Lifestyle

DEAR DR. ROACH: My primary care physician wanted me to stop taking calcium (and the vitamin D that accompanies it) due to risks such as kidney stones. However, my endocrinologist, whom I see for thyroid issues (I'm currently on levothyroxine), thinks that I should continue with it.What does one do when doctors give conflicting advice? What are the risks if I continue? I'm taking two Citracal tablets each day with 4,000 units of vitamin D. As of late, I have not been taking it very regularly at all. What damage am I doing? -- D.H.ANSWER: Calcium and vitamin D are necessary for bone health, but unless a person is severely deficient or has a condition known to improve with vitamin D, giving supplements has not been proven to be of much (if any) benefit. There is a small risk of kidney stones with calcium supplements and a possible increase of the risk of heart disease. (There's conflicting evidence on heart disease.) So, unless there is a strong reason to use calcium (such as osteoporosis), I don't recommend calcium supplementation, although I do recommend calcium in my patient's diet.Paradoxically, dietary calcium decreases kidney stone risk, even though calcium supplements increase the risk. (It's thought to be the high amount in the blood after taking the supplement.) Although vitamin D may not be helpful for most people, it is seldom harmful at doses below 8,000 units daily.When your physicians disagree, it's OK to ask them to discuss it. I never mind calling my patients' expert consultants, and the newer medical record systems can make it very easy to briefly communicate.DEAR DR. ROACH: What are the symptoms of Clostridioides difficile (C. diff)? -- A.T.ANSWER: C. diff is an unfortunate, all-too-common gastrointestinal infection. The cardinal symptom is watery diarrhea, often with fever and abdominal cramping. C. diff is usually associated with antibiotics that kill healthy bacteria in the gastrointestinal tract, which allow C. diff to take over. However, not all cases are associated with antibiotics. Just being in a hospital (or recently having been in one) is a risk, as is being older.The spectrum of C. diff runs from asymptomatic (a few percentage of people have bacteria in their colon all the time without problems) to mild disease to severe and life-threatening disease. Looking for C. diff is only appropriate in people with a new onset of diarrhea (a usual criterion is three watery bowel movements in a day) with no other explanation, especially if they have one of the risk factors that are listed above. C. diff is more likely in people taking proton-pump inhibitors like omeprazole, and it is one more important reason as to why physicians shouldn't prescribe antibiotics lightly.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

Q: My arthritis is getting worse, and my doctor says I have to fight against letting it slow me down. My joints hurt, so how can I do that -- and why would I want to? -- Patty R., Evansville, IndianaA: Osteoarthritis (OA) is a degenerative disease in which the tissues in your joints, such as cartilage, tendons and ligaments, break down over time, leading to bone damage. For many of the 30 million Americans with the condition, the pain that OA causes interferes with mobility -- and that then causes its own set of problems, including increased pain, weight gain, depression and a whole bunch of other serious conditions.A study in the journal RMD Open found that over 20 years, folks with OA are almost three times more likely to develop one or more other serious conditions than folks who don't have OA. The most frequent comorbidities are back pain, diabetes, mood disorders, heart, kidney and lung disease, cancer and cataracts.The good news is that there is solid evidence that increasing physical activity reduces OA pain, increases mobility, and helps prevent associated complications. Harvard Medical School recommends a combination of 1. flexibility/range of motion exercises -- but without causing pain; 2. muscle-building exercises using your own body weight or resistance bands; and 3. low-impact aerobics like swimming, walking or using an elliptical trainer. That trio provides the best push-back against sore joints and helps you maintain a healthy weight while you protect your internal organs from chronic conditions and cancer. For info on how to best get into these different types of activities, check out "The RealAge Workout" and Dr. Mike's book "The Great Age Reboot." Also, ask your doc about taking ASUs (avocado soy unsaponifiables). It's a disease-modifying supplement that stops the progression of osteoarthritis. And to understand how adopting a diet that fights inflammation -- combined with physical activity -- can boost your return to a healthier, more mobile daily life, explore the iHerb.com blog "Natural Joint Support."* * *Q: Some days, I feel like my brain is turning to mush. I'm only 62 but I forget words or where I put the car keys or my phone. It may be related to stress at home and work, but whatever the cause, I want it to stop. Suggestions? -- Gregory Y., Urbana, IllinoisA: There are many causes of cognition problems, but you indicate that yours are from stress. Well, stress -- especially chronic relationship stress -- is the most common cause of cognition problems. The Cleveland Clinic Wellness website explains that it's because it can affect your nutrition (you may eat excess comfort foods or skip meals), sleep patterns (you may sleep too much or not enough) and physical abilities (you get a sore back or stiff neck), and all that contributes to body-wide inflammation and brain fog.You'll be glad to hear that research shows that having some fun playing sports, walking with friends, and sweating without fretting, sharpens your cognition. Moderate-intensity aerobic exercise three days a week increases the size of the hippocampus, your brain area involved in memory and learning, by 2% in a relatively short time. That's enough to undo a couple of years of declining brain function. And according to Harvard Health, research shows that inactive middle-aged adults who walk briskly for 45 minutes five times a week improve their ability to pay attention and their verbal fluency, have a stronger working memory and increase their mental processing speed. In addition, the Alzheimer's Society says regular exercise can reduce the risk of Alzheimer's by 45%. We suggest you start by reaching out to a friend or joining an exercise group in order to get physical activity for at least 30 minutes five days a week. You'll feel more relaxed and think more clearly, as you extend your longevity. For more tips, Dr. Mike's book "The Great Age Reboot" offers 36 ways to reduce your risk of cognitive problems, and take a look at iHerb.com's blog "Fitness for Longevity." * * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

DEAR DR. ROACH: I had a biopsy done, and several samples showed prostate cancer. A PET scan showed no other cancer. My doctor is uneasy about removal or treatment because of my age (80 years old). Otherwise, I am in excellent health. What treatment, if any, should I have? -- R.B.ANSWER: Prostate cancer really isn't one disease. There's a large spectrum of aggressiveness. Highly aggressive cancers can spread locally or to distant sites very early on in the course of disease, while much more slow-growing cancers are unlikely to ever grow enough to become a problem in a person's lifetime. As a general rule, younger people are more likely to have aggressive cancers, but this isn't always the case.The goal of prostate cancer screening is to find cancers that are "just right." They are aggressive enough to grow and spread, but there's still enough of a chance to find the cancer before it's too late. This generally includes men who are between the ages of 50-75. (Some men at a high risk should begin at age 45.)In men over 75, most of the cancers are so slow-growing that screening for prostate cancer doesn't make a lot of sense. Prostate cancer surgery causes harm, with erectile dysfunction and incontinence being common (and even a small risk of death). Screening begins to have a net benefit after about 10 or 15 years.I recommend surgery only if this were a higher-risk cancer based on the pathology of the tumor, the level of your PSA, the size of the tumor through a scan, and possibly the genetic characteristics of the tumor. Most men at your age do not benefit from treatment of a more indolent cancer, and it is usually far better to keep an eye on the cancer by repeat blood testing and scans.When you speak to the urologist again, you want to have a clear idea of whether this is a more aggressive cancer or one of the more common, slow-growing kind that will likely never cause you any symptoms.DEAR DR. ROACH: About six years ago, it was thought that I might have had a mild transient ischemic attack (TIA). No damage to my brain tissue was discovered, and I've been taking 12.5 mg of metoprolol (a half-dose because of its side effects) and 20 mg of atorvastatin ever since.Should I be monitoring this part of my health with an occasional visit to a specialist (a neurologist or cardiologist?) or through special tests? Nothing further was suggested, but strokes and heart attacks run on my mother's side of the family. I am 77. -- H.S.ANSWER: A TIA has symptoms similar to a stroke, but the symptoms are temporary. No death of brain cells occurs. However, a person with a TIA is at a higher risk for a stroke, so careful control of any stroke risk factors is important to reduce the likelihood of a stroke.Among the most important risk factors are blood pressure and cholesterol. Metoprolol is not the common first-line treatment for blood pressure, so I wonder why it was chosen. But if your blood pressure isn't under ideal control (less than 120 mm Hg systolic and less than 80 mm Hg diastolic), then that's the critical issue. Blood pressure should be checked frequently. Atorvastatin is a powerful medicine, so cholesterol usually doesn't need to be rechecked as often.Your regular doctor can check on these and any other risk factors you may have (such as smoking and diabetes). You should consult with a neurologist as well.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

Q: My doctor says I'm over-stressed and that's making my cortisol levels fluctuate wildly. I don't understand what cortisol has to do with anything. Can you offer me some info and a plan? -- Greg T., Fort Worth, TexasA: Chronic negative stress from work, family or other circumstances has health-changing effects that impact everything from your ability to concentrate to your heart function. It's often smart to seek psychotherapy to help you become aware of what is tying you in knots. But you also can do a lot to avoid the damage to your body that cranking out too much of the stress hormone cortisol and stress-impacted proteins can do. First -- what is stress? Well, it's a response to a situation -- and it can be positive. In fact, the stress response known as "fight or flight" maximizes your ability to avoid or counter danger. But it works best in situations where you can run away from danger or benefit from being fueled with extra strength. Stress also helps when there is a chance that you're going to be injured or exposed to an infection, because it stimulates the production chemicals that help regulate the immune system.But when fight or flight kicks in and you can't reasonably do either (you have to stay at work and you can't fight with your boss), then you're left with residual physical changes that cortisol and stress-induced proteins cause -- elevated blood pressure, inflammation, fatigue, cognitive problems, and an increased risk for weight gain and diabetes.That's why learning to manage stress is so essential. Smart steps include:-- Ditching added sugars, which can boost cortisol levels.-- Eating about 2.5 ounces of dark chocolate daily for two weeks. That lowers cortisol levels according to a study in Antioxidants.-- Taking omega-3 supplements. One study found that taking 2.5 grams a day for four months lowered cortisol levels by up to 33%.-- Enjoying 150 or more minutes weekly of aerobic activity.-- Practicing laughing yoga, mindfulness and deep breathing exercises. -- Enjoying your posse and your purpose* * *Q: I hate to admit it but sometimes, even when I am stuffed, I get obsessed with having something to eat. Why does this happen and how can I tamp down my food cravings? -- Sonia K, Ann Arbor, MichiganA: There are many reasons that you may crave food when you are not actually hungry: boredom, sadness, anger, fatigue, loneliness, even genetic predispositions. That's because eating something that registers as a treat or a consolation can elevate your level of hormones that reduce stress and activate your brain's reward centers. But luckily, so can exercise, interacting with your posse, doing something that matters to you and that helps others, and making sure you get quality sleep. And in the long run, discovering the pleasures and rewards of healthy nutrition and positive self-care, well, that offers the greatest rewards possible -- a happier, healthier, longer life.To be able to change how you make yourself feel better, you want to pay attention to the difference in how you feel when you have physical hunger and when you have what might be called "head hunger." Ask yourself what's going on in your head as you reach for that unhealthy snack. Write it down. Identify stressors and triggers. Some may be from outside stimulation such as a food commercial or from an aroma. Some may be purely internal -- from longings (of non-food things). Now, go munch a handful of celery, blueberries or walnuts instead. See how that makes you feel. Repeat this as often as cravings appear. You will discover a lot about why -- and about how to stop.And do check with your doc to see if any medication you are on, like steroids, anti-seizure drugs, certain antidepressants, or oral contraceptives might be fueling your cravings. For more info on making healthy food choices check out our updated "YOU On a Diet, the Owner's Manual to Waist Management" and iHerb.com's blog on "Mindful Eating."* * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

DEAR DR. ROACH: I've had diverticulitis repeatedly since 2016. It's been bad enough 10 times (with belly pain and fever) that I was given antibiotics. I've had it at least that many more times where I wasn't as ill (usually just had belly pain), and I didn't take antibiotics, since it went away on its own. I have not needed to be hospitalized for it. I've had three or four CT scans during flare-ups that confirmed diverticulitis.I'm scheduled to have surgery to remove the part of my colon where I keep getting the infections. During the last attack, the emergency room doctor and my primary care doctor said that I need to get it done. The surgeon said it was up to me, laid out the risk involved, and told me that there was about a 98% chance that surgery would cure my diverticulitis.Would you please discuss diverticulitis and your recommendations in your column (including when you'd recommend surgery, or at least a surgery consultation)? -- L.R.ANSWER: Diverticulitis is an infection in the small outpouches of the colon, called diverticula. Most people with diverticula ("diverticulosis") never get diverticulitis.In general, I don't recommend surgery lightly. No surgery is completely free of risk. Elective colon surgery sometimes unexpectedly requires a colostomy. However, in your case, a careful consideration of surgery is appropriate given your multiple recurrences.It sounds like you have had "uncomplicated" diverticulitis, since you've never required a hospital admission. Although we used to treat uncomplicated diverticulitis with oral antibiotics, they do not seem to have much benefit, so they are usually not given. Complicated diverticulitis, fistula, bowel obstruction, peritonitis, and bowel stricture are usually treated in the hospital. One important reason to consider surgery is to prevent a complicated episode of diverticulitis, which can be dangerous -- even life-threatening.People with at least one episode of complicated diverticulitis are usually recommended for surgery, as they are at a high risk for another complicated episode. However, your risk for developing a complicated episode of diverticulitis, having had multiple episodes of uncomplicated diverticulitis, is small -- about 3%. In my mind, there is no compelling reason to undergo surgery. However, you are very likely to keep getting recurrences of uncomplicated diverticulitis, so it is a reasonable option.Your surgeon is right about the likelihood of not having diverticulitis again after surgery, but the exact chance depends on where your diverticula are. Most commonly, they are in the sigmoid colon, which is the part that gets removed. It sounds like the surgeon thinks that you are likely to have a favorable outcome based on your anatomy.Were you my patient, I would ask you how painful and debilitating your episodes have been. If they are generally not so bad, I am unlikely to recommend surgery. However, if you have had prolonged courses of pain and have been unable to do regular activities, I certainly recommend a surgical consultation.Finally, just a brief word about nuts and seeds: Many of my patients and readers have been told to avoid these, as they can plug a diverticula and cause diverticulitis. This seems to be extremely unusual, and most data show that nuts and seeds do not increase the risk of a recurrence of diverticulitis, instead decreasing the risk.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

DEAR DR. ROACH: My daughter is in her 30s and has been experiencing infertility for several years. She and her husband have been tested, and the issue is her egg quality. She has had several rounds of in vitro fertilization with no success.At age 19, she was prescribed Accutane for her acne. She had to take a monthly pregnancy test in order to take this medication. I researched this medication at the time and was aware of the depression side effects. I was also aware that if a pregnancy occurred while taking this drug, it would have to be terminated. The situation was not a concern at the time.Now, years later, her fertility doctor says she has eggs, but they are of poor quality. What is your medical opinion on this medication affecting fertility? I read that Accutane was banned in 2009. -- C.M.ANSWER: Isotretoin (Accutane) is the most effective treatment for acne, but it has potential for serious side effects and can only be given after a thorough review of its risks.I have to correct two misapprehensions. Although brand-name Accutane was discontinued in 2009, generic isotretoin was not banned and still remains an extremely beneficial treatment that is safe when used appropriately. Secondly, there is no obligation while on this medicine to commit to a pregnancy termination.Great care needs to be taken to prevent pregnancy with repeatedly negative pregnancy tests before starting therapy, as well as two forms of birth control in any person who could get pregnant (unless they are abstinent). There is a high likelihood that a baby who is exposed to isotretoin will have severe damage or be stillborn. If a pregnancy occurs while on isotretoin, the drug must immediately be stopped, and the person needs to be referred to an expert in reproductive toxicity. A pregnancy termination should be discussed, but the decision is always up to the patient (except where prohibited by law).Although isotretoin can cause severe damage to the developing fetus if taken during pregnancy, a study showed that any effect on fertility was gone by 18 months after treatment. There are many reasons why a woman can have difficulty getting pregnant due to eggs that are less likely to get fertilized. Age is a major factor, but many genetic conditions, chemotherapy, radiation, viruses (including COVID-19), and autoimmune diseases are known causes.I wish your daughter the best of luck. I have had several patients give up after several rounds of IVF, only to conceive a healthy baby naturally.DEAR DR. ROACH: In a recent column, a reader mentioned that they were having problems coming up with words and wondered if a supplement would help. They mentioned taking medication for neuropathy. Some of the medications for neuropathy have brain fog as a side effect. -- P.A.ANSWER: I appreciate your writing. Of all of the causes for people to have memory and concentration problems, a side effect from medication is one of the most common and is easily reversible. You are right that many medications used for neuropathy, especially gabapentin and pregabalin, can cause difficulty concentrating. Many people describe this as brain fog. It's worthwhile to discuss any medication, even over-the-counter ones and supplements, with your doctor to see if any of these might be causing this symptom.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

Q: I started taking one of those new GLP-1 medications to lose weight, but I stopped taking it after about two months because I didn't like how I felt. So, all that expense, a bunch of discomfort, and I only lost about 8 pounds -- far less than my goal. What should I do now? -- Sandra W., Shreveport, LouisianaA: We're hearing a lot of stories like yours, and the latest studies back them up. Almost six of every 10 people who start on a GLP-1 weight-loss drug like Wegovy stop taking it before they lose much weight, according to a study by the Blue Cross Blue Shield Association. This echoes an analysis by pharmacy benefit managers that found that 68% of folks who started on GLP-1s for weight loss weren't still taking them one year later. While there may be enormous benefits from these medications -- beyond weight loss -- especially for folks who are overweight and have cardiometabolic disease, they clearly aren't for everyone. So, let's talk about a weight loss plan that has no monthly bill or negative side effects and offers you a longer, happier, healthier lifespan.It is called a 'Do-Over" and you can learn all about it in Dr. Mike's book "This is Your Do-Over: 7 Secrets to Losing Weight" and Dr. Oz's iHerb.com blog, "Dr. Oz's 9-Step Daily Wellness Routine."The goal is to adopt a lifelong set of habits and goals -- gradually, so that you stick with them. They include slashing your intake of highly processed foods and opting for a plant-based diet (with fatty fish like salmon); starting a daily walking routine with a buddy, heading for 10,000 steps a day; making sure you spend time with your posse and finding a purpose (that gives you the incentive to keep making life more fun and healthier); and adopting stress management techniques like meditation and yoga. We promise you'll have more fun, achieve improved health and lose weight -- and you'll be able to sustain that for the rest of your longer, healthier life!* * *Q: I'm worried that the super-cleaning and antibacterial products I'm using are doing more harm than good. What's the smart balance between protection from infections found on hands and surfaces and protection of my health? -- Seth R., Evanston, IllinoisA: Americans are germ and microbe-phobic, spending $1.7 billion annually on bacteria-slaying disinfectants and cleansers. But in many instances, old-fashioned soap and water -- used to clean countertops, washing your hands, and clothes -- will protect you from potential contamination from harmful bacteria and viruses. One study found that while soap kills influenza A viruses in 30 seconds, hand sanitizer takes around 4 minutes. (On the other hand, if you can't wash your hands, hand sanitizer is a smart alternative.) However, antibacterials in cleaning products can kill off good-for-you microbes on your skin and in your gut, making you vulnerable to acute and chronic diseases and fueling antibiotic resistance. For help finding the safest products, check out the EPA's Safer Choice (epa.gov/saferchoice). The trillions of microbes that live on your skin and in your gut and those found in some fermented foods and probiotics are essential for your health. For example, one recent study found that folks who eat a lot of foods like yogurt, kefir, sauerkraut, and kimchi and/or take probiotic supplements have a dramatically lower risk of developing chronic obstructive pulmonary disease (COPD) than folks who don't enjoy those microbe-loaded foods and capsules.Another study shows that gobbling up the bacteria in those foods and from probiotics -- especially for folks age 60 and older -- is a surefire way to protect your brain from cognition problems and Alzheimer's. Yet a third study showed that having healthy gut bacteria can reduce your risk of contracting an infection by up to 25%. Our suggestion: Choose certified safe cleaning products and keep your biome healthy and happy with high-fiber and probiotic foods and probiotic supplements (see "Probiotic Benefits" in the iHerb.com blog).* * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

DEAR DR. ROACH: I switched to nonalcoholic beer a week ago due to an upcoming fibroscan on my liver later next month. I was diagnosed with a mild fatty liver this past August. I'm experiencing insomnia, plus I get up to urinate five to six times a night. Previously, it was only two to three times a night. Any thoughts or recommendations? -- A.C.ANSWER: The most important recommendation I have is to continue keeping off alcohol. Even the relatively modest amount of alcohol in beer is not a good idea in people with MASLD (metabolic dysfunction-associated steatotic liver disease, what we used to call "fatty liver"). Switching to nonalcoholic beer was a wise choice. Alcohol probably increases the risk of liver disease worsening into conditions such as steatohepatitis, fibrosis and ultimately cirrhosis. (A fibroscan is a test to look for fibrosis of the liver.)Why you are having to urinate more at night isn't completely clear to me. If you are drinking more nonalcoholic beer than you were drinking regular beer, this would explain it. The effect of alcohol on urination is complex; alcohol initially suppresses the antidiuretic hormone (ADH), which causes increased urine output. The ADH levels are lower later on, so it's possible that while drinking beer, you got rid of your fluid faster.When you have excess urinating at night, the first step is to stop drinking so much (of any fluid) in the evening and nighttime. If this doesn't solve the problem, it's time to consider issues with the prostate (for men) and bladder (for men and women).Alcohol also has variable effects on sleep, and if you are used to drinking most nights or every night, your body could be going through a mild withdrawal where insomnia is very common. I expect this to get better over time, and I recommend avoiding sleep medications, either over-the-counter or prescription. If the sleep problem continues, there are behavioral treatments you can try. Just ask your primary care doctor.DEAR DR. ROACH: I am a healthy 63-year-old female. I recently applied for a life insurance policy. I submitted my blood work and was surprised when my GGT level came back significantly elevated. All of the other liver-enzyme tests, including the ALP, ALT and AST, were completely normal and have been for years.I followed up with my primary doctor, who ordered a sonogram on my liver that also came back completely normal, with no signs of fatty liver disease. I typically will have two glasses of wine if I'm out to dinner, which is around two to three nights per week. My primary care doctor said that they do not typically order the GGT test, especially when all other enzyme tests are normal. Do you think I need to follow up further? -- K.C.ANSWER: I agree with your primary doctor. The GGT is a liver enzyme that is elevated in many liver conditions. It is extremely sensitive, meaning that it will almost always be elevated with many liver diseases. But it is not specific, meaning that it can be elevated without any significant liver disease. (When I was a student, one resident joked that the GGT level goes up "if you look at the liver sideways.")Even your very modest alcohol use might be enough to raise the GGT levels slightly. But given the other normal blood tests and your normal ultrasound, I do not recommend further testing.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

DEAR DR. ROACH: My childhood friend just emailed me that she has a 1.1-cm lesion on her lung. It was found on a CT scan. She's having another CT scan today. She is a former smoker and has COPD. Is the lesion something that's part of COPD? What's the difference between a lesion and something else? -- J.B.ANSWER: A "lesion" is simply a term that means something doesn't belong there, but in this case, the suspicion is that it means some kind of mass. The big concern in a current or former smoker is lung cancer. The appearance of the lesion in the CT scan can help tell what it represents.There are calculators that can help give an idea of how likely a lung lesion (we often use the term "nodule" for a solid lesion) is to be cancer. Based only on the information you gave me, there's about a 15%-20% chance of cancer, which is high enough that she would be recommended a biopsy. Depending on where it is in the lung, the biopsy can be done by bronchoscopy, ultrasound, or a CT-guided biopsy through the skin if the nodule isn't close enough to a large airway.If it (hopefully) isn't cancer, it could be scar tissue, a current or past infection, a benign tumor, or many other possibilities, almost all of which are better than lung cancer.DEAR DR. ROACH: My husband has Type 2 diabetes and has been on Trulicity for a few years with great results. Lately, when it's time for refills, the pharmacies are saying that it's on back order and not available for three to four weeks. I am concerned how this affects his diabetes and health. Why is there this discrepancy? -- K.F.ANSWER: Dulaglutide (Trulicity) is in the class of GLP-1 agonists, like semaglutide (Ozempic and Wegovy). Not only are they good treatments for diabetes, they tend to promote weight loss and reduce the risk of heart disease. Consequently, they are in high demand.Semaglutide and a similar drug, tirzepatide, have been approved for weight loss by the Food and Drug Administration, while Trulicity has not. However, many insurance companies are demanding that their customers try a different drug when their doctor has prescribed semaglutide, and dulaglutide is one of the most common ones to try. They are very similar, although Trulicity isn't tested as thoroughly for weight loss. The manufacturer, Eli Lilly, has stated that manufacturing shortages are likely to extend through December 2024.It is very frustrating to have a medicine that you have been taking for years become unavailable, and the potential for harm is significant. It takes the body weeks (or months) to get used to the higher doses, and if a person is off of it for more than a few weeks, they may have to restart at the lowest dose and build up again to the higher dose to avoid severe side effects. For your husband, going without his needed medication will make his diabetes less well-controlled.I'm afraid that I don't have a good solution. The drug companies are making truly enormous profits from these medicines and have every incentive to increase manufacturing (which they are). But demand continues to outstrip supply.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

DEAR DR. ROACH: I had lab work done recently and received a panic call from the doctor's office that my vitamin D level was 29 ng/mL. I needed to start 50,000 IU once a week for 12 weeks immediately. I am confused how I could be deficient of the sunshine vitamin since I live in South Florida, and I go outside a lot with good skin exposure. I walk the dogs, garden, play golf, and drive a convertible. I do not wear sunscreen, and I get a fair amount of vitamin-D-fortified foods.I also take a calcium supplement with 500 units of vitamin D twice daily. I do not have Crohn's disease, ulcerative colitis, celiac disease, or other malabsorption diseases. None of my meds indicate vitamin deficiency in the warnings. I am totally baffled! How can this be? -- Anon.ANSWER: Well, first off, I don't see the reason for a panicked call, since a level of 29 ng/mL is in the range that most experts consider acceptable. A very large study on vitamin D supplementation didn't show a benefit in fractures, cancer, heart disease, brain function, or any of the numerous other outcomes when used in people like you. I have limited my prescribing of vitamin D to people with very low levels, which is usually in people who have the risk factors that you don't have.Why isn't your vitamin D level higher? Some people have genetic conditions that keep them from optimally making vitamin D, even in the presence of sunlight. Those with darker skin are less able to make vitamin D, so they are more likely to have lower levels. But I still wouldn't worry too much about a level of 29 ng/mL.Finally, taking 12 weeks of 50,000 units a week will certainly make your vitamin D level higher, but once you stop it, it will eventually go back down to where you are now, unless you increase your supplement dose. It's not really an issue for you, since 29 ng/mL is fine, but people with very low levels or with osteoporosis are sometimes treated with weekly vitamin D and don't receive any ongoing supplementation when the course is finished.DEAR DR. ROACH: I recently heard from a professional in my balance-training class that "the 80s are tough." I just recently turned 75, and I'm wondering if there is anything I can do to survive the 80s and remain in decent shape. -- M.R.ANSWER: A few of my patients have told me that their 80s have been great, and they haven't had any problems. But most people do find that the older they get, the more likely they are to develop medical symptoms. Unfortunately, some of them can't be prevented, but there certainly is some advice I can give to my older readers who want the best chance of good health:The first is that your choices really matter. Start with a healthier diet -- less processed food, less simple sugar (especially sugary beverages), plenty of fruits and vegetables, and high-quality protein sources. Regular exercise is important as well. Balance training is great; this can help prevent falls, as does strength training. Cardiovascular exercise, especially of moderate intensity, helps reduce heart disease risk. Regular medical checkups remain important, whether they're for blood pressure checks, preventive care screenings, or just having someone see if a new concern comes up.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved