University Health System Blog

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. Tony Chang answers the question: “Is heart rate a concern while exercising during pregnancy?”

The recommendation regarding the safety of exercise in pregnancy has evolved throughout the years. It has been a subject of debate for many years due to the lack of clinical research available and fear of litigation for poor recommendations.

In 2002 the American College of Obstetric and Gynecology guidelines addressed both recreational and competitive athletes for the first time. The new recommendations said that athletes without complicated pregnancies can remain active during pregnancy and should modify their routines as medically indicated and with medical supervision as needed.

A year later the Society of Obstetric and Gynecology of Canada in conjunction with the Canadian Society of Exercise Physiology issued guidelines stating women without contraindications in pregnancy should be encouraged to exercise without any limitation even on rate of heart beat.

The guideline for safe exercise only applies to normal, uncomplicated pregnancy. Keep in mind, however, that if you have a history of complicated pregnancy, exercise at high levels may not be healthy.

Pregnant women should not exercise if they have a history of premature labor, previous surgery on the cervix, significant heart disease, pregnancy induced high-blood pressure, or persistent vaginal bleeding during pregnancy.

It’s good to check with your doctor and limit high-intensity exercise if you have a history of severe anemia, poorly controlled high-blood pressure prior to pregnancy, history of seizure disorder, or history of thyroid disease.

At any time during your exercise training, you should stop if you feel dizzy, short of breath, have a headache, chest pain, noticed vaginal bleeding, decrease baby movement, or have amniotic fluid leakage.

See your doctor prior to restarting your exercise regimen

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. Mary Beth Hogan answers the question: “What is the difference between a skin prick test and a RAST?”

Both tests are designed to detect an allergen specific allergic antibody (IgE). This antibody is made by the body’s immune system, and when allergen is detected, a series of events is set-off which is finally expressed as symptoms such as sneezing, itchy eyes, runny nose or even a life threatening reaction such as anaphylaxis.

Diagnosis of allergy is made when detection of allergic antibody is made, and this antibody, when combined with the allergen, could be responsible for the symptoms.

Prick testing is performed when a drop of allergen is loaded onto a plastic device, that when used to prick the top most layer of the skin, results in a very minute localized reaction helping to establish that allergic antibody is present.

This test is no longer performed with a needle, making it nearly painless. Its advantage is that results are known in 20 minutes. In addition, it is far more cost-effective than blood tests. Its disadvantage is that antihistamines such as Benadryl block the allergic reaction from happening and patients must be off these medications for seven days before skin testing. It also cannot be performed on skin with rashes such as atopic dermatitis.

Blood tests are generally known as RAST (radioallergosorbent test) or PharmaciaCAP testing. Its advantage is that it can be performed if the patient has a rash or is on an antihistamine.

Disadvantages of the test are that it can be painful. In addition, the presence of large amounts of allergic antibody can obscure results with this test, making it a little less accurate than a skin prick test.

This problem with false positive results is particularly true with food tests. It is significantly less cost-effective when large numbers of allergens need to be tested as compared to skin tests. There is also a delay in finding out test results compared to skin testing.

Which test is required to diagnose allergy is also decided by your doctor based on what type of allergy is suspected.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at the University of Nevada School of Medicine and University Health System. Dr. Hogan is based out of Reno, Nevada.

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Dr. Evan Klass answers the question: “Is there any connection between hypothyroidism and female infertility?”

Definitely. Hypothyroidism, when it is not treated or not treated adequately, reduces ovulation, and obviously, no ovulation, no pregnancy. In addition, when hypothyroidism is not treated adequately, a woman’s libido or interest in sexual activity may be reduced (no sex, no pregnancy).

Most patients with hypothyroidism have Hashimoto’s thyroiditis [PDF], an autoimmune disease which causes the thyroid to fail. Some people who have normal thyroid function may be found to have Hashimoto’s thyroiditis by doing a specific blood test for thyroid peroxidase antibodies. The presence of these antibodies in the blood, even with normal thyroid hormone levels, has been associated with reduced fertility and with increased risk of miscarriage.

Finally, for women who have hypothyroidism who become pregnant, it’s essential that their thyroid hormone dosage be adjusted early in the first trimester–the dose will almost certainly need to be increased in pregnancy.

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. Mary Beth Hogan answers the question: “Why are my allergy symptoms much worse in the morning?”

Symptoms of sneezing, congestion and itchy, runny nose or eyes are frequently worse in the morning for several reasons. One possibility is that you are allergic to something inside your house. Allergens that you “sleep with” such as pets and dust mites are causing allergic reactions as you breathe them in with symptoms then noticed upon getting out of bed in the morning.

In addition, sleeping with open windows and then breathing in pollens that you are allergic to can cause early morning symptoms. This is particularly true for pollens as peak pollen release time from plants occurs between five to ten o’clock in the morning.

Avoidance measure to improve these symptoms include encasing the pillow, mattress and box spring in dust mite proof covers with frequent washing of bed linens in hot water and hot dryer.

Other measures to improve morning allergy symptoms include sleeping with the windows closed and either removing pets from the house or performing special cleaning measures for pet dander removal.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at the University of Nevada School of Medicine and University Health System. Dr. Hogan is based out of Reno, Nevada.

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Dr. John Pixley answers the question: “What tests determine whether a person has arthritis or osteoarthritis?”

Arthritis is a general term that identifies the area that is diseased or is painful. More often than not pains are not a reflection of arthritis at all and reflect muscle spasm, tendonitis, bursitis (a sac outside of a joint) or even disease in the abdomen or chest. A history, physical examination, laboratory and X-ray evaluation allow for establishing both the presence of arthritis and the proper diagnosis.

Once the clinical evaluation identifies that arthritis is present, the physician then determines whether it is part of a larger disease process or not.

Osteoarthritis is in essence a disease where the cartilage degenerates. Causes include genetics, obesity, deconditioning, previous injury and certain metabolic conditions, such as iron overload or thyroid disease. There is no specific test.

Treatment of osteoarthritis is directed at the underlying cause, as well as, minimizing further cartilage deterioration. Osteoarthritis of the knee is best studied and understood. Here, weight reduction, walking, medications to relieve pain, such as acetaminophen, and therapeutic exercises directed by a physical therapist have been shown to improve patient functioning.

The role of glucosamine is controversial. The best studied is DONA (glucosamine sulfate), which has received approval in Europe as a medication. Unfortunately, many of the preparations in commercial pharmacies, health food stores and Web sites have not been studied in a randomized controlled fashion to establish their effectiveness. Other therapies include joint injections with glucocorticoids and viscosupplements, which may provide benefit, and are approved by the U.S. Food and Drug Administration. Finally, total or partial joint replacement may be required if the cartilage deterioration is far advanced.

John Pixley, M.D. is an internist and rheumatologist in Reno, Nevada, with more than 30 years of medical experience. He practices with University Health System in Reno.

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Dr. Mary Beth Hogan answers the question: “When should I have allergy testing?”

Any age group can be tested and we have seen newborns already allergic to cow’s milk. However, testing should be limited to those allergens likely to be present in that age group. For instance, children less than a year old may be allergic to pets and dust mites, but are very unlikely to become allergic to pollens. Up to 70 percent of children and adults may have allergies which trigger their recurrent wheezing or asthma.

Individuals requiring asthma hospitalizations or have difficult to control asthma should be tested. Infants, children or adults with asthma in the absence of viral infections should also be allergy tested. Anyone with a history of a significant reaction to a food, bee stings or chronic eczema should be tested. Likewise, people with nasal problems and hay fever who respond poorly to antihistamines and topical nasal steroids should be tested.

Going to a physician specifically board certified in allergy will help ensure the proper tests are done. Your primary care physician can help you decide whether allergy testing would be helpful for you or your child.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at University Health System, the clinical practice of the University of Nevada School of Medicine. Dr. Hogan is based out of Reno, Nevada.

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Dr. Scott Hall answers the question: “When should I use a hot pack or cold pack to treat a sports injury?”

Generally cold packs should be used after an acute, or sudden, injury.

Cold acts to reduce pain and swelling. Good results are often seen when cold is applied directly over the injured area shortly after the occurrence. Ice is generally used, but there are other good substitutes, including frozen vegetables and cold packs.

One should remember not to apply the cold pack too long as frostbite may occur. I recommend keeping the pack on the injury 20 minutes on and then removal for 20 minutes before re-application.

Heat may be used after the acute injury to promote increased blood flow and decrease residual stiffness.  Individual comfort should guide the duration and intensity of heat.

Heat packs are commonly used and various types are available at pharmacies and shopping malls.

Scott Hall, M.D. is an assistant professor and director of sports medicine at the University of Nevada School of Medicine Department of Family and Community Medicine in Reno. Dr. Hall is board-certified and holds a Certificate of Added Qualifications in Sports Medicine. He has served as a team physician for several professional and scholastic sports teams. He currently serves as team physician for Damonte Ranch High School in Reno.

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Dr. Mary Beth Hogan answers the question: “Do allergy shots provide relief from allergy symptoms?”

Allergy injection therapy is a treatment modality in which the allergy patient receives injections of the allergenic substance to which she is allergic.

The allergens selected for treatment are determined by the sensitivity shown on the skin testing and their relationship to the patient’s history. The allergy extract contains only those allergens that cannot be avoided.

Allergy immunotherapy is a specific therapy which treats the basic cause of the patient’s problem—their allergy. It increases their resistance to those allergen to which they are allergic, resulting in fewer symptoms after allergen exposure.

Allergy immunotherapy is used in patients whose allergy symptoms are severe and are not adequately relieved by the use of oral medication and avoidance measures. It may also be used in one whose symptoms are becoming worse each year in an effort to prevent progression to more severe allergic problems.

There is also evidence that allergy immunotherapy performed for allergic children may prevent progression to asthma.

All in all allergy shots reduce medication need by 60 percent and may even get rid of allergy symptoms completely.

Once allergy shots are discontinued, the duration of benefits resulting from allergy shot injections varies from one person to another.

In some people, improvement is permanent. In others, mild symptoms return, but can be controlled with medication. A few patients develop increasing symptoms and require a reinstitution of allergy shots.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at the University of Nevada School of Medicine. Dr. Hogan is based out of Reno, Nevada.

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

Dr. Evan Klass answers the question: “I’ve heard that you shouldn’t eat sweet fruits such as mangoes if you have diabetes. Is this true?”

The sweeter the fruit the more concentrated the sugar content. So the sweeter the fruit, the smaller the portion size needs to be. So when people say that fruit is healthy, it is partly true.

Fruit does contain vitamins and is free of fat, but it has lots of natural sugars. Remember that all sugar is natural–it comes from a plant source.

That’s the problem with fruit juice. Juice gives all of the sugar of many fruit servings–the sugar of about four oranges is in one glass of juice!

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.