Ashlar’s Lunch & Learn –

Physician Offers Information On A Range Of Ailments

By Jan Howard

Dr Jeffrey Friedman fielded questions about various health problems during a Lunch and Learn program September 12 at Ashlar of Newtown.

Dr Friedman, the medical director of Ashlar of Newtown for 16 years, specializes in internal medicine at Community Health Associates in Newtown.

 About 40 area residents took part in an open discussion that addressed such concerns as when to begin testing for colon cancer, the importance of cholesterol levels, and treatments for ear disorders.

Ear Disorders

Dr Friedman said it is often difficult to determine the exact cause of an inner ear problem that causes dizziness and nausea.

“In 99 percent of the cases, a specific cause is never delineated,” Dr Friedman said. A doctor must make sure there is no growth on the nerve that is stimulating the problem.

There is no good surgical or non-invasive treatment for the dizziness unless something points to a specific problem, such as a growth. He said antihistamines may be helpful, and Antivert may give some relief. Low doses of Valium have also been found to be helpful, he noted.

A throbbing sensation in the ear is a common problem, Dr Friedman said. “It is due to the blood flow near the nerve. Nothing can be done about it. “ Again, he noted, a doctor must make sure there is no other problem, such as a blockage in the neck. Usually it is a chronic problem.

Aortic Stenosis

Aortic stenosis is the narrowing of the aorta so that blood is being pumped through a smaller opening. Symptoms may include chest pain on exertion and palpitations. It can cause sudden death, Dr Friedman said.

The most common treatment is replacement of the damaged valve. He said some valves require the use of blood thinners for life.

Colon Cancer

 At what age should there be a full colonoscopy if there is no family history of colon cancer?

“Insurance companies will say never,” Dr Friedman said. “Your insurance company may not pay for it.”

Dr Friedman said family history and symptoms of altered bowel habits and any bleeding should be considered. Knowing the incidence rate is also important. The incidence of colon cancer is low until age 40, he said. At age 50, the incidence of cancer increases, starting with polyps. Dr Friedman recommends two tests, a sigmoidoscope at age 50 and a colonoscopy from age 50 to 60.

Spinal Stenosis

Surgery for spinal stenosis depends on the symptoms, Dr Friedman said. Spinal stenosis is the narrowing of the spinal canal due to changes in the lumbar spine, such as a disc that protrudes and presses on a nerve or abnormal growth of bone because of arthritis.

“Any type of surgery carries with it some element of risk,” he said. Anti-inflammatory medicines can provide relief as well as an injection of steroids.

Osteoarthritis

There are many types of arthritis, Dr Friedman said. The most common is osteoarthritis, which occurs with the passage of time. “It’s wear and tear, “ he said. “Over time the joints deteriorate and get changes in them.”

Rheumatoid arthritis is an autoimmune disease in which cells destroy the joints. Dr Friedman said there are disease modification agents that can be helpful.

There is no drug for osteoarthritis, he said. He suggests losing weight for less wear and tear on the joints. In the neck, it can cause changes in the bone and pinching of nerves that cause pain. Muscles then tighten so a person has pain from the arthritis and from tight muscles. Anti-inflammatory medicines are helpful as well as range of motion exercises. “The key is doing the exercises every day,” he said.

Leg Cramps

A common problem is cramps in legs that occur in the middle of the night, Dr Friedman said. “It’s terrible when it happens, but no one knows why.” The best treatment includes medicine and stretching exercises. “When you exercise regularly twice a day, it is most helpful,” he said.

 

Sciatica

Pain and tingling in the legs or buttock area relates to a pinched nerve in the back known as the Sciatic nerve. If the reason for the pain is arthritis, the condition will be chronic, he noted. If a disc has popped out, then goes back in, the pain will go away.

He said stretching exercises and maintaining good mobility are helpful. Back pain sufferers should be careful when bending and turning. Anti-inflammatory drugs can help. Riding in a car for a long period of time can cause compression on the sciatic nerve. He suggested shifting position often and using a cushion.

Lyme Disease

There should be no after affects from Lyme disease if a patient has completed the full three to four weeks of antibiotics, Dr Friedman said. Any side effects would be temporary except in rare cases. He noted it is uncommon for the symptoms of Lyme to return, but a person can be re-infected. He said his office has seen at least ten cases of Lyme disease a week.

Medicines And Vitamins

For possible medicine interactions, check with your doctor or a pharmacist, Dr Friedman said. Having one physician who knows all your medications is important, he said. The problem is that most patients today have more than one physician. It is important they know what medicines are being taken. Having all medicines filled by one pharmacist will make it possible to avoid harmful interactions.

Dr Friedman recommends taking a multiple vitamin with iron daily. He also recommends between 1,500 and 2,000 milligrams of calcium per day for women who are postmenopausal, or two Tums a day. He cautioned that calcium is not absorbed without vitamin D. “That is the key,” he said. He also recommends 400 to 800 units of vitamin E per day.

Estrogen

He said postmenopausal women who take estrogen significantly outlive women who don’t. Estrogen also slows down the rate of bone loss and helps avoid osteoporosis as well as helps the heart, he added. There are replacement therapies for women who are unable to take estrogen that have the same positive effects as estrogen.

Caffeine is a risk factor for osteoporosis, he said. “I’m a coffee lover,” he said, “but limiting caffeine is a wise thing to do.”

Bugs And Cholesterol

The West Nile virus has received a lot of publicity, but there have been no recorded cases in Connecticut, he said. “The best preventive measure is to use insect repellent,” he said.

Many studies have shown that the reduction of cholesterol levels is important to lower the risk of heart disease. There is good cholesterol (HDL) and bad cholesterol (LDL), he said. While the body needs some of the bad cholesterol, too much of it goes to the walls of the arteries, where it sticks.

 “There are great medicines that are safe,” he said, which raise the HDL and lower the LDL. He said these medicines are used in addition to, not instead of, a controlled diet and exercise.