October 2009

Q. You are always my go to Doc when I need an important opinion. How do you feel about this vaccine? I am in front of young children as a substitute teacher (on an occasional basis), my son Jonathan is 25 and my daughter Allison is 22. Paul has no unusual situtations.

A. You should get in the "middle" of the line - and looks like there won't be enough for another month to go around. Although I think it is as safe as any other vaccine I would follow recommendations - give to high risk pregnant women, immune compromised, caregivers of the vulnerable - and then perhaps your kids as they are under 26 and in the target group...good for you (and me) is that for once we are too old to have much risk.

I WOULD get the seasonal flu however no matter...and this too might help boost all our flu immunity.

Q. Dr. Marie's book says that having sex is good for health especially as we age, and I have heard that before. Does that mean specifically having intercourse? Or can it mean self-stimulation for the woman who doesn't have a partner. In other words, is it the orgasm that promotes the good health benefits, or is it the act of engaging with the other person?

A. Sorry I am so delayed in answering your question. It has been hard for researchers to separate out the various aspects of sex and health. On the one hand, having an intimate relationship, including a sexual relationship, with another has long been linked to good health. Sex may be a surrogate marker for intimacy and being connected and not the critical ingredient. On the other hand, the physical act of orgasm (however achieved) is also linked to release of neurotransmitters and other bodily changes that apparently promote good health too - one becomes relaxed, is often able to sleep (clearly linked to great health outcomes), etc.

I often say that whatever helps you to get a restful nights sleep of 7-8 hours and keeps you feeing good and connected during the day is probably some of the most factors we can hope to achieve for our health.

Q. 1-I have functional impairments, that limit my daily activities, and they have been getting progressively worse.

a)-I have difficulty turning over in bed (because my upper back is rigid)

b)-I can not stand or walk too long (because weight bearing makes my leg muscles get stiff, and heavy and burning pain.) My shoulder muscles were not afected until nine months ago. And now they also get stiff and sore, when I use them.

c)-I can not get in and out of the bathtub, or climb a few steps (because my knees are sore and weak, and my legs feel heavy-like cement.) d)-I have severe tiredness and feel ill all day long (I fall asleep in mid afternoon, and I can not make it through the day.)

My doctor said my CBC, MET and TSH tests were normal. He also said the following tests were abnormal, but he could not explain my disabilities.

LDH: 327 (reference 100-200)

Compliment Def Assay: 256 (reference low >60.)

RAJI: 78 (reference <63.)

Blood: Alpha 2 globulin .23 (reference .11-22) Blood gammopathy

Urine: protein

Do I need other tests? I also have pain & stiffness in my neck, sacroiliac, hips, and knees, and I get daily rashes.

Am I contageous? What specialist should I see?

A. Sorry for my delay in answering you. It does sound like you have some rheumatologic problem - either an autoimmune condition or some other chronic blood or inflammation illness. Have you seen a rheumatologist? Has your sedimentation rate been checked? How old are you? Did they consider PMR/polymyalgia rheumatica, a condition of older adults? From the sounds of your complaints, which are worsening, and your abnormal inflammatory factors in your blood, I would think it is important that you get the right diagnosis and find the right treatment.

Hopefully at this point you have gotten to the bottom of this. Again, I am so sorry I didn't answer you sooner and I can only imagine how frightened and frustrated you must have felt.

Q. Last week a friend forwarded to me an e-mail that was sent to Dr. Savard from a woman in upstate New York concerning her 15-year-old daughter and a case of undiagnosed Lyme disease. In it she mentioned a neurologist and how helpful this doctor had been, especialy regarding her daughter's inability to feel her legs or walk.

We are having the same situation with our 13-year-old son, who has been suffering since early summer. He is currently unable to feel his legs and he is unable to walk. This woman mentioned a drug called topromax and that it is helping her daughter. Can you tell me what this drug is and what it does? I would like to mention it to our neurologist today.

A. I am so sorry to hear about your son. Does he have lyme disease? Have you seen a superb neurologist to be sure of the diagnosis? Where are you located?

Topamax was originally developed as antiseizure medication but has also been useful to prevent chronic migraine as well. Drugs such as Topamax are no being tested/used in a host of neurologic conditions but I guess my first concern is that you have the correct diagnosis.

Let me know if I can offer suggestions....will try.

Q. I just turned 50 and am in peri-menopause. I am reading Dr. Savard's book and am finding it a great help to me! However, I need to know how many days to take the prometrium. I just started the Vivelle-Dot transdermal and cyclical prometrium. My doctor (a man) whom I had to tell I wanted the projesterone separate from and cyclically with the Vivelle patch, has me taking it the first 10 days of the month. I've done it once now and stopped after the 10th. Well, yesterday the 11th and today the 12th, I am still bleeding. So I've been bleeding in some form or another for 12 days! Could I possibly get some feedback on this since I am following the advice in Dr. Savard's book? Can I just take the prometrium the first 5 days of the month?

A. It is not unusual for a woman at perimenopause to have fairly heavy bleeding from the Prometrium (progesterone). Depending on how much of a lining your body has build up already in the perimenopausal period - the heavier you are the greater the lining build up oftentimes is. By taking the Prometrium 200 mg capsules (yellow ones) for AT LEAST 10 to 12 days each month you will eventually thin out the lining of the uterus (the progesterone actually thins the lining from the estrogen buildup) and have only spotting or no bleeding at all (some months I spot for a few days, others I don't get any signs of blood). How much Vivelle are you on? 0.05 mg is usual starting dose at menopause - and of course the higher the estrogen dose the more the expected bleeding too.

Although bleeding is clearly a nuisance, it will almost certainly lessen quite a bit and hopefully almost stop - but either way - from the extensive research on hormones the cyclic way of taking progesterone is most "natural" and seems to effect the breast a lot less too. Yes, taking both estrogen and smaller dose of prometrium every day would eventually guarantee no bleeding - but in my opionion - this is less than ideal because of the constant daily prometrium rather than cyclically (as nature intended and research seems to bear this out). A vaginal ultrasound would also tell your doctor how thick the uterine lining is at some point if you continue to bleed - and as long as the lining is thin - this is great peace of mind too.

Hope this answers your questions.