Q: My doctor checked my vitamin D levels and told me to take 1000 units of vitamin D daily. Is this a good idea?
Dr. Chris Prakash
A: Your doctor appears to be on the right track. Most of us know we need vitamin D for strong bones. Vitamin D allows your body to absorb calcium. Without it, your bones can become brittle and weak (osteoporosis).
Now it appears that this nutrient, or rather a lack of it, may play a role in several diseases. The number of research studies on vitamin D has soared in recent years (almost 4000 citations last year). The following disease associations have been postulated based on research:
So, it appears that Vitamin D may be more important to our health, than we realized.
How can you get Vitamin D?
Your body produces its own vitamin D. However the trick is exposing some portion of your skin to direct sunlight for 15 to 30 minutes a few days a week. But the UV rays that stimulate production of vitamin D can also cause skin cancer. So, most experts don’t recommend getting your vitamin D from sun exposure. One way to get vitamin D is through your diet. In the U.S., nearly all milk is fortified with vitamin D, and many brands of orange juice are, too. Even ready-to-eat breakfast cereals can contain a healthy dose. Fish, especially fatty fish like salmon, tuna, mackerel, and sardines, are a good source of vitamin D. Other food sources of vitamin D include egg yolks, cod liver oil, beef liver, margarine, yogurt, and some cheeses.
What should your vitamin D levels be in the blood?
The level of Vitamin D can be checked by a simple blood test – 25-hydroxyvitamin D test, also called 25(OH) D. Ask your doctor to order the right test (not the 1,25-dihydroxy-vitamin D). Most commercial labs still state the normal range as 20 – 56 ng/ml. However, most experts believe that 25(OH) D levels should be above 50 ng/ml (125 nmol/L) year-round, in both children and adults (Bruce Hollis, Robert Heaney, Neil Binkley et al). The Vitamin D Council recommends the 25(OH)D levels should be between 50–80 ng/ml, year-round.
How much Vitamin D should you take?
This is a controversial topic, and there is a lack of consensus among experts. The recommended dietary allowance, as per Institute of Medicine is 600 IU per day for adults up to 70, and 800 IU for ages 71 or older. You should have your levels tested, and if lower than 50, you may need a higher supplemental dose to optimize the Vitamin D levels.
How Much Is Too Much?
There is an upper limit to how much vitamin D you can safely take. The Institute of Medicine recommendations for adults say that a daily intake of up to 4,000 IU of vitamin D is safe. Taking more than 10,000 IU per day can cause kidney and tissue damage. The best approach is to check with your health care provider before taking vitamin D supplements.
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com
Q: My underarms sweat a lot, even when it is cold. I am a young and otherwise healthy guy. This is causing a lot of social anxiety. What is causing it, and what can I do about it?
Dr. Chris Prakash
A: You are not alone. Excess sweating (hyperhydrosis) is a common disorder, and affects almost 3% of the population. The excessive sweating cannot only be localized (involving the underarms, or palms and soles), but it can be generalized (all over the body) as well. It is often a severe and emotionally distressing problem for people with the condition.
What causes it?
The most common type of excessive sweating is called primary focal hyperhidrosis. This is localized, such as to underarms, hands, feet, face or groin. Symptoms also tend to be symmetrical, occurring on both sides equally. This usually starts in childhood or adolescence. Although it is a problem, it’s not a sign of disease. People who have it are otherwise healthy. The cause of this is believed to be a minor malfunction in the nervous system. There’s some evidence that it could run in families.
The other less common form is called generalized secondary hyperhidrosis, and causes sweating all over the body – not just on the hands or feet. It’s called secondary because it’s being caused by an underlying health condition. There are a number of different medical conditions and diseases which may cause it, such as: menopause, thyroid problems, diabetes, tuberculosis, rheumatoid arthritis, or some types of cancers. Medications can also cause general excessive sweating (Some psychiatric drugs and blood pressure medications).
When should you see the doctor?
How do we treat it?
While there is no cure for focal excess sweating, the following treatment options may be tried:
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com.
by Sucharu Chris Prakash, MD
Q: I have had a sore throat and cough for 3 days. How do I know if I have a cold or the flu?
Dr. Chris Prakash
A: This is the flu season. In fact this year, the flu (influenza) has been rampant across the U.S. The number of flu cases seems to be waning in Texas, however by no means is the danger over. You ask a very important question. Not every sore throat, cough or fever means that you have the flu. The Common Cold and Flu symptoms can sometimes overlap. If you’re trying to determine if your symptoms are a cold or the flu, the following may help, but it can often be difficult to differentiate, and may require a visit to your doctor.
What are the symptoms of a cold?
Cold symptoms can last from 2 days to 2 weeks, and often include:
What are the symptoms of the flu?
The flu usually comes on suddenly, though people can host the flu virus for 1-4 days before symptoms begin to emerge. People feel some or all of these symptoms:
So, What are the key differences?
How can flu be prevented?
What to do if you have the flu?
These medicines reduce the severity and shorten the duration of influenza (flu) symptoms by 1 to 1½ days if given within 48 hours of the onset of symptoms.
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com
*by Sucharu Chris Prakash, MD*
Dr. Chris Prakash
By now, you must have heard that Hillary Clinton has a blood clot. The Secretary of State was admitted last week to a hospital in New York City after doctors discovered a blood clot. During an overseas tour, she picked up a bad stomach virus. Days later, she fainted and suffered a concussion. An MRI of the brain revealed that she had a blood clot. Her doctors said that the clot was situated in a vein that is in the space between the brain and the skull right behind the ear. The secretary did not suffer neurologic damage. Clinton has a history of blood clots. In 1998, as First Lady, she had a clot behind her right knee.
So, how common are the blood clots? Can they be life threatening? How are they treated?
DVT (Deep vein thrombosis) is often found incidentally. Symptoms often go unnoticed. DVT is a blood clot that usually starts in the leg, but like in Hillary’s case, can involve any vein in the body. It can even travel to the lungs resulting in pulmonary embolism (PE), which can be fatal.
Every year, between 400000 and 600000 Americans get DVT, and up to 100000 people die each year of DVT and its complications. Not many people are aware of its dangers. This problem is grave enough that the Surgeon General issued a “call to action” to raise awareness of this problem.
Why do people get DVT?
Several factors can put people at risk of developing blood clots, such as:
How is the diagnosis made?
Symptoms are not always obvious. However, these may include:
* If any of these symptoms arise, seek immediate medical attention, since they may be indicative of pulmonary embolism (PE), the most serious complication of DVT, where part of the blood clot breaks off and travels to the lung. PE can be fatal.
The doctor will diagnose DVT based on history, physical examination, and results of tests. An ultrasound (venous Doppler) of the leg is the most common test done to diagnose DVT. Rarely, a venogram may be ordered, where dye is injected into the vein, and x-rays taken. However, a clot can even be seen on an imaging study such as an MRI or CT scan.
Testing may be necessary to check for inherited clotting disorder that can cause DVT. This may be the case if you have repeated blood clots, or if you develop blood clots in an unusual location, such as a vein in the liver, brain or kidney.
How is a DVT treated?
Patients are started on anticoagulants (blood thinners). These may be a combination of injections (heparin in different forms) and pills (warfarin). Most of the times, treatment can be done without needing to be hospitalized, but in some situations, hospital stay may be necessary. There are several newer medications approved by the FDA to treat blood clots. These medications obviate the need for injections, but may not be suitable for everyone. The decision on which blood thinner to use, and for how long, is made by the doctor based on a number of individual factors.Some patients are unable to take blood thinners due to the risk of internal bleeding. These patients may require an inferior vena cava filter (IVC filter). This is placed in the inferior vena cave (large vein that carries blood from the legs to the heart). It works by potentially trapping any clots that may break off, and prevent them from traveling to the lungs.
Prevention is the key!
There are several simple measures you can take to prevent DVT:
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com
by Chris Prakash, MD – eParis Extra!
Dr. Chris Prakash
Q: I am a healthy 30 year old woman. I had an episode of sharp chest pain which lasted a few seconds. I did not go to the doctor. Should I have? Could I have had a heart attack?
A: Chest pain is a symptom that can be perplexing, and a cause for anxiety for both the patient as well as the doctor. Is that pain you are having in the chest, a sign of a heart attack? Should you rush to the ER? Or should you just blame it on “gas” and move on?
These are questions that millions of people and their doctors face each year. It’s a problem because chest pain can stem from dozens of conditions besides heart attack, ranging from pancreatitis to pneumonia to panic attack.
Once you get to a doctor, the doctor will use several pieces of information, from your history, EKG, and blood tests to determine if indeed there is something wrong with your heart. But the problem is how you know when to go to the doctor!
So, what should you look for, to decide if the chest pain is a sign of heart attack? The following box (some information obtained from Harvard Heart Letter) illustrates some of the differences between “dangerous” and “not so dangerous” chest pain:
| More likely to be a heart attack | Less likely to be a heart attack |
| Pain or pressure, tightness, or squeezing sensation | Sharp or knifelike pain brought on by breathing or coughing |
| Gradual onset of pain over the course of a few minutes | Sudden stabbing pain that lasts only a few seconds |
| Pain that extends to the left arm, neck, or jaw | Pain that is localized to one small spot |
| Pain accompanied by difficulty breathing, a cold sweat, or sudden nausea | Pain that lasts for many hours or days without any other symptoms |
| Pain or pressure that appears during/ after physical exertion or emotional stress (heart attack) or while at rest (unstable angina) | Pain reproduced by pressing on the chest or with body motion |
More than six million Americans with chest pain are seen in hospital emergency departments each year (Harvard Heart Letter). Only 20% of them have a heart related problem, such as a “heart attack” or “unstable angina”. A few have another potentially life-threatening problem, such as pulmonary embolism (a blood clot in the lungs) or aortic dissection (a tear in the aorta). But most of the six million, though, had a condition unrelated to the heart.
Remember:
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com
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