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Questions on the body's water needs; immunotherapy drugs; suicide prevention; back pain - answered by Upstate's experts

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Q: How can I help someone who may be suicidal?

A: “There are things you can look for. What you see leading up to suicide is, usually people will withdraw socially. They may start losing their ability to function, either at school or at work. There are going to be more strained relationships. And, the person is usually more negative; when any issue is being raised, they have a real pessimistic kind of outlook on things.

“If you know this person‘s hurting and in trouble, if you don‘t ask the question, you‘re not going to know.

It‘s easy for me to say, ‘Just ask the person: Are you having thoughts about suicide lately?‘ It‘s very hard to actually do, partly because of social stigma. You don‘t want to insult the person. Some people are concerned it might put the idea into the person‘s head.

“What we know from research is, it doesn‘t put the thoughts into the person‘s head. It actually is protective. You‘re actually diminishing the risk of suicide by asking about it. ‘Have you ever tried to hurt yourself?‘ ‘How close have you come lately?‘ ‘Do you think you might actually carry out those thoughts?‘

“Someone who is at imminent risk needs to be evaluated — and may even need to be hospitalized — by a professional who can determine risk. Upstate‘s Psychiatry High Risk Program offers evidence-based treatment for high risk youth and young adults who are not in need of immediate hospitalization. Call 315-464-3117.

“Access to firearms is maybe the single most preventable thing that we can do as family or community. If there is someone at risk, make sure they don‘t have access to firearms.”

— Psychiatrist Robert Gregory, MD, director of Upstate‘s Psychiatry High-Risk Program

Upstate University HospitalQ: What‘s the best way for athletes to determine how much water to drink when they train or compete?

A: “You don‘t need a formula. You don‘t need to do any calculations. The rule is: Drink when you are thirsty. Your body actually knows what it is doing. It will make you thirsty if you need more water.”

— Emergency physician Jeremy Joslin, MD, medical director of endurance events around the world

Q: Will a new mother get pregnant if she has sex during the time she is nursing her newborn?

A: “As long as a woman is exclusively breast-feeding — she can pump and bottle-feed breast milk, but she cannot use any supplementation, no formula or anything else, whatsoever — it is effective birth control for six months. But after that, it doesn‘t work very reliably.

“It‘s called the lactational amenorrhea method, or LAM.”

— Renee Mestad, MD, chief of general obstetrics and gynecology

Q: Are immunotherapy drugs a cure for cancer?

A: “The jury is still out on that. We have patients with advanced cancer who were on these drugs in early clinical trials for two years, and now they have eight years of follow-up, and they are still in remission. So, I think immunotherapy has great potential. As with many therapies, we first use these drugs in patients with advanced disease. Then, if they‘re beneficial, we try them in earlier-stage disease, and that‘s really where there may be greater potential for a curative effect.”

— Stephen Graziano, MD, chief of adult hematology oncology

Q: Why do women awaken to use the bathroom at night?

A: “Most times, it‘s systemic diseases, not necessarily related to just the bladder. It can be things like diabetes, heart disease or heart failure, even sleep apnea. Nocturia can also be the initial sign of depression.

“People who have fluid overload, or too much fluid in them, they can also urinate at night because when they lay down, the fluid shifts, and they make more urine, and they then have to urinate.

“It‘s not uncommon to have this problem. If you‘re having this problem, you should mention it because a lot of physicians don‘t routinely ask, especially women, about urination at night. Unless you bring it up, no one knows it‘s a problem for you. And, it‘s important to make sure this is not the first sign of diabetes or heart disease.”

— Urologists Timothy Byler, MD, and Mickey Daugherty, MD

Q: How do I begin to overhaul my poor eating habits?

A: “Look at what you‘re doing. Are you drinking sodas? Are you eating processed foods? Are you NOT eating vegetables? Look at what you‘re doing, and look at what can you change. Can you say, ‘I‘m going to try to have a salad every day?‘ Or, say you‘re drinking two bottles of soda every day. Can you go down to one bottle, instead of saying, ‘I‘m never having soda?‘ You want to make a change in a way that it just gradually becomes part of your routine, and it‘s not so drastic that it isn‘t sustainable.”

— Maureen Franklin, registered dietitian nutritionist

Q: If I had chickenpox as a child, and I‘m 50 now, why do I need a shingles vaccine?

A: “If you had chickenpox as a child, or if you don‘t know if you had it, you are at risk for developing shingles later in life.

“The virus that causes chickenpox (varicella zoster) can actually remain latent in your nerve fibers, and then later in life can reactivate as the zoster virus, or shingles. We‘re not exactly sure why it reactivates, but as we get older our immunity toward varicella starts to decrease. We might have other medical conditions or be on medications that suppress our immune system or our ability to fight off infection.

“The Centers for Disease Control and Prevention now recommends healthy adults ages 50 years and older to get the Shingrix vaccine. It is the new, preferred vaccine. And that‘s even if you already had the Zostavax shot previously. Zostavax, the old vaccine, has about a 70-percent efficacy that wanes over time.  As you get older the efficacy of the vaccine actually decreases. In comparison, Shingrix is essentially a protein and an immune booster that are mixed together, and it has about 90- to 99-percent efficacy.”

— Pharmacist Ali Scrimenti, PharmD

Q: Does a firm mattress prevent back pain?

A: “What I advise my patients is to sleep on the mattress that‘s most comfortable. Some people like a firmer mattress, but there is no evidence that makes any long-term difference in your back health.”

— Daryll Dykes, MD, orthopedic surgeon and spine specialist

Hear the experts

HealthLink on Air logoThese answers are excerpted from “HealthLink on Air,” Upstate‘s weekly podcast/talk radio show in which experts  share information on a variety of subjects. Listen at 6 a.m. or 9 p.m. Sundays on WRVO Public Media, visit upstate.edu/healthlinkonair, or search for “HealthLink” in iTunes or other podcast sources.

Upstate Health magazine fall 2018 issue coverThis article appears in the fall 2018 issue of Upstate Health magazine.