Sweating ALL the time- is this normal?

Q. Dr. Tam- I am a 24 year old woman with an embarrassing issue: I sweat ALOT.  Not just after exercising, but ALL the time (except at night) and regular deodorant just doesn't help. My feet are affected too. Is this normal? What can I do?

A. Sweating, the body's normal physiologic response to heat, serves to regulate your core temperature.  Excess sweating can be embarrassing, but it is rarely serious.  If you experience focal sweating  (underarms, palms or soles) that impairs daily activity, occurs for at least 6 months, is not due to medications or illness, and begins at age < 25 this is called "primary focal hyperhydrosis".  Though not dangerous, it can significantly affect your quality of life!  In this condition, the perspiration is the result of an exaggerated response of the sweat glands to normal emotional stress.  The condition can initially be treated with a prescription strength antiperspirant (used on palms and soles as well!).  Please be aware that generalized sweating, or sweating that occurs at night must be discussed with your doctor, as this could indicate a more serious cause. For more information on hyperhydrosis, you can visit the Sweat help site: http://www.sweathelp.org/en/

What blood pressure goal should I aim for?

Q. Hi Dr. Tam. I'm a 61 year old woman and was recently told by my doctor that my blood pressure was high ("145/88"). I'm confused, as some sources say that is normal, and others say I need to be on medicine. Which is right??

A. In the current medical climate, trying to figure out blood pressure goals is enough to raise your blood pressure!  The reason we care so much about high blood pressure, or 'hypertension' is that it can lead to heart attacks, stroke, and death. Yet how high is "high" has yet to be answered definitively.  In 2013, the Eight Joint National Committee released updated guidelines for physicians (http://jama.jamanetwork.com/article.aspx?articleid=1791497). According to these guidelines individuals > 60 years old (and without diabetes or kidney disease) should have a target blood pressure of < 150/90. So therefore, your blood pressure would be considered at goal. BUT.... stay tuned, as a recent study by the National Heart Lung and Blood Institute of almost 10,000 patients with high blood pressure over the age of 50 showed that aggressive lowering of blood pressure below 120 actually resulted in a 30% decrease in cardiovascular events (https://clinicaltrials.gov/ct2/show/NCT01206062?term=Systolic+Blood+Pressure+Intervention+Trial&rank=1). So the jury is still out on this one. Best to discuss with your physician to determine benefits/ risks of starting medication.

In the meantime, ensure that your blood pressure was confirmed at least twice in the office before starting any medications.  In addition, lifestyle changes such as a healthy diet, exercise, and avoiding tobacco can usually be tried prior to medication if deemed acceptable by your physician. Good luck!

When should I get a Pap smear?

Q: Hi Dr. Tam! I'm 19 years old and never been to a gynecologist. I've had sex with two guys in the last year. I haven't yet gone to get a Pap smear and wondered when I should start?

A: Great question! A Pap smear is a test performed by your doctor in which a brush is gently inserted into the opening of the cervix and used to collect a sample of cells to check for cervical cancer.  Pap tests can allow for treatment of abnormal cells and help prevent cervical cancer related deaths.  The most important risk factor for cervical cancer is a virus called "HPV" (human papilloma virus). This virus is transmitted from skin-to- skin contact including any kind of sexual intercourse.  Most of the time, the virus never causes symptoms, which is why it is important to be screened.
While having multiple sexual partners is a risk factor for cervical cancer, the major women's health guideline groups in the U.S. recommend not starting screening until age 21, even if you are sexually active at an earlier age.  The reason for this is that most teenagers will have false positive results (a test reads "abnormal" but the disease isn't actually present) resulting in unnecessary procedures.  Additionally, the vast majority of these HPV infections are short-lived and never go on to cause problems.  (Of note, women who have sex with women are also at risk and should be screened!)
So while you are not due yet for Pap test, if you haven't already, you should consult your pediatrician regarding the HPV vaccine (which can reduce your risk of cervical cancer). For more information on current screening guidelines, check out the American College of Obstetricians and Gynecologists recommendations: http://www.acog.org/Patients/FAQs/Cervical-Cancer-Screening.

Does an aspirin a day keep heart disease away??

Q: I'm 39 years old and as far as I know healthy- I exercise a few times a week, eat relatively healthy, and don't smoke. However, my mom and dad (both in their late 60's) have heart disease.  I'm told therefore, that I am at risk. My question to Dr. Tam is- should I start taking a baby aspirin a day to help prevent heart disease?

A: First, congrats on taking care of yourself! You are correct that family history of heart disease is a personal risk factor for heart disease. Plaque build-up in the arteries, "atherosclerosis", can start early in our lives, typically accelerating and manifesting itself in women after the age of 55.  So the best thing to do in your 30's and 40's is to monitor blood pressure and cholesterol levels, and ensure a healthy weight. I would emphasize that diet, exercise (at least 30 minutes of cardio 5 times a week), and other lifestyle modifications are critical toward reducing your risk of heart disease. In addition, smoking is a major contributor to damaged arteries and should therefore be avoided. 
Aspirin works to decrease blood clots on the surface of arterial plaques. For years, physicians assumed that taking a daily aspirin could help prevent heart attacks in otherwise healthy women (just as it does in men). However, it wasn't until the Women's Health Study that women were included in adequate numbers to draw meaningful conclusions. In fact, this long term study found that among almost 40,000 healthy

women, aspirin did NOT prevent heart attacks as it did in men.  However, a benefit was found for aspirin in preventing strokes in women.  The U.S. Preventive Service Task Force, a leading guideline authority, recommends that aspirin be used for stroke prevention in women > 55 years when benefits outweigh the risk of potential bleeding (a possible side effect with aspirin).  They state that there is insufficient evidence to recommend aspirin for primary prevention in women <55 years like yourself. Therefore, the jury is still out on this one.  I would recommend instead to continue your heart healthy diet and routine exercise, ensure at least 6-8 hours of sleep a night, drink alcohol in moderation, and scheduling an appointment with your physician to check your blood pressure, cholesterol, and other possible risk factors.

Preventing worsening arthritis

Q: I having been having knee pain over the last few months that my doctor tells me is due to osteoarthritis.  I take ibuprofen which helps the pain. But I wondered what other options are available that help improve the pain and prevent worsening?

A: Osteoarthritis (OA) is a common cause of joint problems in which the joint cushion, or cartilage, wears down, resulting in pain and decreased function.  We do not currently have ways to reverse the damage of the joint, so the management of OA involves relieving pain and improving mobility.  The good news is that some minor lifestyle changes can make a big difference. These include weight loss, heat/cold application to the joint, assistance devices for walking (like a cane), and consistent aerobic exercise and muscle strengthening.  Weight loss not only relieves the excess stress on the joint, but can slow the progression of cartilage loss.  Importantly, though many people with OA say that their joints hurt after exercise, a consistent strengthening and exercise regimen can actually significantly improve pain and functionality (AAOS Knee-OA guidelines, 5/2013).  This can be developed with the help of a trained physical therapist.  As far as other conservative management techniques, the American Academy of Orthopedic Surgery recommends against glucosamine, hylauronic acid, chondroitin and shoe wedges citing limited evidence.

Oh My... UTI.

Q: "I'm a 34 year old woman and have had 3 urinary tract infections in the last year. I don't have health insurance so doctors' visits are expensive. I'm writing to find out what I can do to prevent these infections? Can I treat a UTI without seeing the doctor?"

A: Urinary tract infections ("UTI's") can range from pesky to serious. The infection occurs when bacteria (usually from the bowel) enters the urethra (the tube connecting the bladder to the outside of your body). This can cause burning upon urination, urgency, cloudy or bloody urine, lower belly pain, and in more serious cases back pain and fevers. Preventive measures can work most of the time and consist of hygiene and diet.  But once symptoms begin, antibiotics are required.  Here are some preventive tips:
1. Wipe front to back (to decrease risk of bacteria into urethra).
2. Avoid frequent long baths.
3. Don't forget to empty your bladder! (urinate about every four hours).
4. Use tampons versus pads.
5. Clean the genital area before sex. (sex can introduce bacteria, thus the term "honeymoon cystitis")
6. Drink plenty of water.
7. Consider estrogen cream if post-menopausal
Of note, a popular theory is that cranberry juice can help prevent UTI's. There is some evidence that cranberry juice (by preventing the bacteria from sticking to the urinary tract) can decrease recurrence in young women, but the evidence is not strong and may not benefit everyone who tries it.  However, cranberry juice should NOT be used to treat a UTI. The only effective treatment is antibiotics.
You should contact your doctor if you have any symptoms of UTI in order to rule out other conditions and ensure you are on the appropriate therapy to prevent serious complications (in fact, your physician may be willing to treat you even without a visit). Women at risk of serious complications, like diabetics, the elderly, pregnant, or immunocompromised should be seen promptly.  Interested in more info? Check out this slide show from WebMD: http://women.webmd.com/ss/slideshow-urinary-tract-infection-overview.

Are heels hazardous??

Q: "I'm a 27 year old female and have been having pain at my right big toe joint for 3 days. I do wear heels on a regular basis (but never had this problem before), and am wondering if my shoes are responsible for this. Thoughts?"

A:  You'll have many sympathizers on this one- it's unfortunate the price we may have to pay for our Louboutin-prone decisions.  But yes, indeed, the pain you highlight may be related to your use of high heels. The bad news is that with continued wearing of heels, the symptoms will only get worse and more widespread. The good news is that we have the capacity to do something about it.
Women suffer four times the number of foot problems as men, which in large part may be a result of the footwear we choose. High heel use has been associated with calluses, corns, bunions, arthritis, chronic knee pain, back problems, toe pain and deformity, and poor posture. Heels distort the natural distribution of weight on the foot and ankle, placing the bulk of weight on the forefoot. This increased force on the forefoot causes the entire body to compensate, leading to conditions like knee arthritis. Additionally, this shift in dynamic can lead to loss of arch integrity, causing great toe pain and distortion.
So here are some tips: 1. Limit heel wearing to heels 1.5" or shorter, and no more than 3x/week. 2. Add a metatarsal foam/gel pad to provide cushion and increase shock absorption. 3. Stretch foot/calf muscles after use. 4. Pay attention to your feet (like you've done)!- callous formation or great toe joint pain may be the first sign of loss of arch integrity. 5. For foot stability, choose a wider heel rather than a stiletto. (But be aware that wider heels have been shown to be just as harmful to the knee joint as narrower ones.) 6. For ideal comfort, choose walking or running shoes with good arch support and stability. (Flat shoes and sandals come with their own set of problems and are not a solution to your foot pain.)
Maybe we should take advice from the power-suited Wall Street women of the 1980's- wear your sneakers to work.