Vik Rajan, MD
President, Houston Patient Advocacy
Dr. Vik Rajan is the founder of Houston Patient Advocacy, which provides health information and advocacy to patients and families who have questions about their health, feel lost in the medical system and need guidance, or need assistance with insurance claim denials or medical billing problems.
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Question
Could medicine interaction cause mom slurred speech and drooling?
Slurred speech is generally thought of in the context of stroke/mini-stroke symptoms, but if slurred speech and drooling is occurring only... Slurred speech is generally thought of in the context of stroke/mini-stroke symptoms, but if slurred speech and drooling is occurring only in the context of having taken medications, it could be caused by medications that can produce drowsiness, of which there are many. Slurred speech and drooling caused by medications could also occur in the context of medications causing dystonic reactions although there are usually other more visually obvious signs of dystonic reaction besides slurred speech (i.e. intermittent muscle spasms, oftentimes in the face).
You will want to talk to your mother's doctor to further evaluate her symptoms, and if they are indeed thought to be related to medication, deduce which medication(s) may be the culprit.
If you have further questions about this topic or others, feel free to contact me directly (click on my profile for details).
Hope this helps. Best wishes.
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
You will want to talk to your mother's doctor to further evaluate her symptoms, and if they are indeed thought to be related to medication, deduce which medication(s) may be the culprit.
If you have further questions about this topic or others, feel free to contact me directly (click on my profile for details).
Hope this helps. Best wishes.
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
Can a person choke on their dentures?
Choking on one's dentures while sleeping is a possible and previously documented occurrence, which is why it is typically recommended... Choking on one's dentures while sleeping is a possible and previously documented occurrence, which is why it is typically recommended not to wear dentures while sleeping. The type of dentures (partial vs complete, size, shape, how it's bonded, how well it fits, etc) and the patient (jaw and oropharynx shape and size, whether they move around a lot while asleep, whether there is dementia or not) play a role in determining the amount of risk there is for choking on dentures during sleep.
You will want to talk to you mother's dentist about this further to better determine the choking risk for her and help consider what can be done to mitigate that risk if you are unable to convince your mother to take her dentures off before going to bed, but the safest scenario is for dentures to be removed prior to bed.
Hope this helps. If you have further questions about this topic or others, feel free to contact me directly (click on my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
You will want to talk to you mother's dentist about this further to better determine the choking risk for her and help consider what can be done to mitigate that risk if you are unable to convince your mother to take her dentures off before going to bed, but the safest scenario is for dentures to be removed prior to bed.
Hope this helps. If you have further questions about this topic or others, feel free to contact me directly (click on my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
How do I coordinate multiple physicians as a caregiver of my mother?
Coordinating care for an elder with multiple physicians can be very challenging, especially if you have limited time and/or do not have a... Coordinating care for an elder with multiple physicians can be very challenging, especially if you have limited time and/or do not have a medical background to help you out. If you are having difficulty with doing this on your own, you may want to see if there are private patient advocates in your area that can help you out with this issue. There is a list of them at:
http://www.nahac.memberlodge.com/directory.
I recently wrote an article that discusses the role of private patient advocates in the health care system. You may want to read about it as well.
Best wishes,
Vik Rajan, M.D. see more
http://www.nahac.memberlodge.com/directory.
I recently wrote an article that discusses the role of private patient advocates in the health care system. You may want to read about it as well.
Best wishes,
Vik Rajan, M.D. see more
Question
Is it normal for the elderly with anxiety to have chronic diarreah?
It is possible to have anxiety-induced diarrhea. It can occur in the context of irritable bowel syndrome or just by itself. The diarrhea... It is possible to have anxiety-induced diarrhea. It can occur in the context of irritable bowel syndrome or just by itself. The diarrhea would be associated with anxiety producing events and would be non-bloody, and there would be no other symptoms (like fever, vomiting, severe abdominal pain).
Of course, one would want to make sure there isn't any other causes of chronic diarrhea before attributing it purely to anxiety. Various stool testing can be done that is not invasive, and it is also important to rule out lactose intolerance (which is a common yet sometimes overlooked cause of chronic diarrhea).
The primary management for anxiety-induced diarrhea is treating the anxiety. While pharmacotherapy is one way to treat anxiety, stress relieving exercises (whether breathing exercises, meditation, tai-chi, yoga, or whatever else helps quickly relieve the stress) also helps. Taking extra fiber is generally a good idea if you have diarrhea, although it may not be as effective in anxiety-induced diarrhea. Anti-diarrheal medications (like immodium) may or may not work either.
Talk to your mother's doctor about this all next time, but if you want to get this properly addressed by your doctor, you may want to schedule an appointment specifically for this issue, so he/she will have enough time to properly evaluate it.
Hope this helps you out. If you have further questions, feel free to contact me directly (click on my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Of course, one would want to make sure there isn't any other causes of chronic diarrhea before attributing it purely to anxiety. Various stool testing can be done that is not invasive, and it is also important to rule out lactose intolerance (which is a common yet sometimes overlooked cause of chronic diarrhea).
The primary management for anxiety-induced diarrhea is treating the anxiety. While pharmacotherapy is one way to treat anxiety, stress relieving exercises (whether breathing exercises, meditation, tai-chi, yoga, or whatever else helps quickly relieve the stress) also helps. Taking extra fiber is generally a good idea if you have diarrhea, although it may not be as effective in anxiety-induced diarrhea. Anti-diarrheal medications (like immodium) may or may not work either.
Talk to your mother's doctor about this all next time, but if you want to get this properly addressed by your doctor, you may want to schedule an appointment specifically for this issue, so he/she will have enough time to properly evaluate it.
Hope this helps you out. If you have further questions, feel free to contact me directly (click on my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
My 87 year old mom was in the hospital. Now that she is home she is tired and dozes off, should I be concerned...
Certainly talk to your mom's physician about this, but consider what medications she is on (which is often adjusted, added, or... Certainly talk to your mom's physician about this, but consider what medications she is on (which is often adjusted, added, or subtracted in some way), and make sure drowsiness is not one of the side effects. There are a number of medications that can do that. There are other potential causes of drowsiness besides medication side effects, but that would be one of the first things to consider.
If you have further questions about this topic or others, feel free to contact me directly (click on my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
If you have further questions about this topic or others, feel free to contact me directly (click on my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
How does one prevent getting C-Diff again when she is in a nursing home?
Good question. Those w/ c-diff tend to have it colonized (to a minimal extent controlled by other helpful gut bacteria). That means... Good question. Those w/ c-diff tend to have it colonized (to a minimal extent controlled by other helpful gut bacteria). That means c-diff can regrow to the degree to cause another colitis (gut inflammation) under certain circumstances. To help avoid this (but cannot totally prevent it) includes the following:
1. Avoid non c-diff treating antibiotics if possible. The primary c-diff related antibiotics are metronidazole and vancomycin (oral). All other antibiotics can kill all other gut flora to allow c-diff to regrow to the degree to cause colitis.
2. Avoid proton pump inhibitors if possible. They are associated with getting back c-diff colitis (perhaps because less stomach acid to keep c-diff in check). If acid-reducing medication is necessary, one can try histamine-related blockers (like Pepcid, Zantac).
3. Oral probiotics can provide some help in preventing c-diff colitis, though not guaranteed.
4. Make sure thorough hand-soap washing is being done when dealing with a patient with c-diff (alcohol based sanitizers don’t work).
5. Make sure room/surfaces of any patient with c-diff are bleach cleaned.
6. Make sure anyone known to have active c-diff diarrhea is contact isolated (gown/glove + water/soap handwashing) in their own room.
And if recurrent c-diff colitis is happening that is not responding to c-diff antibiotics, it is worth considering fecal transplantation (done in some specialized centers) that can work well by better replacing normal gut bacteria.
Of course, make sure to talk to your elder’s doctor about these ideas before implementing them (especially any medication/treatment related ideas). If you have further questions about this topic or others, please feel free to contact me directly.
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
1. Avoid non c-diff treating antibiotics if possible. The primary c-diff related antibiotics are metronidazole and vancomycin (oral). All other antibiotics can kill all other gut flora to allow c-diff to regrow to the degree to cause colitis.
2. Avoid proton pump inhibitors if possible. They are associated with getting back c-diff colitis (perhaps because less stomach acid to keep c-diff in check). If acid-reducing medication is necessary, one can try histamine-related blockers (like Pepcid, Zantac).
3. Oral probiotics can provide some help in preventing c-diff colitis, though not guaranteed.
4. Make sure thorough hand-soap washing is being done when dealing with a patient with c-diff (alcohol based sanitizers don’t work).
5. Make sure room/surfaces of any patient with c-diff are bleach cleaned.
6. Make sure anyone known to have active c-diff diarrhea is contact isolated (gown/glove + water/soap handwashing) in their own room.
And if recurrent c-diff colitis is happening that is not responding to c-diff antibiotics, it is worth considering fecal transplantation (done in some specialized centers) that can work well by better replacing normal gut bacteria.
Of course, make sure to talk to your elder’s doctor about these ideas before implementing them (especially any medication/treatment related ideas). If you have further questions about this topic or others, please feel free to contact me directly.
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
Should my 88 year old dad have Mohs Surgery at his age?
In general Mohs surgery is a safe and effective technique with advantages (compared to standard excisional surgery) in less cosmetic defect... In general Mohs surgery is a safe and effective technique with advantages (compared to standard excisional surgery) in less cosmetic defect w/ better healing and better removal of skin tumors. The anesthesia is local which is simple (as opposed to general anesthesia). It can be done in elderly patients. However, it can take time (a few hours typically) that requires cooperation and patience of the patient. In an elder with dementia (if emotionally labile or non-cooperative) that could be an issue.
Both of you should discuss your concerns with his dermatologist beforehand to make sure he is comfortable with the procedure. If you have further questions about this topic or others, feel free to contact me directly.
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Both of you should discuss your concerns with his dermatologist beforehand to make sure he is comfortable with the procedure. If you have further questions about this topic or others, feel free to contact me directly.
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
What concerns should I have about my loved one having a rear molar extracted?
You’ll want to talk to the dentist or oral surgeon about this for specifics, but in general, risks for a tooth extraction include... You’ll want to talk to the dentist or oral surgeon about this for specifics, but in general, risks for a tooth extraction include complications such as infection, prolonged bleeding, swelling, nerve damage, jaw fracture, sinus damage, damage to nearby teeth, incomplete extraction, and, last but not least, dry socket. Because of advanced age, which by itself is associated with slower healing, weaker immunity, and slightly weaker bones, the risks for dental extraction complications are a bit increased, though not be as bad as it would be for someone who smokes, has diabetes, major organ failure/dysfunction (in heart, lung, liver, kidneys), etc. The risk for jaw fracture/damage would be somewhat higher if actual osteoporosis or osteopenia were present. What is even more important to know is if bisphosphonates (medications for osteoporosis) are being taken due to the risk for osteonecrosis occurring after a dental procedure. If there are reasons to believe a dental extraction may be high risk, it is preferable to have an oral surgeon do the extraction.
Hope this helps a bit. If you have further questions about this topic or others, feel free to contact me directly (see my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Hope this helps a bit. If you have further questions about this topic or others, feel free to contact me directly (see my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
My mom is 91, and she has been having fainting spells. does anyone know anything about this?
“Fainting”, also known as syncope, is an abrupt, temporary loss of consciousness w/ loss of postural tone (i.e. slumping/falling downward)... “Fainting”, also known as syncope, is an abrupt, temporary loss of consciousness w/ loss of postural tone (i.e. slumping/falling downward) that is followed by an immediate recovery (within a few minutes) which is caused by a temporary sharp decrease in blood flow to the brain. It is important to distinguish syncope from other causes of loss of consciousness where recovery is not immediate (e.g. shock or cardiac arrest, coma, stroke, seizures), or where convulsions may occur (i.e. seizures), or where loss of consciousness was preceded by head trauma (e.g. concussion). You may find these distinctions are not always properly made when syncope is discussed (even on medical websites), but making these distinctions helps better understand the disorder and keeps everyone on the same page.
There are several major reasons for syncope. One of the more common reasons is vasovagal (also called neurocardiogenic) syncope which involves a complex neurovascular reflex response that lower blood pressure and decreases heart rate to cause decreased blood flow to the brain which results in fainting. There are a wide variety of commonplace triggers for vasovagal syncope, including prolonged standing, heat exhaustion, fatigue, swallowing, coughing/sneezing, sudden stress/fear, urinating, laughing, etc. This kind of syncope is benign and can be diagnosed by clinical history and, if needed, by a procedure called tilt-table testing.
Another potential cause of syncope is orthostatic-related, in which standing up results in a drop in blood pressure (usually with an increase in heart rate). This can be cause by volume-depleted states (e.g. prolonged vomiting/diarrhea, poor oral intake, substantial acute blood loss), blood pressure medications, or dysfunction of the autonomic nervous system (which controls blood pressure/heart rate) that can occur in disorders like diabetes, spinal cord injuries, parkinson’s disease, and others.
Then there are cardiac causes for syncope that can include arrhythmias (irregular heart rhythms), structural problems (aortic valve disease, cardiac masses), hypertrophic cardiomyopathy, tamponade, or any other cardiac conditions that cause decreased blood outflow from the heart to the point of transient poor blood flow to the brain, resulting in fainting. Again, this is distinguished from cardiac situations that result in prolonged blood flow stoppage (cardiac arrest) or prolonged severe decrease in blood flow (cardiac shock), where one would pass out but not wake back up in a few minutes.
Finally, there is cerebrovascular syncope where there is a transient drop in blood flow to the brain caused by problems at the level of the blood vessels flowing to the brain. Transient ischemic attack (TIA, also known to non-medical people as “mini-strokes”) can less commonly present as syncope, but usually TIA has some neurologic deficits (like paralysis, vision loss, sudden numbness/tingling, confusion, trouble speaking, etc) instead. A vascular steal syndrome (where blood flow to the arm is blocked causing shunting of blood flow away from the brain during arm exercise) is another rare cause of cerebrovascular syncope. Cerebrovascular syncope is to be distinguished from a true stroke where loss of consciousness, if it occurred, would be prolonged.
It is important to talk to one’s doctor about syncope sooner rather than later to find out what’s going on and to make sure there is not some dangerous underlying cardiac or neurological disease. Even if it is caused by a benign condition, syncope by itself, particularly in the elderly, can result in a traumatic injury like head trauma or hip fractures just by virtue of falling down, and that can cause a lot of problems. If syncope is occurring frequently, it would be also important to have fall safety precautions instituted in the place where the elder is living to help prevent injuries.
Hope this helps answer your question. If you have further questions about this topic, feel free to contact me directly (see my profile for details).
Best wishes
Vik Rajan, M.D.
DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
There are several major reasons for syncope. One of the more common reasons is vasovagal (also called neurocardiogenic) syncope which involves a complex neurovascular reflex response that lower blood pressure and decreases heart rate to cause decreased blood flow to the brain which results in fainting. There are a wide variety of commonplace triggers for vasovagal syncope, including prolonged standing, heat exhaustion, fatigue, swallowing, coughing/sneezing, sudden stress/fear, urinating, laughing, etc. This kind of syncope is benign and can be diagnosed by clinical history and, if needed, by a procedure called tilt-table testing.
Another potential cause of syncope is orthostatic-related, in which standing up results in a drop in blood pressure (usually with an increase in heart rate). This can be cause by volume-depleted states (e.g. prolonged vomiting/diarrhea, poor oral intake, substantial acute blood loss), blood pressure medications, or dysfunction of the autonomic nervous system (which controls blood pressure/heart rate) that can occur in disorders like diabetes, spinal cord injuries, parkinson’s disease, and others.
Then there are cardiac causes for syncope that can include arrhythmias (irregular heart rhythms), structural problems (aortic valve disease, cardiac masses), hypertrophic cardiomyopathy, tamponade, or any other cardiac conditions that cause decreased blood outflow from the heart to the point of transient poor blood flow to the brain, resulting in fainting. Again, this is distinguished from cardiac situations that result in prolonged blood flow stoppage (cardiac arrest) or prolonged severe decrease in blood flow (cardiac shock), where one would pass out but not wake back up in a few minutes.
Finally, there is cerebrovascular syncope where there is a transient drop in blood flow to the brain caused by problems at the level of the blood vessels flowing to the brain. Transient ischemic attack (TIA, also known to non-medical people as “mini-strokes”) can less commonly present as syncope, but usually TIA has some neurologic deficits (like paralysis, vision loss, sudden numbness/tingling, confusion, trouble speaking, etc) instead. A vascular steal syndrome (where blood flow to the arm is blocked causing shunting of blood flow away from the brain during arm exercise) is another rare cause of cerebrovascular syncope. Cerebrovascular syncope is to be distinguished from a true stroke where loss of consciousness, if it occurred, would be prolonged.
It is important to talk to one’s doctor about syncope sooner rather than later to find out what’s going on and to make sure there is not some dangerous underlying cardiac or neurological disease. Even if it is caused by a benign condition, syncope by itself, particularly in the elderly, can result in a traumatic injury like head trauma or hip fractures just by virtue of falling down, and that can cause a lot of problems. If syncope is occurring frequently, it would be also important to have fall safety precautions instituted in the place where the elder is living to help prevent injuries.
Hope this helps answer your question. If you have further questions about this topic, feel free to contact me directly (see my profile for details).
Best wishes
Vik Rajan, M.D.
DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
Why are women more prone to auto immune diseases like Rheumatoid Arthritis, Lupus?
That's a good question. And the truth of the matter is . . . we (the medical/scientific community and humanity as a whole) . . .... That's a good question. And the truth of the matter is . . . we (the medical/scientific community and humanity as a whole) . . . don't exactly know.
However, it does have something to do with the fact that men's and women's bodies function differently by virtue of:
(1) genetics - women with two X chromosomes versus men with XY chromosomes, and the X and Y chromosomes do a lot more than just determine gender
(2) hormonal differences - women with estrogen/progesterone cycling every month versus men with testosterone
(3) potential gender-based immunological differences - which would be by virtue of influences of hormonal and genetic differences as described above
That's why medications and diseases are known to act differently in men vs women, and for that matter, in different races. Yet, for a long time historically speaking, medical research assumed that diseases and medications that were not obviously gender-specific would work the same in everyone and they typically used a "70 kg male" as the typical patient for testing purposes. It's been over the last few decades that research has focused more on how the same diseases act differently between gender and race, but there's a long way to go. The next step in future medical research would to discover possible gender/race specific treatments that would work better in a particular group compared to the generic treatment used for everyone.
Hope that answers your question. If you have further questions about this topic or others, feel free to contact me directly (see my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
However, it does have something to do with the fact that men's and women's bodies function differently by virtue of:
(1) genetics - women with two X chromosomes versus men with XY chromosomes, and the X and Y chromosomes do a lot more than just determine gender
(2) hormonal differences - women with estrogen/progesterone cycling every month versus men with testosterone
(3) potential gender-based immunological differences - which would be by virtue of influences of hormonal and genetic differences as described above
That's why medications and diseases are known to act differently in men vs women, and for that matter, in different races. Yet, for a long time historically speaking, medical research assumed that diseases and medications that were not obviously gender-specific would work the same in everyone and they typically used a "70 kg male" as the typical patient for testing purposes. It's been over the last few decades that research has focused more on how the same diseases act differently between gender and race, but there's a long way to go. The next step in future medical research would to discover possible gender/race specific treatments that would work better in a particular group compared to the generic treatment used for everyone.
Hope that answers your question. If you have further questions about this topic or others, feel free to contact me directly (see my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
Mom is developing a sore spot on her butt cheek. I have tried a number of creams but it isn't getting better....
Assuming one is dealing with a mild bed sore and that it is not infected, antibiotic creams, antifungal creams, and diaper rash creams will... Assuming one is dealing with a mild bed sore and that it is not infected, antibiotic creams, antifungal creams, and diaper rash creams will not be effective. Cleansing solutions (like betadine or peroxide) can make it worse.
Avoiding pressure on the sore is the most important thing (frequent turning every 1-2 hours if lying down, using an air/foam mattress, or any other ways to avoid her putting pressure on the sore).
Making sure the sore is covered with a dressing (such as a transparent wound dressings) for wound protection and mild moisture retention, and making sure the area on and around the sore is clean is the second thing (urine and stool will further irritate and potentially infect the sore).
Make sure nutrition is good and no smoking is occurring.
Make sure her doctor is aware of this issue and evaluates the sore. It would be useful to be aware of wound care experts to help guide you and your mother in case the sore becomes more problematic, but typically if proper measures are taken and the sore is mild (i.e. no skin breakage or minimal breakage), the sore can heal over several weeks.
Hope this helps you out. If you have further questions about this topic, feel free to contact me directly (see my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Avoiding pressure on the sore is the most important thing (frequent turning every 1-2 hours if lying down, using an air/foam mattress, or any other ways to avoid her putting pressure on the sore).
Making sure the sore is covered with a dressing (such as a transparent wound dressings) for wound protection and mild moisture retention, and making sure the area on and around the sore is clean is the second thing (urine and stool will further irritate and potentially infect the sore).
Make sure nutrition is good and no smoking is occurring.
Make sure her doctor is aware of this issue and evaluates the sore. It would be useful to be aware of wound care experts to help guide you and your mother in case the sore becomes more problematic, but typically if proper measures are taken and the sore is mild (i.e. no skin breakage or minimal breakage), the sore can heal over several weeks.
Hope this helps you out. If you have further questions about this topic, feel free to contact me directly (see my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
My mom had constant symptoms of a urinary tract infection.Does anyone have experience with this?
A bit more clarification would be important to be able to give you better information, but I think I now know what you are implying. First... A bit more clarification would be important to be able to give you better information, but I think I now know what you are implying. First off, one would have to know what is the basis for her doctors treating the UTI in the first place. Presumably they did a urine dipstick which would have been suggestive for UTI, although it is not diagnostic unless you have a urine culture to back it up, which takes several days to get a result for. Then you may be saying that the urine culture has kept coming back negative. Is that correct?
As far as what's going on with her "vaginal burning sensation", it is important to distinguish whether it is actually vaginal or urethral, which can be hard to do considering they are in the same general region. A urethral burning sensation will worsen during urination because urine is acidic and irritates any inflamed tissue that is present. Then it would be important to distinguish whether that burning with urination is felt near the urethral opening or further inside. There are other potential causes for "urethritis" other than urinary tract infection. Further history and examination would be required by her doctor to sort it out. On the other hand, if there is no burning felt with urination, it may be more of a vaginal irritation, which has its own set of potential causes and could be evaluated by a gynecologist.
The problem with trying to figure this out in an elder with dementia is that she may not be able to tell you where and when she feels the pain, but if you can elicit that difference out of her during one of her more lucid periods, that would be very helpful.
One thing for any elder with dementia and burning sensation, whether vaginal or urethral, you want to make sure hygeine down there is very good and that wiping is done front to back. Having leftover stool/urine residue can be quite irritating on its own.
If you have further questions about this topic, feel free to contact me directly.
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
As far as what's going on with her "vaginal burning sensation", it is important to distinguish whether it is actually vaginal or urethral, which can be hard to do considering they are in the same general region. A urethral burning sensation will worsen during urination because urine is acidic and irritates any inflamed tissue that is present. Then it would be important to distinguish whether that burning with urination is felt near the urethral opening or further inside. There are other potential causes for "urethritis" other than urinary tract infection. Further history and examination would be required by her doctor to sort it out. On the other hand, if there is no burning felt with urination, it may be more of a vaginal irritation, which has its own set of potential causes and could be evaluated by a gynecologist.
The problem with trying to figure this out in an elder with dementia is that she may not be able to tell you where and when she feels the pain, but if you can elicit that difference out of her during one of her more lucid periods, that would be very helpful.
One thing for any elder with dementia and burning sensation, whether vaginal or urethral, you want to make sure hygeine down there is very good and that wiping is done front to back. Having leftover stool/urine residue can be quite irritating on its own.
If you have further questions about this topic, feel free to contact me directly.
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
What is MRSA? How dangerous is it?
MRSA - methicillin-resistant staphylococcus aureus; resistant to pencillin/cephalosporin based antibiotics, as opposed to MSSA... MRSA - methicillin-resistant staphylococcus aureus; resistant to pencillin/cephalosporin based antibiotics, as opposed to MSSA (methicillin-sensitive staph aureus) which is sensitive to those type of antibiotics
Treatment for MRSA typically includes vancomycin if needing an intravenous antibiotic. If only needing an oral antibiotic, sulfa drugs (and sometimes clindamycin) are typically the first ones used.
The seriousness of an MRSA infection depends on the location and severity. For example, a mild MRSA cellulitis (a type of skin infection) or skin abscess, may be easily treated with a short course of sulfa drugs. On the other hand, MRSA septicemia (bacteria in the bloodstream) can be life threatening and would require intravenous vancomycin.
What it means for your situation depends on the specific circumstances, including type and severity of MRSA infection. I hope the information provided above helps you out. If you have further questions about this, please feel free to contact me directly (see my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Treatment for MRSA typically includes vancomycin if needing an intravenous antibiotic. If only needing an oral antibiotic, sulfa drugs (and sometimes clindamycin) are typically the first ones used.
The seriousness of an MRSA infection depends on the location and severity. For example, a mild MRSA cellulitis (a type of skin infection) or skin abscess, may be easily treated with a short course of sulfa drugs. On the other hand, MRSA septicemia (bacteria in the bloodstream) can be life threatening and would require intravenous vancomycin.
What it means for your situation depends on the specific circumstances, including type and severity of MRSA infection. I hope the information provided above helps you out. If you have further questions about this, please feel free to contact me directly (see my profile for details).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The health information provided above is FOR EDUCATIONAL PURPOSES ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. No doctor-patient relationship is established with this interaction. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
Question
My mom had constant symptoms of a urinary tract infection.Does anyone have experience with this?
Let me correct myself, the article has just been published and can be found on my profile. If you have further questions beyond what is... Let me correct myself, the article has just been published and can be found on my profile. If you have further questions beyond what is addressed in the article, let me know. see more
Question
My mom had constant symptoms of a urinary tract infection.Does anyone have experience with this?
This question is well-timed for an article I just submitted yesterday to agingcare.com regarding management of recurrent urinary tract... This question is well-timed for an article I just submitted yesterday to agingcare.com regarding management of recurrent urinary tract infections in elderly patients with dementia. It is quite comprehensive and should help you out. It will be published anytime in the next couple of days, but if you would like to know more about it sooner, you are welcome to contact me directly (see my profile for details).
Best wishes,
Vik Rajan, M.D. see more
Best wishes,
Vik Rajan, M.D. see more
Question
My mom sees ants. What should I do?
Based on the limited information provided, possbilities include an actual vision disturbance that would need to be evaluated by an eye... Based on the limited information provided, possbilities include an actual vision disturbance that would need to be evaluated by an eye doctor, or a visual hallucination that could be a sign of dementia or delirium, depending on the onset, length of time, and accompanying symptoms. Ultimately, this problem should be discussed with your mother's doctor, but if you have further questions about this topic, you are welcome to contact me directly (see my profile for information).
Best wishes,
Vik Rajan, M.D.
DISCLAIMER: The health information provided above is for EDUCATIONAL PURPOSES ONLY and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION. No doctor-patient relationship is established with this interaction. The information provided is not meant to diagnose or treat any illness or disease and is not a substitute for the evaluation and advice of your personal physician or other medical professional. While striving to be factual and exact, no warranties are made regarding the accuracy of the information provided. You are always advised to consult with your personal physician about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided here is not advised and would be solely at your own risk and liability. see more
Best wishes,
Vik Rajan, M.D.
DISCLAIMER: The health information provided above is for EDUCATIONAL PURPOSES ONLY and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION. No doctor-patient relationship is established with this interaction. The information provided is not meant to diagnose or treat any illness or disease and is not a substitute for the evaluation and advice of your personal physician or other medical professional. While striving to be factual and exact, no warranties are made regarding the accuracy of the information provided. You are always advised to consult with your personal physician about any health concerns that you have and about any of the information provided here. Sole reliance on the information provided here is not advised and would be solely at your own risk and liability. see more
Question
Is it Attention Deficit Disorder when people only pay attention to things that interest them?
With regards to your question, ADD is a subtype under the broader category of ADHD (attention deficit hyperactivity disorder) that is... With regards to your question, ADD is a subtype under the broader category of ADHD (attention deficit hyperactivity disorder) that is characterized by inattention, distractibility, disorganization, and forgetfulness. It may be seen in adults (or even children) who do not present with the hyperactivity features of ADHD more commonly seen in the pediatric population. The features of ADD, as defined in the DSM IV are the following:
1. Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
Often has difficulty sustaining attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
Often has difficulty organizing tasks and activities
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools)
Is often easily distracted by extraneous stimuli
Is often forgetful in daily activities
These symptoms must be (1) seen in two or more settings (work, school, home, or other social settings), (2) cause significant impairment in academic, occupational, or social life, and (3) not be better explained by other psychiatric or medical conditions, such as mood disorders, psychosis, schizophrenia, dementia, intoxication, delirium, etc.
I hope this answers your question to your satisfaction.
Best wishes
DISCLAIMER
Though the author of this information is a licensed physician, the information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
1. Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
Often has difficulty sustaining attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
Often has difficulty organizing tasks and activities
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools)
Is often easily distracted by extraneous stimuli
Is often forgetful in daily activities
These symptoms must be (1) seen in two or more settings (work, school, home, or other social settings), (2) cause significant impairment in academic, occupational, or social life, and (3) not be better explained by other psychiatric or medical conditions, such as mood disorders, psychosis, schizophrenia, dementia, intoxication, delirium, etc.
I hope this answers your question to your satisfaction.
Best wishes
DISCLAIMER
Though the author of this information is a licensed physician, the information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more
How do you know what stage your loved one is in, with Dementia?
1. One way is a 7 stage process
A link to the the Alzheimer's Association will provide more details: http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
2. The other way is a simpler 3 stage process, which can be described in the following link:
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Dementia_through_all_its_stages
Whatever the stage of dementia your loved one is in, it is important to discuss this with his/her physician and start planning ahead as the dementia progresses. Consulting a geriatric care manager can also help with the planning.
Best wishes,
Vik Rajan, M.D.
DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability. see more