Moderator: We are pleased to have Dr. Whynot joining us for our Body1 Summer Health Series, every Wednesday at 1pm est.

Moderator: This is the last of a series of six discussions with Dr. Whynot.

Moderator: Dr, Whynot thank you for joining us. Users, we welcome your questions.

Silja: What kind of breathing exercises should I be doing during physical exertion and non physical exertion. I have bronchitis's, an infection in my lungs (for several years) that the doctors have not yet been able to trace after many tests, procedures and biopsies. Shortness of breath--day and night is the result.

Dr James Whynot: This is a very complicated question and one that can only be answered by your doctor in conjunction with a respiratory therapist and a physical therapist. One must know your current lung status, frequency of exacerbations (worsening) of the disease, medications, and exercise status. At times a specific rehabilitation-on going maintenance program is developed in conjunction with a multidisciplinary team consisting of a pulmonary physician, therapists and possibly a physiatrist

David Anderson: My wife has varicose veins in her left leg. And a family history of varicose veins. One area just below the knee has a semi-hard node that is painful but goes away when the lower leg and foot is massaged pushing blood upwards. Is there any treatment other than medical procedures that will help ease the problem?

Dr James Whynot: The standard non-medical treatment is as you have discovered, massage and elevation. Other treatments that are non-surgical are specific exercises to improve the upward circulation in the leg, support stockings and walking or flexing the leg to make the muscles pump the venous return upwards. There is also some evidence that using herbal medication (horse chestnut) will improve varicose veins

jillmill : My daughter receives Ivig treatments every couple of months and they are having a problem with finding good veins. Is there something we can do to help speed the healing of her veins or will they never heal? They are even having problems doing blood draws now.

Dr James Whynot: If the veins have been punctured a number of times, they become harder to find and harder to use. If this is the case and someone is having intravenous medications frequently or blood drawing frequently, there are various surgical alternatives that can be done to give access - such as a PICC line and an implant able intravenous port. These are all made to be in the body long term without infection occurring and may be a good solution - ask your doctors about this type of access.

Alice: I just had my first child and during the course of my pregnancy I was told that I was Rh negative and Sensitized, I was told when I have another child that I will have to receive intrauterine blood transfusions. Are these really necessary? How will they affect the child?

Dr James Whynot: You are Rh negative which means you do not have the Rh antigen in your blood stream. If you were sensitized, this means that you first child was Rh positive. During delivery there is mixing of the mother and baby blood and the baby's Rh positive blood got into your system and now you have developed antibodies to the Rh antigen. If you have another child, there is a high liklihood that the baby will be Rh positive and the antibodies that you have in your blood stream may - and I underscore may - cause an anemia or low blood count in the baby. This is something that needs to be watched. If the blood count falls too low, there is a possibility of intrauterine blood transfusions, which will bring the baby's blood count back up. As with any transfusion - it is though about carefully before the transfusion is given because giving the baby these cells may cause other antibodies to form in the baby's system making it harder to transfuse in the future.

Moderator: Dr. Whynot, we have a question that asks: How important is family history in determining one's risk for cardiac problems. My father had a triple bypass at age 65. He also smoked for 30 years prior to this and had relatively bad eating habits. I don't smoke, I exercise and have relatively good eating habits. Are my genetics or behavioral practices more important indicators in regard to my risk for cardiac problems. Thanks.

Dr James Whynot: There are three major risk factors for heart disease - cigarette smoking, elevated cholesterol (total, LDL and/or triglycerides), high blood pressure. Family history is a minor risk factor, but still important. What we look for is a group of people who have early heart disease - at age 30 or 40 or 50 - that is a positive family history. The best prevention is to modify all the major risk factors - no smoking, control blood pressure, have a low cholesterol and to exercise at least three times a week where the heart rate becomes elevated so one is in the aerobic zone. Your father had the most major of all major risk factors - smoking - and this coupled with eating habits probably led to his triple bypass at age 65

Mwebb: I am having surgery on the 27th of August to remove scar tissue after 8 previously operations afterly a motorcycle accident where my knee impacted the road (what a mess). Anyway my question is when they remove the scar tissue - will it grow back. What keeps it from returning? Thanks.

Dr James Whynot: When you operate on any part of the body, the body always heals by growing scar tissue (with a few exceptions). When the scar tissue interferes with the function of the specific part of the body, one usually has to re-operate and then hope the person will comply with the rehabilitation program and follow-up. For joints the one thing that makes a difference as to whether the scar tissue interferes with function is following the rehabilitation program exactly - trying to keep the joint as loose and as mobile as possible. Although you can not stop scar tissue from forming, this will minimize the impact on the function of the joint

Beth : Dear Dr. Whynot, I am a 41 year old female who works out in a healthclub by doing cardio and weight training. I have worked with a trainer to make sure I do my exercise correctly-however, I continue to experience knee pain and do not know why. I do a leg press utilizing proper form-yet each time I try to increase my weights, even by only adding 10 pounds, my knee or knees will cause me pain and burning, usually on the top to outside. Sometimes its one knee vs. the other..if I stop I will need to do so for a couple of weeks before I can try again, but I cant seem to progress and I don't know why! I also will get pain in my lower back as well. My physician tells me to skip the weights and use an elliptical which is easier on the knees. I'd like to find out what is wrong and then devise a plan that is best for me, and I really like weight training. Will an x-ray tell me what is wrong? What kind of x-rays should I ask my doctor to order? Or do I need an MRI? If a patient came to you with this information, could you help me to design a plan of action to understand what is going on? I'm so frustrated! Thank you Beth

Dr James Whynot: The key to making a diagnosis is a complete and through physical exam. For the knee this should be performed by an orthopedist preferably one who has an interest in sports medicine, as I said last week. Once the exam is performed, that will guide the physician as to what testing needs to be done next and whether one needs a referral for an MRI. A physical therapist or a special type of physician will then be consulted and a specific exercise program under the supervision of the physiatrist or sports medicine physician will be designed. If you have not seen a sports medicine orthopedist, I would start there - if you have, I would get another opinion

She_Jock_626: Hey doc - Is it true that it is bad to like crack your knuckles and back and stuff that it will make you have arthritis later or something

Dr James Whynot: No not really it is another myth.

Brian: I am 35, and I just grew an inch in the last month! What might have caused this sudden growth spurt? Should I be concerned?

Dr James Whynot: It is unusual for one to grow after about age 21 or so. One disease that can do this is acromegally or possibly a problem with one of the hormones in the pitituary, a gland located in the brain area that secretes specific hormones. You should bring this concern to your doctor since it is unusual

Moderator: Dr. Whynot, we have a question: What is gout and what factors lead to someone having gout?

Dr James Whynot: Gout is a disease where there is a build up of uric acid crystals in a joint or joints. Uric acid is a waste product and normally is filtered out by the kidney. When levels are relatively high, the crystals can deposit in a joint and thus give pain in that joint. It is not true that gout only occurs in rich people or people who have a diet high in rich foods. Gout can occur in people who eat a lot of food with purines in it - such as red meat. Some medications can cause gout - especially diuretics. If a person has gout, it manifests itself as a warm red tender joint, most commonly the big toe joint. The area may be very sensitive - so much so that even a sock on the area of the toe is painful. Treatment is usually straightforward with usage of either an anti-inflammatory agent (such as Advil or Aleve) or in some cases colchicine.

FDooley: A friend of mine tells me I have acidic sweat- we discussed this when after being gifted a gold watch by my gf- it tarnished rather quickly (over a period of two months) is this a medical condition? Can I do something about it?

Dr James Whynot: Everyone has acidic sweat - its an immune defense mechanism - although some are more acid than others. There is not much that can be done for the acidity in sweat. if you wear metal watches that tarnish from the sweat, the best defense is to coat the back of the metal with clear nail polish

Greta Friedman: I heard shingles is very close to chickenpox and that if you had pox you were likely to get shingles. I'm hitting age 50 pretty soon and did have the chicken pox (the vaccine wasn't around then) would getting the vaccine now protect me any?

Dr James Whynot: Shingles is the same virus as chicken pox. Once you have the chicken pox virus (varicella zoster), the virus lives forever in your nerve roots. Various stimuli can reactivate the virus and thus one gets shingles or herpes zoster. The stimuli are varied and are different for different people. The vaccine will not prevent shingles, since you already have the virus in your nerve roots. The key to shingles is to have it diagnosed early where the oral medications will help shorten the course. Shingles first starts out as a pain in one area of the body quickly followed by a flat red rash and then bumps form in the rash. If you have this type of symptom, then see your doctor immediately so that medications can be started

Jules_86: I've just been diagnosed with a ruptured milk duct, my doctor, put me on anti-biotic. He also mentioned that it is common in women of english/scottish/Irish descent, can you please explain?

Dr James Whynot: A milk duct can become plugged and then when they are plugged the normal secretions build up, leading to rupture. It is fairly common. I do not know why it is more common in women of English Scottish or Irish descent

Lynn: We have been recommended to possibly have arthroscopy surgery on my 14 year old daughters left knee. The diagnosis by her sports medicine/orthopedist was patella dislocation. It has occurred 3 times in the last two years, two times causing fairly serious swelling and pain. Have been looking for the difference between the two procedures and why one is better than the other. Lateral release or lengthen?

Dr James Whynot: I am sorry I do not know the answer to this question, since it is an orthopedic question and I am an internist. I cannot comment on the pros and cons of the procedures

Moderator: Dr. Whynot, we have a question that asks: "I had a birthmark around my eye until about 7 years old. At that time, my parents took me to a plastic surgeon that "removed" it by placing skin over the mark. Was the skin simply placed over the birthmark or was the mark in some way actually removed?"

Dr James Whynot: Usually the birthmark is excised (removed) an a skin graft is placed in its place. It is not possible to place skin over skin, since the top layer of skin will not obtain an blood supply and thus die

Aaron: I have a student, who complains about his vision during reading activities, he used to wear glasses but no longer does so. I have noticed when he does read his eyes become very red and he rubs them a lot. He says he has the same problem watching tv, but when he wears his old glasses he not longer has that problem. What do you suggest? do you think that the glasses might have a security blanket like affect for him?

Dr James Whynot: Usually if the eyes are strained they will become red and inflamed. I would say it would be important to see why the student no longer needs glasses and whether he has better vision with glasses. Not all visual problems have to do with distance or close up vision - he may have astigmatism where the cornea is irregular. It would be important to discuss with the parents and possibly have an ophthalmologist - not optometrist - evaluate

Moderator: Another question asks: "I know I should eat better as this leads to better overall health. Where should I start in putting together a better diet for myself? Is there a book you recommend in this regard?"

Dr James Whynot: Diets are ever changing, and as of today, it appears that the best diet for overall health is a vegetarian diet - although this is a very hard diet to follow. Short of that, one probably should go to the low carbohydrate diet - and for my money Barry Sears' diet The Zone diet is the best - it is through, scientifically valid, and will maintain correct weight, sugar ratios and cholesterol.

Ash: I have been taking Claritin or Clarinex for years and the last year was prescribed singular for my asthma. I had to use my inhalers more often as well as my nebulizer. Do you think there might be problem taking these drugs together?

Dr James Whynot: There should not be a problem taking the drugs together. Without knowing specifics it is difficult to determine why your asthma was worse.

Moderator: That is all the time we have today. As always, we want to thank Dr. Whynot for his time and excellent advice for Body1's Summer Health Series. We also want to thank our audience for their questions and patronage of the Body1 Network. We look forward to your participation in other discussions.