Category Archives: Women’s Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #54: ORAL THRUSH


Thrush is an infection of the mouth with an organism called candida albicans. It is most common in the newborn and with young children, but can occur in adults if they have an immune deficiency,  use corticosteroid inhalers, are diabetic, or take broad-spectrum antibiotics.

A combined mother–child problem can occur with breast-feeding mothers in the newborn period. The mother’s  nipples may become infected, giving it to the baby, and they can pass back and forth. A baby who has thrush is also susceptible to diaper rash caused by candida.

There is a sense of irritation and some pain associated with thrush in the mouth, the diaper area, and the nipples. Thrush appears as cottage cheese-like areas on the throat and tongue.

The normal immunity usually keeps thrush at bay. In a newborn, however, the immune system is not fully developed. Sometimes the hormones of pregnancy facilitate thrush in the mother. Diabetes and smoking can also allow thrush.

Sometimes the thrush infection will go down into the swallowing tube, the esophagus, and produce inflammation. This can cause pain on swallowing, and is most common in AIDS and other immunodeficiency states.

Treatment of surface candida infections like throat is usually with Mycostatin– containing mouthwashes or creams. If it spreads beyond the surface, however, you will need more potent medications. Candida albicans is everywhere, and your immunity is your main defense against it.

Keep your immunity as solid as possible naturally, with good sleep, diet and exercise.

—Dr. C.

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Brain Health: How To Recognize Strokes (Video)

If you don’t know the signs of a stroke, you’re not alone. Thirty percent of people under the age of 45 don’t either. The key is to B.E. F.A.S.T. Learn how this acronym can help you save a life. The information in this video is accurate as of 9.17.21 and is for information purposes only. Consult your local medical authority or your healthcare practitioner for advice. Resources: Stroke: Causes and Prevention: https://cle.clinic/3hIHtab Stroke Signs & Symptoms: https://cle.clinic/3oLyQhc Stroke Risk Factors: https://cle.clinic/3hJ8r1s

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #53: GRAVES’ DISEASE

Graves’ disease is the most common cause of hyperthyroidism. Hyperthyroidism is an over activity of the thyroid gland, and can also be produced by an overgrowth in the gland called an adenoma.

The thyroid gland is an H-shaped structure sitting astride the wind pipe. If a physician palpates the front of your neck, she is most likely trying to see if she can feel the thyroid gland. Enlargement of the grand can interestingly be produced by either overactivity or under activity.

Graves’ disease is an auto immune disease, where the antibodies produced attach to the TSH receptor on the thyroid gland, stimulating overactivity.

Many  metabolic processes are regulated by the thyroid gland, and increased activity produces difficulties like insomnia, fast irregular heartbeat, shaking of the hands, heat intolerance, and irritability. Other symptoms are protrusion of the eyes, fatigue, muscle weakness, and unexplained weight loss.

The doctor suspects the disease because of the symptoms, and must do blood tests and perhaps imaging tests to make the diagnosis. Treatment consists of decreasing thyroid activity, either by radiation techniques, anti-thyroid chemicals, or surgery.

It is very difficult to reduce thyroid activity in exactly the right amount, so that thyroid administration will be necessary. This can be tricky, and requires several visits for adjustment.

The ultimate cause of Graves’ disease is unknown. The immediate cause is thyroid stimulating immunoglobulin. Graves is an auto immune disease, and is more common in people who suffer from other autoimmune diseases, such as type one diabetes, rheumatoid arthritis, or inflammatory bowel disease. The doctor will question you about some of these diseases.

Both causes of hyperthyroidism have occurred in friends of mine. The friend with the adenoma had an easier time with medication adjustment, and had no other problems. The one with the Graves’ disease has had a difficult time getting a proper dose of thyroid medication, and she has other problems with auto immunity. Women typically have more  autoimmune problems.

Interestingly, the commonest cause of low thyroid activity is also an autoimmune disease. Some of the symptoms of low thyroid are the opposite of excessive thyroid activity; sleeping is excessive, there is sensitivity to cold, unexplained weight gain, and sluggishness.

Check with the doctor if you have any of the symptoms mentioned.
There is a Cleveland clinic discussion of Graves’ disease following this article.

—Dr. C.

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Health: Preventing Deadly Falls Among The Elderly

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #52: RHEUMATOID ARTHRITIS

Painful, stiff joints are almost the rule as we get older, it seems. Both osteoarthritis and rheumatoid arthritis contribute to that eventuality. Osteoarthritis typically worsens as we get older, whereas rheumatoid arthritis starts in middle age.

Rheumatoid arthritis is much more severe than osteoarthritis, since it is an autoimmune condition with an episodic inflammatory component. A recent medical study of different blood substances found that the “metabolome” has many markers for exacerbation of rheumatoid arthritis.

The main test currently being used to show exacerbation is CRP, C-reactive protein. Rheumatoid factor tests, such as anti-CCP, are used to confirm the diagnosis.

Rheumatoid arthritis tends to involve the small joints of the hand, and osteoarthritis the larger joints, such as the hips and knees. I go a bit against the grain, having diagnosed osteoarthritis of my fingers and toes, more typical of RA, but, even at the age of 89, my large joints are still in good shape, even with a lot of walking. Since walking is thought to increase the perfusion of joint fluid to nourish the knee cartilages, perhaps I should say BECAUSE of walking. Running tends to wear the knees and hips out, because of high impact on the joints.

The inflammation of rheumatoid arthritis tends to wax and wane, but during an exacerbation can be quite incapacitating. The interleukin TNF seems instrumental in causing these flares, and antibodies directed towards TNF, such as etanercept, has been a helpful treatment. This injection is also given for other inflammatory, autoimmune conditions such as psoriasis, particularly psoriatic arthritis, and the inflammatory bowel diseases.

Almost half the people who have rheumatoid arthritis also experience signs and symptoms in other tissues, such as the skin, eyes, heart, and lungs. It is truly a systemic, autoimmune disease.

For more information please consult the following mayo clinic article on rheumatoid arthritis.

—Dr. C.

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DR. C’S JOURNAL: AMBLYOPIA

Amblyopia is an example of how the body suppresses or gets rid of activity that is not used. Amblyopia “ex anopsia” is the leading cause of poor vision in children, and the most common reason is a “lazy eye”. If the eyes do not work together for binocular vision, the weaker of the two eyes has suppressed development and eventually eyesight is lost.

I have a friend who was going in the pilot training, it was found to lack good depth perception, and could not proceed. He now complains occasionally of double vision, and may be an example of the suppressed eye with lack of binocular vision.

I have a muscle in balance which causes a rotation of my eye so that it’s hard to fuse on a horizontal linear object. I was probably able to fuse  when I was younger and avoid this loss of vision in the weaker eye.

So be on the alert for a squint, or wandering eye in children. Get them in early for treatment, the earlier the better, and it must take place before age 5 to 7.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #51: PSORIASIS (SKIN DISEASE)

Psoriasis is a common skin disease, thought to be in the auto immune category. One of the main elements supporting auto immunity is it’s frequent association with an arthritis, which can be severe.

Eczema (atopic dermatitis) is both a skin and an allergic disease, and looks a bit like psoriasis. In my practice I saw many patients with psoriasis, perhaps people confusing allergy and dermatology.

Both psoriasis and eczema have a red inflamed base, with many little silvery scales of skin on top. These patchy areas tend to be on the outside bends of the elbows and knees in psoriasis, contrasting with eczema, where the dermatitis is located on the inside of the bends. Eczema is a lot more itchy.

The cause of the skin lesions in psoriasis is thought to be due to an interleukin called TNF, which calls to the area a number of inflammatory cells which, in addition to the thickened skin area and excess of epithelial cells, leads to a characteristic appearance under the microscope; biopsies are uncommonly needed when there is doubt about the diagnosis.

In its severe form, psoriasis can be very disfiguring, irritating, painful or itchy, and life altering. You have probably seen advertisements on TV.
Psoriasis has accumulated many different treatments, since it has been recognized and treated over such a long period of time. The basis of many effective treatments is “shotgun” systemic  immunosuppression, which reduces the autoimmune inflammatory reaction, but with side effects.

Topical Cortisone cream is the cheapest reasonably effective treatment, and works for mild cases. More recent treatments are specifically aimed out the interleukins which cause the disease, like TNF.

Please refer to the mayo clinic article for more pictures, and discussion of treatment.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #50: HASHIMOTO’S DISEASE

Hashimoto’s thyroiditis is the most common cause of thyroid deficiency. As a practicing allergist, I would routinely palpate the front of the neck area around the windpipe where the thyroid is located. Every few months or so, I would feel an enlarged thyroid, order a high sensitivity TSH test, and, if positive, check for thyroid antibodies.

This saved my patients from having to go through the symptoms of underactive thyroid(hypothyroidism), since I detected the problem at an early stage, before symptoms developed.

Major symptoms of an underactive thyroid include fatigue, increased sensitivity to the cold, constipation, unexplained weight gain, and depression. Be sure to seek medical care if you are suffering from these symptoms.

An elevated LDL cholesterol is one of the biochemical results of hypothyroidism, and can lead to heart problems. I have been hearing that the routine physical examination it is becoming less common, and may even be replaced by telemedicine. The early detection of Hashimoto’s thyroiditis will be one of the casualties, since the doctor can’t find an enlarged thyroid unless she palpates for it.

You might wonder why an enlarged thyroid gland is associated with decreased thyroid production. The way it works is that the pituitary gland at the base of the brain detects a decrease in thyroid production. It responds by secreting a thyroid stimulant, TSH. The TSH causes enlargement of the thyroid gland, leading to the association of an elevated TSH with decreased thyroid activity.

Hashimoto’s  is one of the large number of autoimmune diseases. A person who has an autoimmune disease, such as rheumatoid arthritis, type one diabetes, or celiac disease, is more likely to develop others, and should be alert to that possibility.

Finding that you have  low thyroid activity is only part of the problem. It takes several visits plus input from both patient and doctor in order to arrive at the proper medication schedule. There are several different thyroid medications, and people respond differently to them.

Be on the alert for hypothyroidism. It can sneak up on you.

—Dr. C.