PMS, Renal Artery Stenosis, Allergy Testing & More
Q. I suspect my severe PMS symptoms may actually be premenstrual dysphoric disorder (PMDD). Are there any diet adjustments or vitamin supplements that could minimize my symptoms?
A. The cause of PMS/PMDD is not clear, so symptom relief is the main goal of treatment. Counseling and SSRIs (selective serotonin reuptake inhibitors) are considered first-line treatment for PMS/PMDD. Counseling can include cognitive behavioral therapy (CBT), self-help support groups, and stress/anger management. Fluoxetine and sertraline are SSRIs approved by the U.S. Food and Drug Administration (FDA) for treatment of PMDD. However, many women prefer a more holistic approach to treatment, which can include lifestyle changes like getting regular exercise, stopping smoking, abstaining from alcohol, having a regular sleep schedule, and limiting salt, refined sugars, and caffeine. Several nutritional supplements have also been shown to reduce symptoms, although they have not been approved by the FDA for use in PMDD. Some supplements that may improve PMS/PMDD are vitamin B6 (100 mg/day), vitamin E (600 IU/day), calcium carbonate (1200-1600 mg/day), magnesium (500 mg/day), and tryptophan (6 grams/day). Finally, evening primrose oil (500-3000 mg/day) and chaste tree berry (30-40 mg/day) are two herbal therapies for PMDD that may help breast tenderness but have not been approved by the FDA. Please talk to your primary care provider (PCP) before starting a new exercise program or medication.
Q. My mother is at risk for renal artery stenosis. How can I help her adopt a heart-healthy lifestyle as an older adult?
A. Renal artery stenosis is one of the treatable causes of unexplained hypertension, a leading cause of heart disease in the U.S. Supporting your mother in adopting a heart-healthy lifestyle can significantly reduce her risk of developing renal artery stenosis. In the first place, start by encouraging a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while limiting sodium to help manage blood pressure. Promote regular physical activity like walking or swimming, which is both heart-friendly and low-impact. Monitor her blood pressure regularly and ensure she follows her doctor’s advice regarding medications. Stress management is crucial; introduce her to relaxation techniques like deep breathing or meditation. If she smokes, offer support to help her quit, as smoking is a major risk factor. Lastly, consider joining her in these activities to make the lifestyle changes more enjoyable and sustainable. Your support and encouragement can make a significant difference in your mother’s heart health.
Q. My daughter is worried about going to the clinic for an allergen skin test. What can I do to support her and help her stay calm during the procedure?
A. To support your daughter during her allergen skin test, start by explaining the procedure in simple terms, letting her know that it’s quick and only causes mild discomfort. Stay calm and reassuring, as your demeanor will help her feel more at ease. Skin testing should always start with a scratch test, which is not painful, and only itches if positive. In older children (usually 6 or older), we may consider performing intradermal skin tests which do require small needles—this is only done if the scratch tests are inconclusive. Bring a favorite toy or book to the clinic for comfort, and engage her in a distracting activity like a game or conversation during the test. Teach her some deep breathing exercises to help manage anxiety. Additionally, promising a small reward afterward, like a treat or a fun activity, can give her something positive to focus on. Most importantly, be there with her, offering encouragement and comfort throughout the process.
Q. I have a couple of moles I’m concerned about, but I’ve never been to a dermatologist before. What can I expect during my first appointment?
A. During your first visit to the dermatologist, you will typically undergo a full body skin check to make sure your skin lesions look normal. Patients change into a gown, and then their skin is examined from the scalp to the toes. Any concerning skin lesions are inspected more closely with a handheld tool called a dermatoscope. It uses a specialized filter and magnification to help determine if the skin lesion looks suspicious for skin cancer. If there is a suspicious lesion, a skin biopsy is performed, and precancerous lesions are treated the same day. Many patients are nervous for this type of exam but find the experience to be pretty easy with the help of our kind and reassuring team!
Q. I’m concerned about my 4-year-old son’s extremely picky eating. Do you have any advice on introducing new foods to an anxious child?
A. The most important thing to remember is that you want to minimize pressure. Pressuring your child to eat a new food before they are intrinsically ready creates more stress. Help them build a relationship with food through play and exploration! Play with the food: Get messy! Exploring food through sensory play will lead to higher motivation to eat it. Use a carrot to draw ranch dressing pictures! Talk about the food: Instead of using pressure-based phrases like “Just take a bite,” describe what it looks like, feels like, sounds like, smells like, etc. Model: Show them ways to interact with the food outside of eating it. Involve the child in preparing and serving the food. Family meals are key! Research shows that repeated exposure is one of the most reliable ways to increase food acceptance. Offer new foods in small amounts, and don’t give up!