Ask the Doctor: Late Summer 2018

Q. Osteoporosis is common in my family. How often should I get my bone density levels checked, and what does that involve?

A. Osteoporosis is a disease of progressive bone loss associated with an increased risk of fractures. The disease often develops unnoticed over many years, with no symptoms or discomfort until a fracture occurs.  If no risk factors are present, women at age 65 and men at age 70 should get their bone density levels checked.

If women or men ages 50 to 69 have any risk factors for serious bone loss, for example a family history of osteoporosis, they should get a DEXA (dual-energy X-ray absorptiometry) scan. DEXA scans are recommended every two to three years after age 50 if you’ve been previously diagnosed with bone loss or osteopenia (a bone condition characterized by bone loss that’s not as severe as in osteoporosis). A bone density (DEXA) scan is a simple, non-invasive, and painless exam. The standard test uses a low dose X-ray to detect signs of bone thinning and mineral loss.

Q. My kids love spending time outside during the summer. How can I tell the difference between an allergic reaction and a normal reaction to an insect sting?

A. The most common stinging insect allergies are from fire ants, honeybees, wasps, hornets, and yellow jackets. Most of the time, these insects trigger local reactions that are very painful and itchy, but not particularly concerning from a medical standpoint. On the other hand, some people may experience ‘systemic’ symptoms after being stung including shortness of breath, coughing, wheezing, lip swelling, hives (rash), nausea, and vomiting. In extreme circumstances, a combination of these symptoms can occur (anaphylaxis), which is life threatening. Children and adults that have had symptoms of this severity should be evaluated for venom allergy, because there is about a 60% chance that future stings can cause more severe reactions. This evaluation should include both skin tests and blood tests. If the tests are positive, allergic individuals should be prescribed a device that injects adrenaline (EpiPen or AUVI-Q), which should be carried at all times. Venom immunotherapy (venom shots) is also an option for patients with a life-threatening venom allergy. Venom shots can reduce the risk of life-threatening reactions to insects to less than 5%.

Q. I’ve heard if you have a toothache, you should place an aspirin between the affected tooth and the gum. Is this true?

A. No, you should never place aspirin next to your tooth! Aspirin contains an ingredient called salicylic acid that can burn the gum tissue. This not only will not help the toothache go away, but can also damage the gum tissue causing even more harm. Until you address the reason behind the pain, a toothache will not just “go away.” Pain is an indicator from your body that something is not right, and the only way to discover the source of the pain is to see your dentist. Toothaches can be caused by many things. Some require a simple fix, while others might need advanced care. Either way, the pain will only be relieved when the underlying cause is discovered and treated. So, if you use aspirin, swallow it – never place it in your mouth next to a tooth.

Q.  My children play sports each summer and I’m always worried about concussions. What are the signs I should look out for?

A. Symptoms of concussion may include headache, difficulty concentrating, fatigue, drowsiness, dizziness, fogginess or confusion, balance problems, light sensitivity, and difficulty with memory. Most concussions do not involve a loss of consciousness, so checking for these symptoms is important if you suspect or know that your child had a hit to the head or experienced a hard impact during play. If you observe any of these symptoms, especially if your child is not acting like himself or herself, it is best to seek medical attention from a physician for further evaluation. Your physician may refer your child for physical therapy if symptoms do not resolve in a timely manner or if a quicker return to play is desired. It is very important to avoid returning to play prior to resolution of symptoms.

Q. I’ve often heard Alzheimer’s and dementia used interchangeably. Are they the same thing?

A. Dementia is a general term for symptoms caused by damage to nerve cells in the brain. It can cause problems with memory and communication in addition to personality changes. Causes of dementia include brain injuries, Parkinson’s disease, and vascular disease.

Alzheimer’s is a specific kind of dementia. A brain affected by Alzheimer’s has experienced damage and even death of the nerve cells. Alzheimer’s dementia is diagnosed by excluding other medical conditions including infection or vitamin deficiency via blood tests. Usually, imaging such as an MRI is performed to exclude tumor, stroke, or other structural changes in the brain as well.

The good news is research is underway on how to better treat and prevent Alzheimer’s. For now, some recommendations to help reduce risk include staying physically active, eating a healthy diet, and keeping the brain active. Vitamin D, folic acid, and fish oil also keep the brain healthy.