from bending my knee, and it was painful to walk. I had an MRI and it showed nothing. The doctor gave me a cortisone shot, and it was more painful after the shot than before. It has been 5 days since the shot, and it is starting to feel better now. My problem is my knee area has developed a rash where the cortisone was inserted. Is this normal to form an itchy rash?

Dr James Whynot: It does take the cortisone a few days to work and it is usually painful - more so - after the cortisone injection. It is important to determine if there is a rash on the knee or just redness. Redness can be a sign of skin infection. It is important to contact your doctor for evaluation.

michelle : I am due to go into the hospital for an operation, involving scraping of the knee lining. What does that mean in English????

Dr James Whynot: It is hard to say what they are going to scrape. There are a few things that can be scraped in the knee. The back of the knee cap can be scraped; this is where the cartilage that makes the knee cap glide up and down has become roughened, and they will scrape it and make it smoother to get rid of pain in the area of the knee cap. There are also other areas that can be scraped - the ligaments and the menisci - which are fiber like bands that help move the knee. The scraping is usually done to remove abnormal cartilage or bone to make the knee less painful and increase mobility of the knee.

jerry : I have today noticed that the point of my left shoulder has no sensitivity to touch. It's very localized - no pain, just numb. Any ideas why?

Dr James Whynot: I'm not sure exactly where you are referring to as the point of the shoulder, but usually when there is numbness, there is an alteration in function of one of the sensory nerves. These are the nerves we use to feel hot, cold, sharp, dull, and pain, and loss of this sensation causes numbness. It can be a sign of nerve entrapment, a precursor to shingles or any of a hundred things. I think that if it persists for more than a few days, you should see your doctor for evaluation.

maybaby : Are there any over-the-counter or at-home treatments for rosacea? I have had problems with this before and have been prescribed tetracycline, which severely upset my stomach. I'd like to avoid having that happen again, but would also like to explore other treatment options. Any ideas are greatly appreciated - thank you.

Dr James Whynot: Rosacea is a difficult disease to treat. We are not exactly sure of the origin of the disease, and feel that it may be similar to acne, thus the treatment with antibiotics. If left untreated ,it usually gets worse causing more redness of the skin and new blood vessels to form. About 14 million people have it. Treatment involves lifestyle management - avoiding sun, stress, etc., as well as the usual topical medications. There have been some advances - Rosacea Ltd III is a cream that has helped some patients. Azeleic acid has helped some. Topical Metrogel has helped others. Topical Vitamin A has helped resistant cases. There is also a cream made of snail slime - don't laugh. The snail slime cream is elicina cream - available on the web, and it seems to be very effective in about 50% of the cases.

daisy: Is there any known connection between carotid artery disease and loss of vision? My grandmother is experiencing a seemingly rapid decline in her eyesight and wonders if it is related to her carotid artery - is this possible?

Dr James Whynot: Carotid artery disease can contribute to loss of vision, by sending micro emboli to the retinal arteries. This should be evaluated as soon as possible by a physician.

smithy : How severe a sunburn or how many sunburns over the course of a lifetime would contribute to the development of skin cancer? For instance, if I've never been burned at all, am I at less risk than if I'd had 3-4 burns through my lifetime that were pretty severe? Are sunburns the only risk factor or potential cause of skin cancer?

Dr James Whynot: Sunburns are a risk for skin cancer but not the only risk. The less number of burns you have in your life, the less the risk for skin cancer. Usually we ask people to follow the ABCD's for skin cancer prevention - looking a their skin for changes. A is for Area - the areas that are at risk for sun exposure are the areas where skin cancers occur - so arms, legs, neck, face are at a higher risk since they are sun exposed. We also look at size of lesions - greater than a pencil eraser diameter is a cause for concern. We look at whether the lesions are raised or not - raised are a higher risk. We look at color - black is bad and lesions that are not one smooth color are a cause for concern. Finally we look at border - irregular borders of skin lesions that look like the coast of Maine are bad. So we have ABCD - area, border, color and diameter - these are the important factors in skin cancer

Body1 : Users, we are just about out of time - we'll take one or two final questions.

Ralphie : I have heard that you are not supposed to use Q-tips to clear out your ears... Why not and how exactly are you supposed to clean out the excess wax in your ears, or are you not supposed to do so at all?

Dr James Whynot: The going theory is that you should not put anything smaller than an elbow in your ear... but seriously, q-tips are ok to clean the external ear, but if used to clean the canals, they can push the wax further in or in some cases people can be too aggressive and push the q-tip into the ear drum injuring the drum or the external canal. The best, safest and easiest way to clean ears that build up wax is to use a 50-50 solution of hydrogen peroxide and water and gently syringe it into the ear with a baby's bulb syringe. This will let the peroxide dissolve the wax and then you can gently use the bulb syringe to wash out the solution with warm water. Make sure the water is warm, not hot or cold. As an alternative, you can purchase the Debrox Ear Cleaning system which is an expensive hydrogen peroxide kit, and this will do it.

Body1: Great! Dr. Whynot, thank you for joining us today and we'll look forward to speaking with you again next week, July 30 at 1pm ET.

Body1: Users, thank you for joining us and tune in again next week with your questions!