Dr. John Edward Prieve, D.O.

The short answer is yes, your eyes CAN be affected by screen time. According to WebMD: These days, many of us have jobs that require us to stare at computer screens for hours at a time. That can put a real strain on your eyes. Eye problems caused by computer use fall under the heading of computer vision syndrome.

Thanks for your question.

Ativan belongs to a class of medications called benzodiazepines. These medications are commonly used for anxiety and sleep and are considered "anxiolytic" medications because they are known to reduce anxiety. A side effect of these medications are somnolence or sleepiness which is why they are commonly used at night to help people sleep. Unfortunately, these medications are also habit forming, and after a person is on them for long enough, withholding the medication will produce withdrawal effects, and with these medications, it can be quite severe and include seizures and death. *When taken appropriately they produce a calming effect.* This class of medications is also one of several classes of medications
included in a list called "*Beer's criteria*" which are potentially dangerous in the elderly:

A panel of 13 experts reviewed more than 1,400 clinical trials and research studies published between 2017 and the last update in 2015. Across its five lists, the 2019 AGS Beers Criteria includes:

- *30 individual medications or medication classes to avoid for most older people.*
- *40 medications or medication classes to use with caution or avoid when someone lives with certain diseases or conditions.*

The AGS Beers Criteria aims to guide older people and health professionals away from potentially harmful treatments while helping us assess quality of care,” noted Todd Semla, MS, PharmD, BCGP, FCCP, AGSF, also a co-chair of the AGS Beers Criteria panel for 2019.

“The AGS Beers Criteria should never solely dictate how medications are prescribed, nor should it justify restricting health coverage. This tool works best as a starting point for a discussion—one guided by personal needs and priorities as we age,” added Michael Steinman, MD, a fellow co-chair of the AGS Beers Criteria panel.

In support of this principle, the AGS Beers Criteria panelists used their companion editorial (DOI: 10.111/jgs.15766 <https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15766>) to reiterate that:

- Potentially inappropriate medications are just that—*potentially *inappropriate. They merit special scrutiny but should not be misconstrued as universally unacceptable in all cases or for all people.
- The caveats and rationales informing AGS Beers Criteria recommendations are as important as the recommendations themselves. Appreciating these nuances can help healthcare professionals know why medications are included on the lists, and how approaches to prescribing can be adjusted accordingly.
- Based on an extensive review of more than 1,400 studies, the 2019 AGS Beers Criteria includes five lists of nearly 100 medications or medication classes to avoid or use with caution for some or all older adults.
- The AGS Beers Criteria aims to guide older people and health professionals away from potentially harmful medications while also helping health systems recognize such decisions when assessing care quality. The AGS Beers Criteria should never solely dictate how medications are prescribed, nor should it serve as a justification for restricting health coverage.
- What this means is that people over 65 who are on these medications are at higher risk for an adverse event, including falls, which are a common reason for debility in the elderly.
- Your physician has deemed it appropriate for you to take this at night to sleep, but may not believe it is a safe medication for you to take during the day. It would be best to discuss this further with him. If it is a matter increased anxiety, there are far safer medications you could take during the day.

I hope this helps.

Hi,

Meclizine is an anticholinergic medication commonly used for vertigo (with questionable efficacy), and taken together with diphenhydramine (Benadryl) can have additive effects as they are both anticholinergic drugs, and can inhibit the nervous system. However, meclizine has a half life of 5-6 hours, meaning most of the drug is already out of your system if you took the two drugs 12 hours apart. Therefore, the interaction is likely to be very slight, if at all, and you don't need to seek care about this at this time. Be careful with driving or operating machinery as either of these medications can increase fatigue.

Dr. Prieve

Thanks for your question.

ALS, or amyotrophic lateral sclerosis, is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Amyotrophic refers to muscle wasting. When a muscle has no nourishment, it "atrophies" or wastes away. "Lateral" identifies the areas in a person's spinal cord where portions of the nerve cells that signal and control the
muscles are located. As this area degenerates, it leads to scarring or hardening ("sclerosis") in the region.

Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to their demise. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. With voluntary muscle action progressively affected, people may lose the ability to speak, eat, move and breathe. The motor nerves that are affected when you have ALS are the motor neurons that provide voluntary movements and muscle control. Examples of voluntary movements are making the effort to reach for a smart phone or step off a curb. These actions are controlled by the muscles in the arms and legs.

There are two different types of ALS, sporadic and familial. Sporadic, which is the most common form of the disease in the U.S., accounts for 90 to 95 percent of all cases. It may affect anyone, anywhere. Familial ALS (FALS) accounts for 5 to 10 percent of all cases in the U.S. Familial ALS means the disease is inherited. In those families, there is a 50% chance each offspring will inherit the gene mutation and may develop the disease. French neurologist Jean-Martin Charcot discovered the disease in 1869.

Recent years have brought a wealth of new scientific understanding regarding the physiology of this disease. There are currently four drugs approved by the U.S. FDA to treat ALS (Riluzole, Nuedexta, Radicava, and Tiglutik).

Unfortunately, this question is tough to answer. In MOST patients, diarrhea usually resolves within a few weeks to months. However, because bile is still being produced and constantly leaked into the small intestine instead of sequestered in the gallbladder, some people can have diarrhea for life. It is possible to fix this with a bile acid sequestrant like cholestyramine. I would suggest you talk to your PCP if you are still having symptoms more than a couple months after the surgery.

Typically precautions are taken in the form of an iron cover which keeps the vast majority any of the radiation from reaching your unborn child.
However, routine CXR is not typically indicated for bronchitis. If he is worried you have developing pneumonia, that would certainly be cause for the CXR

Unfortunately, there is no way to "lower" your WBC without addressing the cause. As WBC are formed in the bone marrow, usually a person with persistently elevated WBC (Leukocytosis) should get an opinion from a Hematologist ("blood doctor") to rule out any potential issues with your bone marrow.

People often wonder why they are referred to a Rheumatologist when they are diagnosed with Fibromyalgia. This is because chronic widespread pain is the main symptom, and can overlap with many other conditions. These will need to be ruled out:

- Diagnosis includes
- Pain for at least three months
- Pain above and below the waist
- Pain on both sides of the body

This could include combinations of neck pain, shoulder pain, back pain, hip pain, knee pain, feet pain, and pain in just about every part of the body. People with fibromyalgia may also have:

- Hyperalgesia <https://www.fibrocenter.com/fibromyalgia-pain#pain>
(increased
pain in response to normally painful contact)
- Allodynia <https://www.fibrocenter.com/fibromyalgia-pain#pain> (pain
in response to normally nonpainful contact)

None of this pain will show up on an x-ray or blood test. That’s one reason why getting a diagnosis of fibromyalgia from your doctor may take so long. In fact, it takes an average of more than 2 years to get an accurate diagnosis of fibromyalgia.

Fibromyalgia Diagnosis Can Be a Long, Difficult Journey

Even with a doctor who is very experienced with fibromyalgia, diagnosis can take time. This can be frustrating—for the patient and the doctor. Doctors often diagnose fibromyalgia by first ruling out other conditions that have similar symptoms to fibromyalgia.

- Other conditions can occur together with fibromyalgia
- This can confuse diagnosis.
- Typically, a doctor may have to order numerous tests before he or she can rule out other conditions. In fact, the tests that a doctor orders might be quite different on a patient-by-patient basis. Why? While pain is the core symptom of fibromyalgia, patients can experience their fibromyalgia pain differently. Patients also have different ways of presenting their symptoms.

And this last point presents yet another challenge. Doctors sometimes struggle to get the information they need from their undiagnosed fibromyalgia patients. Sometimes, the problem is that patients may have a hard time clearly describing their symptoms. People with fibromyalgia often face a lack of compassion and understanding from others around them. Sufferers may feel isolated and angry. For some, this reluctance to talk about their symptoms can be a serious roadblock to diagnosis.

Gout is a common but complex form of arthritis that can affect anyone. It's characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.

An attack of gout can occur suddenly and the affected joint is hot, swollen and so tender that even light weight on it such as a sheet can be intolerable.

The signs and symptoms of gout almost always occur suddenly, and often at night.
They include:

Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
Limited range of motion. As gout progresses, you may not be able to move your joints normally.

The pain of back pain often seems worse than it is. The most worrisome causes of back pain rarely cause severe pain, and many common problems (like slipped discs) are usually much less serious than people fear. Only a very small percentage (1% or so) of back pain is potentially serious, and even then it’s often treatable. Many of the 1% are due to cancer, autoimmune disease, or spinal cord damage.

Back pain doesn't usually need to be medically investigated until it’s met at least three criteria: (1) it’s been bothering you for more than about 6 weeks; (2) it’s severe and/or not improving, or actually getting worse; and (3) there’s at least one other “red flag” (age over 55 or under 20, painful to light tapping, fever/malaise, weight loss, slow urination, incontinence, groin numbness, a dragging toe, or symptoms in both legs like numbness and/or tingling and/or weakness).

Red flags do *not* confirm that something horrible is going on, just that it’s time to talk to a doctor. And the absence of red flags is not remotely a guarantee that you’re in the clear, but often does

Dr. Prieve DO