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• What do my cholesterol numbers mean, and what are the ideal levels?
• I'm going to Greece this summer on vacation, and I’m concerned that all the walking will be difficult because I have bunions.  What can I do to prevent making the bunions more tender?
• What can I do about my baby's colic?
• What other options do I have besides surgery for dealing with chronic pain in my lower back?

What do my cholesterol numbers mean, and what are the ideal levels?

A: There are three cholesterol levels:  LDL, HDL and overall cholesterol.  LDL, the “bad” cholesterol, is a major source of the cholesterol that blocks arteries and may lead to a heart attack or stroke.  HDL, the “good” cholesterol, helps keep LDL cholesterol from collecting in the arteries. You also need to pay attention to the level of triglycerides – another form of fat in the bloodstream – because it also can raise your risk for cardiovascular disease.  Your overall cholesterol level is the combination of LDL, HDL and one-fifth of your triglycerides. The American Heart Association recommends an overall cholesterol level of less than 200.  For LDL, the optimal level is less than 100, 100-129 is acceptable, 130-159 is borderline high, 160-189 is high, and over 190 is very high.  For HDL, 50 or less is considered low for women, 40 or less is considered low for men, and over 60 is considered optimal for both men and women.  For triglycerides, less than 150 is optimal, 150-199 is borderline high, and 200 or more is considered high.  While you can’t control factors that affect cholesterol such as heredity, gender and age, you can control lifestyle factors such as diet, weight and exercise.   If making changes in your lifestyle aren’t sufficient to lower your cholesterol, consult your physician about various medications for lowering cholesterol.

-- Dr. John Cranshaw
1580 Valencia St., #201
(415) 550-0877

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I'm going to Greece this summer on vacation, and I’m concerned that all the walking will be difficult because I have bunions.  What can I do to prevent making the bunions more tender?

A: Bunions are a common problem, and you need to attend to them before they interfere with daily life. Bunions are generally hereditary, but poor-quality shoes can contribute to development of bunions in people with a genetic predisposition.  Today, they are relatively easy to correct with outpatient surgery using local anesthesia and sedation.  The surgery takes about an hour, and patients generally achieve 80 percent recovery within six weeks, with the remaining 20 percent occurring over six months to one year.  Because your trip is so soon, I would not advise surgery now.  Instead, buy some very good shoes and get them well broken in before you leave.  You may need to have a shoemaker stretch them to accommodate a bunion.  A podiatrist also can provide temporary removable cushions. When you arrive, consider buying a souvenir cane or walking stick, which will help on unpaved paths and cobblestones. You also can take certain anti-inflammatory medications to reduce discomfort.  I suggest you seriously consider surgery before your next vacation-- so as not to be limited by pain that can be easily and safely helped with today’s techniques and modern instrumentation. Have a great trip!

-- Dr. William Lehrich, Podiatry
1580 Valencia St., #109
(415) 285-7711

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What can I do about my baby's colic?

A:  We don’t really know what causes colic, and medications are rarely, if ever, used. There is some evidence that colic occurs because the baby’s digestive system is still immature. Most of the time, colic starts at about 2 to 3 weeks of age and disappears on its own by the age of 3 months.  Because colicky babies seem to have symptoms of gas in the digestive system, breastfeeding moms should avoid foods that produce gas, such as broccoli and cabbage.  You also should avoid carbonated beverages and beverages containing caffeine, since it is a stimulant.  Babies whose parents smoke also are more prone to colic.  Some colicky babies seem overly sensitive to stimulation, so it may help to minimize noise and distractions.  Rock your baby gently in a quiet, darkened room.  Or place the baby in an infant seat on top of a running clothes dryer so the gentle sound and vibration can help lull the baby to sleep – but do not leave the baby unattended.  Many parents put the baby in a car seat and drive around until the baby dozes off.  If none of these methods help and the crying continues – or if the baby has other symptoms or is not thriving – consult your pediatrician to rule out any serious problems.

-- Dr. Agnes Alikpala, Pediatrics
1580 Valencia St., #601
(415) 285-6210

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What other options do I have besides surgery for dealing with chronic pain in my lower back?

A:  Only a limited number of cases of back pain warrant surgery.  The vast majority of people suffering from back pain, including people with herniated disks, can be treated conservatively.  The most common causes of lower back pain are muscle strains or sprains and normal wear and tear on the spine as the patient ages.  People who are overweight or lead a sedentary lifestyle are at greater risk for recurrent back pain.  The first line of treatment includes rest and the use of anti-inflammatory medications, and perhaps muscle relaxants, during the acute phase.  If the pain continues, your physician may recommend epidural steroid injections to relieve the pain.  Most patients will see an improvement in an acute injury within three to six weeks, after which they can be further helped by learning exercise techniques for strengthening the back and abdomen, as well as proper techniques for lifting.  Even herniated disks can improve over three to four months.  If your pain doesn’t go away, or if you develop severe pain, problems with bowel or bladder control, or numbness, tingling or weakness in your legs, please seek immediate medical attention.

-- Dr. Jules Steimnitz, Physiatry
1580 Valencia Street, Suite 504 
(415) 641-8631

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