as a docHealth & Wellness

Ask This Doc: Q & A

Have you been wondering about anything?

Perhaps you have read something health-related on the internet but are not sure of its accuracy and would like the opinion of an impartial doctor…

Perhaps you just have a general question about how to improve your health…

I have noticed that many people have unanswered questions when it comes to health-related issues. Therefore, if you think I can help, I encourage you to ask them (of course this is not to replace your personal doctor’s advice, but just to offer you another source of information).

You are welcome to leave your question in the comment section or submit it to me directly. 

With love,
Phoebe Chi, MD

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 *Remember, any information provided through this blog is solely for educational purposes and is not intended to be used in place of medical advice. Always consult your trusted health care provider before starting or changing any medications/supplements, diet, and exercise regimens.  


73 replies »

  1. Hi, if diagnosed with severe osteoporosis, how much of vitamin d3 to treat is needed. I am currently taking a combination of calcium and d3 with k and I supplement with 2000iu of d3 as well

    • Hi Tink,

      For osteoporosis, the recommended dose of calcium is 1200mg with 800IU of vitamin D3.

      Since it sounds like you are already taking more than that, I would advise you to continue on your current dose without increasing. Make sure not to take more than 4000IU total of vitamin D daily (unless instructed by your doctor) as this increases your risk of vitamin D toxicity.

      However, vitamin D and calcium alone are not sufficient treatments for severe osteoporosis, which usually requires a bone-forming prescription medication. Has your doctor discussed that with you?

      • My PCP did not recommend a prescription medication, just calcium with d.However my oncologist is recommending either an injection or a tablet. I am not sure yet what to do, since I am concerned of side effects.

        • I understand. I think it would be very helpful if you asked your oncologist directly regarding your concerns. If you know the medication names, you could first look them up (or ask me) and then write down specific questions to discuss with your doctor. There is a wide range of treatments for osteoporosis, and depending on your medical history, there may be one that’s best for you.

          I hope this helps. Wishing you the best. 🙂

  2. Hi, me again!
    I know a fair amount of women, especially in the 55+ group, who have decided that they don’t need to go get their annual gyn exam and mammogram. Some have had hysterectomies, so say there’s nothing to check; others say that the risk of cancer from the radiation is greater than the likelihood that they have cance.
    So then, what is your advice to “older” women? How often do they need their exams and mammograms?

    • Hello there!

      You bring up a very important topic, as many women often wonder the same thing. To answer your question I will address each test separately:

      PAP SMEARS (Cervical cancer screening):
      – If you are YOUNGER THAN 65: Please continue to get cervical cancer screening when your doctor asks you to. Usually this is every 3 or 5 years (depending on what tests were done and what the results were).
      – If you are 65 AND OLDER and your recent pap smears were normal: You can stop!

      -If you have had a TOTAL hysterectomy for noncancer reasons: No more paps needed!
      -If you have had a total hysterectomy for a cancerous or precancerous condition: Still need pap smears (they check vaginal wall cells for abnormalities)
      -If you have had a PARTIAL hysterectomy: Still need paps (per above)

      MAMMOGRAMS:
      – If you are 55 AND OLDER: I definitely still recommend getting them, but you can space them out to every 2 years.
      – When to stop: Some physicians recommend getting mammograms for as long as you are healthy enough to have a life expectancy of at least 10 years. Some say it's okay to stop when you're 75 years old.
      – As for the dose of radiation exposure from a mammogram: it is very minimal, so I would not use that as a reason to not get one.

      So to sum up what is a rather complicated issue: I would encourage any woman in the 55+ age group to ask their doctors directly about what they recommend given her specific medical history, and if you have concerns or reservations…let them know! That's what they are there for.

      I hope this helps! 🙂

  3. I am so glad you are answering all of these questions! I just started taking iron pills (1 per day) about 2 weeks ago. I’m anemic. How will I be able to tell if they are actually working? What should I be looking for? Thank you! 🙂

    • You asked a great question. On average, if a person’s anemia is severe enough that they were having symptoms (fatigue, weakness, headaches, shortness of breath with mild exercise), they usually will notice some improvement in their symptoms within the first week (it would be longer for you since you are on a low dose). If you only had mild or no symptoms to begin with, you might not notice a drastic change in the way you feel, but you can trust that it is definitely working to replenish your body’s iron stores.

      A couple of important things to keep in mind:
      – You are on a pretty small dose of iron. Many times people are prescribed 3 doses a day. Either way is fine, but just note that for you it will take longer to “take effect.”
      – It takes about 2 months on average for your anemia to go away, but it can take up to 6 months for your body’s iron stores to be completely replenished. Therefore, don’t stop taking it until your doctor tells you to.
      – For best absorption, take the iron pill on an empty stomach and with some source of Vitamin C (orange juice or Vitamin C supplement)
      – If you cannot take it on an empty stomach (due to nausea/upset stomach), make sure not to take antacids (like Tums) or drink milk beforehand, as these will prevent absorption of iron.

      I hope this helps. Take care! 🙂

  4. O.k. to get past the corney joke, “Hey doc it hurts when I do this…”
    Doc- “Don’t do that…”
    Seriously though it’s really nice of you to offer advice, I am wondering something. I have a bulging disk in my low back that I take care of through stretching and yoga and I usually don’t have problems with it. Well if flared up after some tennis in the cold (well Texas cold 45 degrees) and now about 4 weeks later its still causing spasms in my low back. But normally it would be bilateral, this time it’s mostly on the right side and the spasms actually go all the way to my abdominal muscles and make me feel a little nauseous also. I do have an appointment next week but I just worry about it hurting only on one side. Thanks!

    • Lol at the joke (although I wouldn’t have been that mean) 🙂

      If you previously were told that you had a bulging disk, the change/worsening in symptoms could be caused by disk herniation (when a small crack forms in the outer layer of cartilage, allowing the central portion to protrude out).

      When a disk becomes herniated, it can impinge the nerves supplying your abdominal muscles and organs, and as a result cause abdominal cramps, nausea, or even loss of bladder or bowel control. And yes, the pain can be unilateral.

      It is good that you have an appointment soon. I would just caution that if your symptoms become unbearable or you develop a fever that you go to a doctor immediately instead of waiting.

      I hope this helps!

  5. What are some ways to combat early onset puberty? Are there any herbs I should use? Thank you, for your open, and Free support. Like Taraji P. Henson said, “When we come together as a Human race; we win every time.”

    • Hi Liz. Could you please clarify? I assume you are referring to yourself, therefore are you asking about “early menopause?” You asked about early “puberty” I want to make sure before I respond. 🙂

        • I understand. Before I answer your question, I want to mention that many doctors now believe that puberty in girls as early as 6-8 years is normal and do not need to be treated. But to address your inquiry…

          Treatments that are proven to work:
          – The only thing that is proven to halt puberty are prescribed hormonal medications called “GnRH analogs.” The main reason doctors would prescribe this medication is to slow puberty and bone maturation so that the child can grow to average height.

          Other remedies that have been suggested to ‘slow down’ puberty (However there is no scientific proof that they are effective so I cannot recommend them as a treatment):
          – Weight reduction if the child is overweight
          – Decreasing the amount of sugars, soda, starches in the diet
          – Eating “organic foods” and more vegetables
          – Limiting dairy products and replacing cow milk with almond/rice milk (due to hormones)
          – Use glass containers instead of plastic (due to the possible chemicals)

          With that said, I assume you have already taken your daughter to see a doctor that can fully examine her and test for other medical issues? The reason is that many different things can cause early puberty–some are easy to treat (and by treating it will stop her puberty), others are more serious (and therefore would be good for her to see a doctor).

          I hope this information helps. 🙂

  6. Such a generous offer Phoebe, you’re the best. I was interested and surprised to learn that stress effects one’s weight, I would imagine that when under stress we often go to comfort foods to soothe our anxieties. I will be back if I need some specific information. Thank you so much!

  7. Hi Phoebe! How does our body determine its set weight point? I am trying to lose 10-15 pounds through dieting as I gained a bit the past year and want to retrain my body to have a lower set point. Thanks!

    • Hi Allie,

      Some background info for people:
      – Your weight “set point” is the weight that your body thinks it should be at and where it fights to keep you through a balance of hormones that regulates your appetite and your metabolism. Most people hover around this point (For example, you may diet but then gain the weight back and you find it is close to where you started).

      What determines your set point:
      – Your heredity and your environment (your eating habits). Even if your genetic factors favor a certain weight, poor long term eating habits can actually change it, making your body “think” that it’s supposed to weigh more or less.

      How to change this set point (for long-term weight loss):
      – The 10% over 6 months rule: It has been observed that on average, the body will allow you to lose 10% of its weight before it starts to “fight back” and become resistant to further dieting. Therefore, aim to lose no more than 10% of weight over 6 months. After 6 months, your body will have created a new set point, so then you can work to lose 10% more of that weight, and so on…

      What has been shown to work long term: Sustained change in eating habits and increased physical activity (both cardio and weight training).

      Therefore, I encourage you to aim to develop healthier eating and exercise habits that will work for you long-term. At the same time, try to minimize stress and get enough sleep. Lastly, be patient. You’ll get there!

      Hope this helps!

  8. Yesterday, you mentioned 10 Weight Loss tips and I thank you for that, as I need to lose about 10lbs…:) Getting there. My question is, does the amount of stress you are under in a given day, week or month play into or affect your bodies inability to shed the weight, even though you may be a fairly active person? Thanks Doc

    • Hi Philip,

      You asked a great question. The short answer is: YES, chronic stress can make it more difficult to lose weight, even if you are an active person.

      Why? You have probably heard of a “stress hormone” called cortisol. When a person is under repeated stressful situations (either physically or emotionally), the production of cortisol markedly increases.

      This stress-induced cortisol affects your brain and body in several ways, but for most people, it sabotages their weight loss efforts by increasing not only their appetite but by triggering cravings for calorie-dense “comfort foods.”

      Even if you don’t eat more and still exercise, high stress can affect the way in which your body stores fat…namely, it increases the accumulation of abdominal fat, therefore making it more difficult to shed the weight around the waist.

      Hope this helps!

    • The short answer is: Yes, carbonated sodas (both regular and diet versions) have been demonstrated to adversely affect the liver by increasing the risk of fatty liver disease.

      The longer answer:
      -For sugary drinks: The fructose contained in them stimulates the process of liver lipogenesis (fat production).
      -For diet drinks: There is some evidence that sugar substitutes and some colorants can increase insulin resistance and inflammatory processes which in turn affect the liver.

      The result is that, keeping everything else the same (physicial activity, calorie intake, alcohol intake), drinking soft drinks seems to be associated with the increased risk of developing what we call “non-alcoholic fatty liver disease (NAFLD)”

      Does this mean you cannot drink any at all? No. But I would definitely recommend limiting your intake (no more than 1 daily).

      As for the carbonation itself (for instance, if you drank carbonated water), it does not harm the liver.

      Hope this helps!

      • Medications can change set-points too – I found out the hard way after an early Prozac trial. I gained 30 stubborn pounds in only a few months – NO change in life-long eating habits.

        Since, in the original study, participants reported losing weight, my doctor didn’t believe my self-report about my diet – as I continued to complain. It took 3 diligent years to lose those 30 (after stopping the drug) – and in year one I only lost 5 measly pounds!!

        I would have given up at that point but, as an actor at the time, I really couldn’t afford to. I was also convinced that if I didn’t reverse the trend and get back to my former weight then, I’d carry those pounds for the rest of my life.
        xx,
        mgh
        (Madelyn Griffith-Haynie – ADDandSoMuchMore dot com)
        ADD Coach Training Field founder; ADD Coaching co-founder
        “It takes a village to transform a world!”

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