What do you want to hear about?

We now have over 100 medical professionals on board who could help with readers questions.

But what do you want to hear about?

What questions have you always wanted to ask your own health care provider . . . but never had the chance?

Please let me know, so we can make this site more interactive. Enter questions or ideas in the box below.

Doc Cindy

(Image is hand necrosis caused by plague.)

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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9 Responses to What do you want to hear about?

  1. Darlene casey says:

    Doc Cindy I have found myself in a strange stituation my mother is in renal failure cellulitis and pancrientis she is recovering at my home . My niece has copd liver failure she had so much ammonia in her blood that she was having seziures she also has degenertive disc her vertabra are fracturing and we found out tonight that she has cracked ribs but because of her back she can’t be wrapped her pain is 10+ plus she has bad knees and an enlarged heart and they keep changing her doctors any suggestions my house is turning into a nursing home they have no place to go I need advice I can’t put family out on the street and a nursing home around here is not an option

  2. Stevedoc says:

    Regarding OSA: As an Internist, I too, used to think that people with OSA are obese, smokers, and drinkers (of ETOH). This is a complete misconception and leads to underdiagnosis of OSA. I found out the hard way: I am normal wt (BMI=24), never smoked, drink socially, age 58. I exercise regularly, both resistance and cardio. For 18 months, I noticed increasingly that no matter how much sleep I got, I felt unrested the next morning. I was fatigued much of the day. I felt like I was aging faster than I should. As time went on, it just got worse. Even affected my ability to concentrate. Medical workup was negative. I went to a medical seminar and the speaker was touting a quantitative EEG test as “an EKG for your brain.” They were doing them for discounted fees at the seminar, so I decided to have one done. To my surprise, it came out very abnormal.

    On the list of possible causes was OSA. I thought it was absurd, but since all other tests were negative, my doctor gave me a take-home sleep apnea monitor. It came out very abnormal. I honestly did not believe the results, and I went for an overnight test in a sleep lab.(talk about denial!) That, too, was very abnormal. The tech showed me monitoring strips showing that almost every time I started to go into REM sleep, I had arousal after several apneic episodes. My apnea-hypopnea index was in the severe category. In short, I was seldom dreaming! REM is associated with increased hypopnea and apnea because of relaxation of the oropharangeal muscles that keep the airway open.

    It explained all my symptoms perfectly. I started with CPAP and have never slept without it since then, for 3 years. Within a few days, I felt like a new man. I, too, used to think that CPAP was difficult to tolerate and most people stopped using it. That is totally untrue. The respiratory therapist tried me on several different types of masks over the first 3 months until I found one that worked great for me (everyone is different). I use a mask with “nasal pillows” that is comfortable, with minimal size and bulk.

    Anyone who says they can’t tolerate CPAP probably hasn’t done the trial and error process to find what works best for them.I have to admit that my motivation is very high to use it as a “maintenance drug.” For those who are not motivated, it probably does get cast aside.

    Please, do not believe the stereotype of OSA is only a problem in obese people. It is under-diagnosed in people like me because it never occurs to doctors as a possibility. I went for 18 months with worsening symptoms, and none of the doctors I saw put OSA in the differential diagnosis! Including me! And I didn’t believe it until I had two abnormal tests!

  3. EMT Prepper says:

    Medical equipment that doesn’t require power, for instance, I know you can use a dentist drill using compressed air from a small 5 gallon air tank.
    Where to get things without a medical license would be nice, too, since technically I am retired and don’t keep up my credentials.

  4. Chip says:

    Any of the Wilderness First Responder courses will cover this question.
    It will start you at no medical education and bring you to the point where you can handle 80% of all injuries that you might face in the EOTWAWKI.

  5. Elizabeth C B says:

    I’d like more information about how to produce effective colloidal silver, to be used in an extended grid down situation.

    {Check out this link to start: http://silver-colloids.com/ – Doc Cindy}

  6. Chris MD says:

    In regards to the CPAP question, I think the risk inthe short term is pretty minimal. People don’t die of OSA, they die of OSA-induced right heart failure, which takes a long time to develop. In the long term, should the disaster go on that long, I suspect the most common cause of OSA (obesity) will be cured by starvation, hence obviating the worry. (And substituting a world of others)

  7. JeanneS says:

    I have seen claims on the Internet that people who use CPAP machines will likely die in the event of extended loss of electrical power. Since my best friend is on a CPAP during sleep, naturally this worries me. Is there any advice on what steps might be taken to help in the event that the machine can’t be used, like alternative sleep positions or mouth guards that open the airway while you sleep?

    [A few thoughts from Doc Cindy . . . sleeping on one’s side instead of one’s back is helpful. Breathe-Right strips may open the airway a little, as may a mouth guard.

    But let’s put a little historical perspective on sleep apnea. I remember medicine before sleep apnea “existed” – that is, before the diagnosis began to run rampant in our culture. Part of the reason it’s so much more common now is the increase in obesity in the U.S. When I send patients for sleep studies, I often get reports back that make it sound like an emergency! Yet somehow, these patients have managed to survive with the symptoms of sleep apnea for years. Neither do I see an epidemic of obese (otherwise healthy) people dying in their sleep without CPAP.

    Additionally, many patients on CPAP get tired of using it, and so simply stop on their own, and are apparently none the worse for it. Therefore, I think sleep apnea is a “diagnosis of the day,” much like mitral valve prolapse once was – not that these conditions don’t exist, but once they’re recognized, suddenly everyone has the condition. Additionally, when testing and technology exist to detect a “new” condition, the profit motive begins to filter in. Once a sleep lab is established, it has to keep busy, and at a couple grand per sleep study, they can be quite lucrative.

    This may sound a bit cynical, but it’s meant to reassure you that most people will be fine without CPAP (and one could argue they already are – most patients go undiagnosed, I’d say). And with the weight loss that should occur when food is scarce, the problem may take care of itself.]

    • pa4ortho says:

      1. get an off-the-grid power system and keep using the c-pap
      2. lose weight
      3. consider surgery if it’s an option
      4. nasal pharyngeal airway (yuck)


  8. Healthcare-for-the-human-fund says:

    I have absolutely no medical training, and would like to have some hands on experience. So if TEOTWATKI occurs (or accident while hiking, etc.) I have some knowledge on what to do.

    In my mind, first aid courses and CPR classes are not enough. I am considering taking an EMT course at my local community college.

    What are your thoughts? I am a software engineer by day and have the evenings and weekends to study/train.

    [First Aid courses are a good place to start. CPR is great, but without EMT/hospital back-up, few survive. An EMT course would be a next logical step. I’d say to read my book, Armageddon Medicine, but it’s not done yet . . . hopefully soon. The articles at http://armageddonmedicine.net/?cat=371 suggest some books and courses you may find useful. – Doc Cindy]

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