University Health System Blog

The Reno Gazette-Journal asks Dr. David Ginsburg, associate professor of neurology at the University of Nevada School of Medicine in Las Vegas, what causes multiple sclerosis in the article, “Mysterious MS” published Jan. 26, 2010.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, please contact him by email or call 702-671-2230.

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Dr. David Ginsburg answers the question: Alzheimer’s disease: What are the possible early warning signs?

While it may be difficult to diagnosis Alzheimer’s disease with relative certainty early in the disease process, the diagnosis typically becomes more firmly established over time.

Patients initially presenting to a physician with complaints of memory loss may have early Alzheimer’s disease, or may alternatively have a less serious condition called “benign forgetfulness.” As symptoms gradually progress to involve other aspects of cognition, such as problems with word-finding, writing, drawing and calculating, the likelihood of Alzheimer’s disease increases.

These problems become particularly concerning when they interfere with daily functioning, such as working, cooking, self-grooming and balancing the checkbook.

When evaluating a patient with memory impairment, a physician will likely screen for a variety of possible causes, including stroke, tumor, epilepsy, depression, vitamin B-12 deficiency, hypothyroidism and hydrocephalus.

The work-up will likely include a brain CT or MRI, electroencephalography (EEG) and a variety of blood tests. A brain PET scan is also occasionally useful to evaluate for regional areas of metabolic disturbances.

If the diagnosis remains unclear, occasionally the patient will undergo a detailed cognitive evaluation by a neuropsychologist. The neuropsychological evaluation may subsequently be repeated after six to 12 months in order to monitor for worsening of the various subtests, which in turn might suggest a progressive neurodegenerative disorder such as Alzheimer’s disease.

The only way to diagnosis Alzheimer’s disease with absolute certainty is with a brain biopsy, which is not typically performed for this condition.

On the other hand, a diagnosis of Alzheimer’s disease is generally confirmed or excluded to a high degree of accuracy on the basis of the patient’s history, examination and a variety of ancillary tests as previously discussed. The importance of early diagnosis cannot be overstated, as a variety of medications are currently available to treat this condition.

David Ginsburg, M.D. is a neurologist practicing in Las Vegas, Nevada. He is an associate professor of neurology at the University of Nevada School of Medicine.

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Dr. Evan Klass answers the question: “What is an epinephrine test and what does it help determine?”

Epinephrine is a hormone produced by the adrenal glands. It is a hormone involved in the “fight or flight” reaction, for instance, the hormone is produced under stressful circumstances and situations.

Levels in the blood vary widely, even the stress of having blood drawn can raise the level.

It is generally not recommended as a test of any condition because of the unpredictable results.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

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Dr. Tony Chang answers the question: “Acute tendinitis pain: Should I apply ice or heat?”

Tendonitis is inflammation of a muscle tendon. Tendons lie at the ends of muscle and attach muscle to bone. If a tendon is inflamed, pain occurs with movement of the muscle or joint.

If tendinitis is an acute injury or the onset is less than 48 hours, applying ice to the injured area is a good choice for treatment.

Ice helps numb the injured area, reducing pain. It also constricts blood vessels (vasoconstriction), limiting blood supply to the injured site which may help decrease swelling. By reducing swelling, there are decreased levels of inflammatory substances that can reduce further tissue injury. Cold treatment can also decrease muscle spasm which may help the tendon healing process.

If an injury is in a more advanced stage of healing usually after four or five days heat treatment can be used.

Heat increases local blood supply (vasodilation), bringing healing cells to the area and potentially relaxing tight muscles. This increase in blood flow to an area of longer term injury is thought to promote healing.

If tendinitis is chronic in nature, there is no strong scientific evidence to support the use of either heat or ice for pain improvement.

However, applying heat to a long-term injury to promote blood flow before exercise and ice to the area to reduce swelling after exercise may be an effective strategy in treatment for chronic tendonitis. The focus of chronic injuries should be on eccentric rehabilitation exercises.

Of course, preventing injuries before they happen is best. Proper stretching and warm up before placing any physical demands on your body is the utmost of importance. Be in tune with your body and pay attention to what you body is telling you. Stop exercising if you start to feel pain.

Tony Chang, M.D. is a fellow of sports medicine at the University of Nevada School of Medicine in Reno. He sees patients at the University of Nevada, Reno Student Health Center, the Family Medicine Center and Nevada Athletics and spends time with community physicians in the care of athletes and individuals following exercise regimens.

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Dr. Evan Klass answers the question: “Can diabetes cause liver damage?”

The relationship between diabetes and the liver has become much more clear over the past five years. Let me first say that type 1 diabetes does not affect the liver. This discussion pertains to type 2 diabetes.

In type 2 diabetes, a primary problem is insulin resistance.

Insulin resistance makes the insulin in your body that’s available less effective in its target organs. These organs include the liver and fat tissue. Insulin resistance can exist before diabetes becomes apparent if the pancreas is able to make enough insulin to overcome the resistance. Eventually, in some people, the pancreas cannot keep up production of insulin and blood glucose begins to rise.

However, insulin resistance itself leads to other hormonal changes which can impact on the liver. Specifically certain fat bodies called free fatty acids are released by fat cells and these can be stored in the liver. This can result in inflammation in the liver which can cause progressive damage. In rare cases, cirrhosis of the liver can result.

The important thing is that this process can be treated with diet modification and medication, but, as with many medical conditions, the sooner treatment is initiated the better.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

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Dr. Aditi Singh answers the question: “Is leg pain after prolonged sitting or standing a concern?”

There are various medical conditions that can cause your symptoms and this should definitely be evaluated by your primary care physician.

But, briefly, some medical conditions that are associated with leg pain due to prolonged sitting or standing include:

• Venous insufficiency or venous disease. The lower extremity veins’ valves are unable to function properly in that they are unable to move blood efficiently from your legs. This causes the blood to remain in the legs and feet which can increase the pressures of the lower extremity veins and can cause pain as well as swelling. There is a wide range of manifestations associated with venous disease, including no symptoms, fullness and swelling of the legs, cramps or pain in the legs while sitting, and pain upon prolonged standing.
• If the leg pain is associated with back pain and a sensation of numbness or tingling of the leg, this could be a sign of disc herniation impinging the sciatic nerve. The sciatic nerve is a large nerve that runs down your lower extremity. The symptom of back pain radiating down to buttock and/or leg is referred to as sciatica.

If you are having such symptoms, it is important for you to be evaluated by a physician so that you are properly diagnosed.

Dr. Aditi Singh is an assistant professor of medicine at the University of Nevada School of Medicine in Las Vegas. She is board certified by the American Board of Internal Medicine.

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Dr. Kate Martin answers the question: “Are flu vaccines safe for me if I’m allergic to eggs?

If you have had a severe allergic reaction to eggs, such as difficulty breathing or swallowing, then you should not get a flu shot.

The explanation for this comes from the process in which the influenza vaccine is made. The actual viruses used for the flu shot are initially grown in eggs. These viruses are later inactivated, or killed, so you cannot actually get the flu from the influenza vaccine. However, as the origin from eggs never goes away, anyone with a severe egg allergy should not receive the flu vaccine.

Kate Martin, M.D. is an assistant professor of family and community medicine at the University of Nevada School of Medicine in Las Vegas. She practices at the Family Medicine Clinic.

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Dr. Tony Chang answers the question: “Are energy drinks with high caffeine amounts okay for athletes?”

In our sports world today, athletes may look for that extra edge—a way to boost energy, improve endurance, quicken reaction speed and counter drowsiness. Many athletes will consume energy drinks unaware of the health and legal hazards.

In 2003 the National Collegiate Athletic Association (NCAA) instituted a list of banned drug classes, including stimulants, anabolic agents and street drugs that are prohibited for use by NCAA athletes. Two common ingredients in energy drinks, taurine and guarana, were banned.

Caffeine is considered a restricted substance and not a banned substance.

The NCAA declared that athletes cannot have a caffeine concentration higher than 15 micrograms per milliliter (mcg/ml) in their body.

Doses of 3-6mg/kg, which do not produce urine concentrations that would result in disqualification, have been found to be ergogenic.

One cup of regular coffee contains 100mg of caffeine and a can of Red Bull contains 115mg of caffeine, while the equivalence in urine within two to three hours is 1.50 mgc/mL and 1.73 mgc/mL respectively.

In a healthy and average sized man, the NCAA limit may be reached by consuming five regular cups of coffee a few hours before drug testing. There may be variations of caffeine content in each product, as well as, metabolic differences unique to each athlete.

Therefore, the safest action is to avoid consuming caffeine-containing products during athletic events.

Energy drinks, which are often loaded with caffeine, sugar and herbal stimulants, may pose various health risks, including:

• The caffeine in energy drinks can increase blood pressure and heart rate.  It has the potential to trigger dangerous cardiac arrhythmias;
• The caffeine in energy drinks can cause irritability, restlessness and nervousness. Excessive caffeine is also associated with headaches, tremors, nausea and insomnia;
• The caffeine in energy drinks may also be linked to increased risk of dehydration during exercise, which can lead to hampered performance as well as heat illnesses; and
• The high sugar content in most energy drinks can contribute to undesired weight gain, and sugar high crashes.

In addition, excessive amounts of energy drinks have been associated with manic episodes, seizures, chest pain, heart attacks and sudden cardiac death.

I recommend against the consumption of high-caffeinated energy drinks prior to activity. Many of these drinks contain NCAA banned substances such as taurine and guarana.

I also do not recommend drinking more than two cups of coffee prior to activity based on the adverse effects of high caffeine as stated above.

Tony Chang, M.D. is a fellow of sports medicine at the University of Nevada School of Medicine in Reno. He sees patients at the University of Nevada, Reno Student Health Center, the Family Medicine Center and Nevada Athletics and spends time with community physicians in the care of athletes and individuals following exercise regimens.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Can you be considered obese if you have a normal body weight?”

If you are what is considered an ideal body weight, according to the Metropolitan Life Insurance tables from the 1940s, you will generally not be considered overweight or obese.

The Centers for Disease Control (CDC) defines being overweight and obese by a body mass index (BMI). BMI is a person’s weight in kilograms divided by their height in meters squared.

BMI is a better value for measuring a person’s weight compared to actual weight in pounds. This is because a 210 pound man who is 6 feet 6 inches tall is probably more lean than a 210 pound man who is 5 feet 6 inches tall.

The CDC defines a normal weight as a body mass index between 18.5 and 24.9. Overweight is between 25 and 29.9. Obesity is defined as a BMI greater than 30 and morbid obesity a BMI greater than 40.

The problem with body mass index is that it does not directly measure fat content.

However, it is still a valuable tool because for most people other than very muscular body builders or athletes, a BMI suggesting overweight or obesity means that medical problems and a shortened life expentancy comes along with it.

A diet and exercise plan and in some cases, surgical treatment for morbid obesity, can resolve medical problems, improve quality of life and avoid premature death.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

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Dr. Evan Klass answers a question from Kerry in Reno, Nevada: “Can type 2 diabetes have an effect on a person’s mood, causing anger, irritability and/or depression?”

Type 2 diabetes is frequently associated with mood disturbances, especially depression.

The manner in which it causes these changes is not certain. Is it related to the effect of changes in glucose in the brain or is it related to the stress of having a difficult chronic illness?

Depression is under-diagnosed in patients with diabetes and there is very good evidence that treating depression improves diabetes control.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.