health

You're Extremely Unlikely to Catch the Same Cold Twice

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 23rd, 2017

Dear Doctor: My wife had a bad cold, and then I unfortunately caught it. Then, just as I was recovering, she got it again. What's going on? I didn't think it was possible to get the same cold twice.

Dear Reader: It's tempting, and even logical, to think that your wife's cold has ricocheted between the two of you. However, viruses are abundant and opportunistic, so who was infected with which bug, and at what point in time, is up for grabs.

It's entirely possible that you became infected with the same virus that caused your wife's cold. But it's equally likely that you brought home another virus of your own. If so, then on her next go-round, she may have actually caught your cold.

If she did indeed pass along her virus to you, then the second cold she caught was most likely a new and different virus. That's because, thanks to the marvels of our immune systems, it's extremely unlikely to catch the same cold twice. Even if you do manage to become re-infected, thanks to the antibodies provided by your immune system, the new cold takes a significantly milder form.

However, cold and flu viruses mutate readily. When that occurs, despite having developed antibodies to fight off the original cold, the altered virus can indeed make you sick again. Whether your family's illnesses were the result of one, two or even three different viruses, there are simple and effective steps you can take to limit their spread. These precautions are worth implementing at home, at work and while out in public.

Viruses can survive for up to three days on surfaces and inanimate objects. When caring for someone who is ill, don't share food, drink, dishes, glasses or cutlery. Wash everything used by the cold sufferer in hot, soapy water as soon as possible.

Be aware that the books, pens, remote controls, telephones, electronic gadgets and doorknobs that the sick person touches can harbor the virus. A spritz with a bleach solution or a disinfectant cleaner is a good idea. Making sure the sick person frequently washes or disinfects their hands is important. Ditto for the caregivers and all others in the house.

Do what you can to build up your own immune system. Eat well, drink plenty of fluids, take part in regular exercise and get enough sleep. Avoid rubbing your eyes, touching your nose or putting your hands to your mouth after touching public spaces where viruses may linger. And don't forget your annual flu shot.

If you do get sick, please don't try to power through. If your employer offers sick leave, take it. Your co-workers will be grateful. If you have no choice but to go to work, don't try to be a hero. Take advantage of the many over-the-counter remedies that can lower fever and reduce the symptoms that make colds so miserable. And follow good cold hygiene by taking every precaution possible: Sneeze and cough into a tissue, wash your hands often, and don't share food, phones or any objects that may harbor germs, so as not to spread the virus.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Joint Replacement Usually Needed for Avascular Necrosis

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 22nd, 2017

Dear Doctor: My husband was diagnosed with avascular necrosis in his right hip. Can you please tell me what this is and how to treat it? He's not a surgical candidate for hip replacement due to his age, and he doesn't want to take prescription pain medication. What can he do?

Dear Reader: These are smart questions to ask. As the name implies, avascular necrosis of the bone is an interruption of the bone's blood supply. This supply consists of a rich, thin network of blood vessels similar to the small roots of a plant. Because blood supply from surrounding tissues is limited, the bone becomes dependent upon these small vessels to survive; if blood flow is interrupted, the bone nourished by a particular vessel will die. This damages the architecture of the bone and causes a loss of calcium, eventually causing the bone in that area to collapse. Each year, 20,000 to 30,000 people in the United States are diagnosed with avascular necrosis.

Such interruption can be caused by blood clots; circulating fat; bubbles of nitrogen (seen in decompression sickness); damage from fractures or dislocations at a joint; radiation therapy; or inflammation of vessels in conditions like lupus.

Drugs can play a role as well. Anti-inflammatory steroids, such as prednisone and methylprednisolone, increase the risk of avascular necrosis, especially for people treated with high-dose steroids for a prolonged period. In fact, steroids are believed to be a factor in 21 to 37 percent of patients with avascular necrosis.

Alcohol consumption is believed to be a risk factor in 31 percent of cases, with heavy use leading to fatty deposits within the vessels. The more one drinks chronically, the greater the risk of developing the disease.

Avascular necrosis is more likely in people with lupus, antiphospholipid syndrome, sickle cell disease, acute lymphoblastic leukemia or Gaucher disease and in people who have had a transplant. Many times, the cause is unknown.

Avascular necrosis of the hip -- the most likely joint to be affected -- is often the most disabling. The pain initially felt while walking can later occur at rest and, when the condition becomes severe, patients cannot walk at all due to the joint's collapse.

That's not to say treatment might not help. Bisphosphonates, such as Fosamax, have shown benefits in some, but not all, studies. (These drugs also have been linked to avascular necrosis of the jaw.) Iloprost, a dilator of blood vessels, can increase blood flow and has been linked to a delay in the need for a hip replacement. And statins may reduce the risk of avascular necrosis in people taking steroids.

As for pain, core decompression might help. In this procedure, a needle is placed in the bone marrow to encourage bone regeneration. Also, a procedure called osteotomy can alter the bone at the hip so that the area won't be subject to further damage from walking. For most people, however, a total hip replacement is the ultimate solution, resolving symptoms in a majority of patients.

For your husband, I'd recommend drugs to slow the progression of the necrosis, as well as a second opinion from a physician who can help further assess the risks versus benefits of a hip replacement. Age alone generally isn't a deal-breaker. If he truly isn't a candidate for joint replacement, however, his doctor can assess other potential therapies.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Age-Related Loss of Taste and Smell Not Uncommon

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 21st, 2017

Dear Doctor: Does loss of taste occur naturally with old age, or could it be a symptom of an illness? I'm 89, in pretty good shape with good blood pressure, but seem to be losing my sense of taste.

Dear Reader: While it's true than an impaired sense of taste can be related to illnesses that range from a simple cold to a complex neurological disorder, by the time one is 89 (congratulations, by the way!) it's more likely that the decline is age-related. To understand why, we need to talk about two of our senses -- taste and smell.

Let's begin with a tiny and amazing organ -- the taste bud. We enter the world with about 10,000 taste buds, each of which is made up of between 10 and 50 sensory cells. These cells are bundled together like the sections of an orange, and are connected to a complex web of nerve fibers.

Each bundle is tipped with a fluid-filled pore that behaves as a funnel and, via minute fibers known as taste hairs, delivers molecules to the sensory cells to be "tasted." The nerve fibers send chemical messages from the taste buds to the brain, where they are interpreted as sweet, salty, bitter, sour and savory, also referred to as "umami."

The taste buds themselves are tucked into undulating walls and grooves on the surface of the tongue, which are known as papillae. The papillae greatly increase the surface area of the tongue. This allows for a significant increase in sensitivity without a corresponding increase in the size of the tongue. Additional tasting cells are found on the roof of the mouth and along the lining of the throat.

As you may have noticed, we recover from a bite or burn to the tongue far more quickly than to other parts of the body. This is due to the remarkable rate at which the sensory cells in the taste buds can regenerate. As we age, though, these cells tend to regenerate more slowly. This affects our sense of taste.

At the same time, our sense of smell, which plays a crucial role in our ability to taste and distinguish the subtleties of flavors, also begins to diminish. When we chew, volatile molecules travel via the nasal cavity from the mouth to the nose. There, as on the tongue, highly specialized cells send signals to the brain, where the incoming data get interpreted as flavor.

Research shows that what is perceived as a loss in the sense of taste is, in fact, often a loss in the sense of smell. The tongue will tell us that something is sweet. But it's the sense of smell allows us to say whether that sweet bite is a peach or an apricot.

A diminished sense of smell has many causes. If the decline in your ability to taste is sudden or severe, a visit to your primary care physician is a good idea. He or she can perform tests to assess the degree of the loss, conduct a physical exam to rule out chronic conditions or disease, and propose medical treatment, if appropriate.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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