Dear Dr. Gott: After 14 years of using our finished basement rec room on a daily basis, I have discovered the presence of radon gas. The level ranges between 6 and 7. To disassemble the room is far too costly on our retirement income. Recent lung X-rays are OK, so what is our risk of cancer after all these years of daily exposure?
Dear Reader: Radon is a radioactive gas that comes from the breakdown of uranium. It is found in almost all soils and permeates the air we breathe. It moves through the ground and into buildings and water supplies through cracks or holes in foundations and solid floors, through gaps in suspended flooring, around service pipes and through walls. It can enter through well water. Once inside a building, the radon is trapped and builds up to unhealthy levels. It can be found in schools, offices, homes and public buildings. Radon can’t be seen, tasted or smelled, yet reports indicate it causes lung cancer, killing thousands of people every year.
Radon in the air is measured in picocuries per liter (pCi/L) of air. While ANY amount of this radioactive gas is bad, the average level in homes across the United States is 1.3 and 0.4 in outside air. Nearly one in every 15 homes in the United States is estimated to have high levels. A level ranging from 6 to 7 definitely requires attention. To begin with, I wouldn’t take one sample test result as gospel. Have a second test to verify the accuracy of your first reading. Then have your water tested. Radon isn’t generally a problem when the source is surface water. The problems result when the source is groundwater or generates through a public water supply that uses groundwater.
There are several methods you can use to reduce the radon levels in your home that shouldn’t break the bank. You can perform a short-term home test by yourself that takes up to three days to perform. Long-term testing can last more than 90 days. Some methods can reduce levels by up to 99 percent, with extremely high levels being brought down to an acceptable range. If you performed one short-term test, I recommend you follow up with either another one or change to a long-term test for verification. The most common one is known as soil-suction radon reduction, which uses a fan-and-vent pipe system to pull radon from beneath your rec room and vent it outside. Even houses with crawl spaces should benefit from this process. By sealing visible cracks and openings around entrance pipes, greater reductions will be realized. One plus is that there will be no major changes or construction costs involved. Check with your local or state offices for the names of certified contractors who can provide good advice and direction if you prefer to take that route.
And now, on to the main issue — your risk after all these years. I find it hard to believe that you would or could simply stay away from a room you have obviously enjoyed for 14 years. You have already had a chest X-ray that failed to reveal any questionable areas. That’s a good thing. But, because of potential dangers, I recommend you make an appointment with an oncologist for his or her opinion.
Dear Dr. Gott: I read your column daily but have never seen you comment on an inguinal hernia. Can you address it? I am in my late 70s and suddenly have one. It is not incarcerated, and I am wondering if I need surgery. If so, can it be done with local anesthesia?
Dear Reader: An inguinal hernia occurs when a portion of the small intestine or internal fat protrudes through a weakened area in the lower abdominal muscles. This occurs on either side of the groin area between the abdomen and thigh, resulting in a bulge. Inguinal hernias are five times more common in males than in females and account for 75 percent of all hernias, of which there are several kinds. An inguinal hernia can occur at any time from infancy to adulthood.
There are two types of inguinal hernia — direct and indirect. A direct hernia is caused by degeneration of connective tissue of the abdominal muscles, common in older people. This type develops gradually because of continuous stress on the muscles involved. Factors include weight gain, lifting heavy objects, muscle strain, chronic cough and straining from constipation. Indirect hernias are congenital and much more common in males because of the way a male develops in the womb. Indirect inguinal hernias can occur in females as well; however, the condition is the result of a weakened area in the abdominal wall, not because of a weakened area of the inguinal canal.
Symptoms of either type include a bulge, pain, burning or discomfort — especially when lifting or otherwise straining — and weakness or pressure in the groin. Incarcerated hernias are so named because the bulge that protrudes is swollen and cannot be massaged back into the abdomen. When this occurs, the blood supply to that area may become compromised. Symptoms can include fever, increasing pain, tenderness, redness and an elevation in the patient’s heart rate. This situation requires immediate attention.
Diagnosis of an inguinal hernia is made through examination by a physician and the medical history provided by a patient.
Treatment for adults is surgery accomplished either through laparoscopy or open repair. The laparoscopic approach uses general anesthesia. Incisions are made in the lower abdomen. A thin tube with a video camera is then attached. The camera allows the area to be viewed on a monitor, and repairs are made using synthetic mesh. This procedure affords shorter recovery time but cannot be used on large hernias or on patients who may have had prior pelvic surgery. Open repair requires anesthesia into the abdomen or spine to numb the area. An incision is made in the groin, the hernia is repositioned into the abdomen, and the abdominal wall is reinforced with sutures. The area is then strengthened with synthetic mesh or screen in a procedure known as herniorrhaphy.
Post-surgical conditions can include wound infection, bleeding, pain at the site of the scar and injury to internal organs. Recurrence can occur. Generally speaking, however, hernia repair using either method is safe and most often uncomplicated.
To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
Dear Dr. Gott: I really enjoy reading your column and hope you can help me deal with a problem. Ten years ago I went to Mayo Clinic with health problems. The rheumatologist was not helpful, nor did she tell me what was wrong with me. She only laughed at me, telling me how bow legged I was. I was so shocked and hurt that I could barely drive myself home.
Last year I went to a different rheumatologist in a different state because of knee pain no one could explain. Again, the doctor did the same thing. I was so shocked I could barely talk. I walked out of his office after he left me feeling angry.
I live in a rural area where doctors are limited. How do I talk to doctors that put me down like that? Both were average looking and not anything special. So where do they get off putting a patient down? I see other people on the street who can barely walk that are far worse off than me in that department.
Thank you for your time on this matter.
Dear Reader: Bow legs were not your choice. They either developed physiologically or pathologically. Generally speaking, physiologic bowing improves without treatment as a child grows. Unless treatment is given, pathologic bowing, which is due to a disease process, tends to worsen as a child grows.
Most babies are born with bowed legs because of the way an infant is curled up during the nine months a woman carries it. By about 18 months of age, the bowing self-corrects. By the age of 3 or 4, a knock-kneed alignment occurs. This, in most instances, corrects to some degree by the age of 5 or 6. There are occasions, however, when the bowing never fully corrects, and this is the reason some adults have bowed legs.
A number of diseases can cause pathologic bowing, with two of the more common ones being rickets and Blount’s disease.
Rickets results from a dietary deficiency of vitamin D, calcium and phosphorus. This is relatively uncommon in the United States because of vitamin supplements and diet but is still seen in less developed countries. It should be noted that even with a normal intake of vitamin D, a breakdown in the mechanism that uses vitamin D in the body can cause a rickets syndrome. The disorder causes cupping and widening of the growth plates that can be identified on a simple X-ray. Symptoms include bow legs and knock knees, swelling at the ends and sides of the bones, muscle pain, curvature of the spine, enlarged liver and spleen and a host of other conditions.
Blount’s affects the inner edge of the upper shin bone at the knee growth plate. It runs across the knee, causing a decrease in the growth plate closest to the leg’s inner side or inseam. The outside portion of the growth plate grows normally, which leads to bowing. The disease affects infants and teens. Both groups have a similarity in that the children are overweight for their age. The deformity is always tied with an inward direction of the foot and ankle. If detected early enough, braces can help. Diagnosis, as with rickets, can be made by X-ray, but simple positioning of the foot, not the knee, is critical for proper diagnosis.
Now, on to your less-than-professional medical contacts. I have no idea how bowed your legs are, but there is simply no excuse for such shenanigans by a physician, whether at Mayo Clinic or the walk-in clinic on the corner in a small town. You were treated poorly. You cannot do anything about the inadequacies of such uncaring, bumbling individuals. If it ever happens again, simply inform him or her that you did not leave a side show to provide entertainment for the viewer: You expected to be treated with dignity. No matter how hard this might be, toughen up and don’t let another person get the upper hand. Were it me, I certainly would never expect to see a bill for services rendered. Laughter should be free and enjoyed by everyone involved.
Request a referral to an orthopedic specialist and get the answers you should have received 10 years ago. Good luck, and remember — hang tough! You can do this.
To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.