Dr. Lucille Len, M.D.

Hello,
Sorry to hear you hurt a very sensitive part of your body.
But it does depend on the type of injury you sustained. Did something hit
your testicle like a hard baseball or did you trip and fall landing on your
bottom with your legs opened wide? Do you have an open wound on your
testicle?

An easier example would be if one injured their knee (then the injury can
be a bruised knee or a fractured knee or a strain knee ligament or a knee
muscle strain); the knee fracture would need surgery & the knee ligament
strain needs a special knee brace to heal well; but a bruised knee or
muscle strain will heal with local ice and ibuprofen or naproxen & a simple
ace wrap.

With all injuries, the 3 main issues to address are: bleeding control
(apply ice), pain control (tylenol, ibuprofen or naproxen) and infection
control (if there is an open wound). There can be complications of bleeding
(hematoma can form). Swelling is best controlled with local ice and
elevating the testicles (i.e. not walking alot in boxer shorts; jockey
briefs would be good support - but not if too tight and hurts to wear
jockey briefs).

Best to see a physician if you can.
LTL, MD

Surgery is always the last resort for any situation. How long have you had hip arthritis? Early on, the pain is not constant & is relieved with NSAIDs (non-steroidal anti-inflammatory meds like advil or motrin (both are generic ibuprofen) or aleve (generic naproxen). But if you take NSAIDs daily for a year, there is a 0.6% risk of getting a stomach ulcer. Hopefully you only need to take NSAIDs for hip pain 3x/week. Any arthritic joint is more painful when there is no movement (e.g. getting out of the car after a long drive or getting out of bed after sleeping for
6 hrs). Therefore exercise (that is why physical therapy is helpful) & movement is critical. Also keeping our weight down is important.
BUT if you have severe pain that interferes with your ability to be independent and do your ADL (activity of daily life - like personal hygiene & cooking & going to work, etc) and your doctor says your joint is bone on bone - go for the surgery. My patients who have had the surgery often tell me they wished they had done it sooner & not suffered the way they did.

Hello, Go at any time there is persistent or recurrent pain. Don't you try to figure it out? Let the physician who has seen many patients with abdominal pain be the person to say it is nothing severe. Important factors are the age of the child/person in pain, what part of the
body/abdomen is involved, does the pain travels & radiates towards another area of the body, the intensity of the pain (on a scale of 0 - 10 where 10 is the worst pain), is pain constant or comes/goes; what makes the pain worst, what makes it better; it's often a bad sign if the pain awakens the child/person from sleep; any nausea/vomiting/diarrhea, any fever/chills; any family history of colitis like Crohn's Disease or Ulcerative Colitis. Simple gastroenteritis can be due to contaminated food or a stomach virus in an otherwise healthy person, these would get better on their own within 24-48 hrs & if don't get better quickly, should then see a doctor.

Hello, Good question but no straightforward answer. Of note: prior to the availability of telehealth that blossomed during the COVID Pandemic, we physicians could never bill for our time talking to patients on the telephone. In my 40 years as a family physician, I have spent countless hours on the telephone talking to patients about their illnesses, concerns, lab results, biopsy reports & for FREE. Nonetheless, no regrets; I love my profession as a family doctor. But times change & presently, by law, providers (physicians, nurse practitioners, physician assistants) are able to bill patient's insurance (if you are self-pay, I recommend you inquire if the doctor's office has a self-pay discounted fee schedule - many offices do have one, OR one can ask to pay in installments) for time spent (whether in the office, via telehealth on video or just on the phone) to explain the details/significance/next steps of any test result. Sorry - most of today's physicians are employed & not in private practice (as I was x 31 years) & cannot make their own decisions on charging patients or not. A corporate billing department is often the 'person' sending out the bills. You can appeal a bill with the billing department (it may be a hassle but be persistent if you feel someone is taking advantage of you). Both my accountant and my lawyer charge by the minute, so in their offices, I don't even accept the water or coffee they offer because it takes time to give it to me & when on the phone I just discuss what is needed & say goodbye.

Hello, I'm so sorry you have had this terrible injury. *The treatment for burns is infection control and pain control. * Looks like it is your leg, so keep the leg elevated since when your leg is down (like walking or sitting) gravity makes your blood go down to your feet & the pain will be worst. The doctor first categorizes the burn as 1st degree (skin is painful & red but no blisters yet), 2nd degree (blisters have formed) or 3rd degree (skin is gone & you see muscle).

Hello, If you are 17 years old & have a weight issue, please make sure your thyroid is okay. Hypothyroidism is the most common medical cause of unexplained weight gain. Do you exercise or into any sports to help you burn calories? Of course, almost everyone has gained weight from overeating during COVID Pandemic. The old rule of watching caloric intake and exercise is still the #1-way to lose weight. Usually, 17 years olds are not cooking or buying their own food choices; they eat what their parents are able to put on the dinner table. Is this an
issue? There is only one OTC med that I am aware of that has research behind it: Alli (generic is Orlistat) - it takes about 1/4 of dietary fat from the foods we eat & sends it out in our stool (can present itself as an oily stool); the problem with this med is if you eat too much fatty food (like a fast-food hamburger+ french fries) you may get sudden diarrhea - like oily stool leakage. Good luck to you.

Hello, If you think you have any sexually transmitted disease go see a doctor (family physician or GYN; or some internal medicine who are adult docs) because treatments exist. It's important to know for your own health of course & also for your partner. Then if it is herpes, you do not know if you got it from a past partner or your present partner. Do not be afraid to discuss this with your partner. If you are afraid to 'lose' your present partner -THEN that is not a partner you want for life. A partner good enough for life is one who is able to help you & him/her
through crisis periods like this for you. A good partner is one with whom you feel comfortable talking about anything; especially tough sensitive conversations. Good Luck & see a doctor ASAP.

This important question is to be answered by your surgeon. So whatever I say is superseded by whatever your surgeon says.

Usually, one is instructed to eat & drink nothing for 12 hrs; no food & no water except for sips of water with pills that your primary care doctor or surgeon says you are to take prior to surgery (sometimes you can take thyroid or blood pressure meds - if these are usually taken by you upon awakening in the AM). Your surgeon will give you a list of meds you should not take for one (some say two) week(s) prior to surgery: no aspirin, no fish oils, no Vit E or a multivitamin with vitamin E, Ginko biloba (or any other nutritional supplements which has a blood-thinning effect). Persons taking diabetes medication must be given specific instructions from their diabetes doctor.

Hello, when I google ingredients of Excedrin Migraine it says acetaminophen, aspirin, caffeine. Amlodipine is a BP med and caffeine (frequent use, high dose) has been shown to cause high blood pressure in some persons. Different persons can have different responses to caffeine. But most likely one dose will not be harmful. Please remind the physician who gives you Rx Amlodipine that you get headaches. Please google Migraine Prevention (Prophylaxis) Treatments since blood pressure pills like Propanolol LA (use LA = long-acting, once-daily formulation since plain propranolol is a 3-4 x /day formulation) & Verapamil ER (ER = extended-release, once-daily) are known to prevent migraines. That way you kill two birds with one stone (address both BP and migraine).

Hello there, I am not trained in alternative holistic medicine, but there is no registry of research studies done to answer your question from an academic perspective. These OTC (over-the-counter) supplements are not FDA approved. Any medication or supplement claiming to be healthy for you is the marketing wording for their product. I googled the product & it claims to be made from 'healthy' ingredients (vitamins, minerals, etc). If that is the case and true, then it should be like taking regular foods and extra vitamins. Thus if you are on Zoloft and eat a healthy diet and some OTC vitamins then it should be safe for you to take this supplement. BUT THERE ARE ALOT OF IF's. I suspect you are also asking this question of the doctor giving you Rx Zoloft.

Hi,

You are 53 yo male with (I surmise from your list of meds) Type 1 Diabetes, hypertension, high cholesterol and GERD. I hope you are vaccinated with 2 shots of either Pfizer or Moderna and boosted. If (this a big 'if') your diabetes, high blood pressure, high cholesterol, and gerd are all under control, then the first thing you should do is get tested for COVID. Rapid Antigen tests are pretty reliable if your test is (+); but if (-), you will need the highly sensitive confirmatory PCR COVID test.

Hello again,

I just replied recommending stop Dicyclomine and try OTC fiber, BUT I just reminded myself you have diverticulitis for which, if you have active diverticulitis, you much be on a low-fiber diet (sooo NO fiber) to rest your GI tract. BUT if you are recovered by diverticulitis, you are safe to take a high-fiber diet (bulky stool can slide the stool right past the not-infected or inflamed empty pouches of diverticuli).

Lucille Len, MD.

Hello,

Very common question - any test can have errors (either false positive OR false negative). But all labs are required to test their own test using known controls of a true positive and true negative in order to get FDA (Federal Drug Administration) approval for EUA (Emergency Use Authorization). The FDA grants EUA if the company seeking approval demonstrates the
appropriate level of sensitivity to detect COVID-19. So, these home test kits are 'antigen' tests that have been shown to be pretty good at detecting COVID-19, so in general - if your test is (+), you have COVID-19 even though you do not have all the symptoms. In fact, it is well-known there are asymptomatic (no symptoms) carriers who do not wear a mask and unknowingly spreads the virus to more vulnerable people like those over 60 years old or who those have medical conditions that make them sicker if they catch COVID-19. Also, the symptoms of COVID-19 start like the common cold (and even like allergies), which is why one must get tested to find out what they have.

Now, if one's Home COVID test is (-), it can be a false negative if test is taken too early in the illness. The guidelines recommend if one has no symptoms, but has had close contact with someone who is confirmed (+), then that exposed person should quarantine at home and be tested with a PCR test.

If you have the flu & feel well enough, you can safely be around someone who has it. NOTE: if you catch the flu, i.e. have tested (+) for Influenza type A, you do become immune but only to this strain of the virus. Influenza type B is a mildly form. Of interest, in the 'flu season' there are other viruses (rhinovirus, adenovirus, respiratory syncytial virus, human parainfluenza virus, et al) that cause 'common cold' symptoms - ALSO coronavirus strains which is the same group as COVID-19). Getting both the annual Flu shot as well as COVID vaccines & wearing a mask, social distancing, washing hands often and sanitizing things we touch (countertops, doorknobs, etc) can minimize our risk of getting sick from all these respiratory illnesses.

Phlegm in throat come from 3 main sources:

- postnasal drip from sinuses (due to allergies like hay fever or respiratory infection like the common cold) - you can try OTC (over-the-counter) Cetirizine (Zyrtec) or Cetirizine-D (Zyrtec-D), which has decongestant if you are stuffy (caution: do not take decongestants like sudafed/pseudoephedrine if you have high blood pressure or enlarged prostate).
- non-med treatments include saline nasal spray, vick's vapor rub (generic store brand works fine), steaming with vick's (boil water in small pot, carefully place on trivet on table, put tiny amount of solid vick's vapor rub into the hot water, cover your head with a towel, eyes closed & breath in the vapor/steam for ten minutes; remove the towel and blow your nose - repeat as needed)
- lungs (like asthma) - this is often seen in persons with hay-fever type allergies; asthma requires treatment with Rx inhalers & you need to see a doctor for this.
- GI tract (gastrointestinal issues from stomach/esophagus like heartburn/acid reflux; there is an entity called silent reflux/GERD (gastroesophageal reflux disease) where there is cough/phlegm without feeling the reflux) - you can try OTC Omeprazole (Prilosec) or Famotidine (Pepcid). Note: the OTC doses of GI meds are always lower than the prescription doses given by doctors (e.g., Rx Omeprazole is 40 mg, but the OTC dose is 20 mg; same doses go for Famotidine).
- Important: If you have silent GERD, you need to be referred to a GI specialist for an upper endoscopy called EGD (Esophagogastroduodenoscopy) - why? Because one serious cause of acid reflux, can be stomach or esophageal cancer; also a stomach fluid culture is taken to see if you have a bacteria called Heliobacter Pylori, which can cause persistent GI symptoms & ulcers).

The above recommendations are offered to you to perhaps help you get some initial relief while awaiting an appointment with a primary care physician (board-certified family practice physician or internal medicine physician). *Primary Care Physicians can take care of 95% of whatever medical issues you have & will refer you to other specialists when needed.*

*Don't self-treat too long, find out the real reason for your symptoms. Take care of yourself. *

If you do not have medical insurance, go to your local hospital and ask if they have a charity care department to help you navigate the medical insurance world. Local churches may also have someone who can guide you where you can go for medical help.

Lucille Len, MD, FAAFP

Unfortunately, there is research that supports both a yes and no answer. Of course, I am sure you have asked your cardiologist. But the consensus (general opinion of the experts in USA) is 1 egg a day is safe (some studies say 2 eggs a day is safe). An important point mentioned in many studies is that it may be more how we cook the egg and what we eat it with that increases the risk of heart disease (and not the egg itself). Therefore, if you eat eggs and have heart disease, eat the eggs in a healthy manner (e.g., a poached egg on whole wheat toast is healthier than an egg fried in butter or egg served with bacon).

Good luck, be safe,

Lucille Len, MD