As a regular feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta:

From Jolene: 
“I have a friend who needs to have his wisdom teeth pulled and will need pain medication. The problem is, he is a recovering addict. Any suggestions?”

Answer:

Jolene, first of all, congratulations to your friend for making it to and staying in recovery. More than 23 million Americans struggle with substance abuse problems every day, according to a recent government survey, but only about 4 million of them actually receive some kind of treatment for their addiction to alcohol or illicit drugs.

That being said, it’s true that since he’s a recovering addict, your friend faces a greater challenge than many when it comes to any type of surgical procedure that’s going to require pain management.

But his pain definitely needs to be treated, regardless. The reason: Studies have shown that if a patient does not receive adequate pain treatment in surgical recovery, his tissues don’t tend to heal as well. Pain that goes untreated can also lead to what pain experts refer to as “wind-up,” meaning the spinal cord gets so bombarded with continuous pain signals that it can lead to a longer, more chronic pain situation. So it’s important to “quiet” the spinal cord by bringing the pain under control.

While the vast majority of patients who undergo oral surgery do take some type of narcotic drug afterward for relief, some people are able to successfully treat their pain with anti-inflammatory drugs such as prescription-strength ibuprofen. These non-habit-forming drugs might be the first step for your friend to try. He will need to discuss this option with his doctor, because there is a greater concern about bleeding with this class of drugs, although usually they are safe especially if taken only for a few days.

If the anti-inflammatory drugs don’t work, however, there are some narcotic drugs that are thought to be less addictive than others. Tramadol is one option. It’s a chemical that works as an antidepressant but also has a weak effect on your brain’s opiate receptors, meaning it can provide pain relief but it doesn’t work as assertively on the brain’s reward system (which can lead to addiction). It’s thought to be safer for people who struggle with addiction. Your friend will need to work with his physician to weigh the risks and benefits of trying a narcotic drug before going down this path.

The critical part of keeping a recovering addict from falling back into a cycle of substance abuse with painkillers is making sure that both the doctor and patient vigilantly monitor the course of pain management. For a procedure like wisdom teeth removal, a patient should start feeling better after a few days, maybe a week max. The doctor should follow up with the patient so that if he still complains of pain, the doctor can re-evaluate what could be causing the pain to continue.

As a regular feature of CNNhealth.com, our team of expert doctors answers readers’ questions. Here’s a question for Dr. Gupta.

From Troy in Silver Spring, Maryland:

“I heard President Obama recently admit that he still smokes cigarettes occasionally. I know he is trying to quit but I’m curious what the health ramifications are for someone who just smokes once in a while?”

Answer:

Great question, Troy. More than 46 million adults in America smoke cigarettes. But 70 percent say they would like to quit, according to a Centers for Disease Control and Prevention study. There is no question that smoking is a hard habit to break. It’s been suggested that nicotine could be as addictive as heroin. And like many Americans reading this right now, the president also struggles to break the habit. Obama admits that,  “as a former smoker, I constantly struggle with it. …Have I fallen off the wagon? Yes.”

However, it’s a myth to believe that if you smoke only two cigarettes a week for example, or just on the weekends, that it won’t affect your health. Even a few cigarettes can increase your blood pressure,and  put you at a slightly increased risk of heart disease and stroke. Some studies show that young smokers who light up only occasionally have signs of artery disease. And though their risk of developing cancer is nowhere near that of a regular smoker, compared with a non-smoker, the risk is elevated.

One group the new anti-tobacco bill targets are so-called “social smokers.’” The concern is that social smoking can turn into a full-time habit very quickly. Big tobacco companies spend millions of dollars researching and marketing to this demographic.

What’s constitutes a social smoker? If you were to ask them, they’d tell you they don’t consider themselves smokers because they don’t do it every day. Studies show social smokers are younger, often  smoke only with friends at social functions and typically don’t typically purchase their own cigarettes in packs. Because of this, tobacco companies often market to social smokers in bars and clubs. The FDA will now regulate tobacco industry marketing in an effort to reduce social smoking in America.

Bottom line, Troy, is that no quantity of cigarettes is safe or healthy for our body. But for the millions of people struggling to quit right, don’t be discouraged if you slip up and smoke. Smoking one cigarette is much better than an entire pack. And by no means does it mean you’re a smoker again. Start fresh tomorrow. And check out www.smokefree.gov for great information on cessation and support programs.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. This week, Dr. Gupta answers multiple questions about bipolar disorder.

The Food and Drug Administration spent two days this week weighing whether three powerful drugs that treat bipolar disorder and schizophrenia should be prescribed for children. The drugs are called atypical antipsychotics. The panel specifically was looking at the risk, benefit ratio of Zyprexa, Seroquel and Geodon. These three drugs come fraught with controversy because the list of risks associated with them. Common side effects include weight gain, high blood pressure, type 2 diabetes and in some situations, sudden cardiac death. The weight gain is not small – in some cases, a teen can put on 40 pounds in a few months after starting the medications. They seem to interfere with part of the brain that corresponds to our ability to feel full.

Most doctors agree that the risks and side effects need to be weighed by doctor, patient and parent. Many experts CNN spoke to who see children with bipolar disorder and schizophrenia believe these drugs are safe and should be widely available for use when a child has a severe mental health problem.

I received hundreds of questions by e-mail and on twitter. Here are answers to a few of the most common ones.

From @cognimmune via Twitter.com:

“At what age can a child be diagnosed with bipolar disorder or schizophrenia?”

Answer:
That is a really great question and one that experts don’t really have an exact answer to. According an expert in child psychiatrist at Seattle Children’s Hospital, Dr. Christopher Varley, diagnosing a child less than 10 years old is very unusual and difficult to do. Most diagnoses are made in the early teen years.

From @shampm via Twitter.com:

“My daughter is adopted and we are having a hard time getting diagnosed [with bipolar disorder]. What can we do?”

Answer:
Diagnosing bipolar disorder can be tricky because many children, and adults, display different sets of symptoms. For instance, not everyone with bipolar disorder will have instant changes to mood or outbursts of anger. Although the main characteristic is a drastic change in mood/personality, one person with bipolar may experience manic depression for a long time, and others may have only short episodes. A person with bipolar disorder may also display changes in his or her sleep patterns, energy level and have difficulty making decisions.

From Tori in Florida:

“I suspect my 16-year-old daughter may suffer from bipolar disorder. How does one know whether to seek a psychologist or psychiatrist for treatment?”

Answer:
This is a an important one, Tori. The biggest difference between the two professions is that psychiatrists prescribe medications and psychologists do not. Psychiatrists are medical doctors and widely viewed as the best people to treat bipolar disorder because most patients with bipolar disorder do require medication. Psychiatrists are well qualified to identify which drugs might work best for a specific patient. But a major part of any therapy for this disorder is considered psychotherapy. And that can be provided by psychologists and other mental health professionals as well. Talk therapy can help you develop coping mechanisms and may help you keep you on your medications. Bottom line? After diagnosis, you may find a combination of treatment from both beneficial.

From Jackie in Massachusetts:

“I heard many of antipsychotic drugs are being prescribed to kids for who aren’t even diagnosed with bipolar disorder? Is that true?”

Answer:
Jackie, this is a question a lot of people have. What exactly are these drugs being prescribed for? A recent study published in the Ambulatory Pediatrics Journal looked at the trends in prescribing atypical antipsychotic medications. It found these drugs are prescribed only 37 percent of the time to treat bipolar and schizophrenia. What makes some critics cringe is that these powerful antipsychotics are being used almost one-third of the time to treat ADHD — which can often be treated with a less-potent drugs or behavioral therapy.

Here is the breakdown of how atypical antipsychotic drugs are prescribed:
- 37.1 percent bipolar disorder & schizophrenia
- 29 percent ADHD
- 13.8 percent nonpsychiatric diagnosis
- 7.5 percent autism
- 5 percent Tourette’s syndrome
Source: Ambulatory Pediatrics Journal

From John in West Virginia:

“I’m having trouble researching ADHD and bipolar disorder. The two seem similar. What is the difference and is it possible to have both?”

Answer:
John, to answer to the second part of your question, yes, it is possible to have both. But it can be really confusing. It’s a clinical diagnosis, and sometimes some of the symptoms sort of overlap, things like inattention, hyperactivity, impulse disorder, those are all things that are associated with ADHD. But specifically with bipolar, you tend to get what are pretty dramatic mood swings so you can have intense euphoria sort of followed by manic depression. That’s one of the big differences. What’s particularly difficult to distinguish in kids is that sometimes a treatment can be very similar as well, so that may be some of the trouble, there. I’d say if you are looking for a cardinal symptom of bipolar, extreme mood swings would be the main difference.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

From Don, New Berlin, New York

“I am curious to know the differences between generic and name-brand drugs. What makes the prices so different? Is there a difference in quality?”

Answer

Hey Don! As you accurately observed, the main difference between generics and brand-name drugs is the cost. Generics cost less than a third as much as their brand-name counterparts. Why the price difference? Because makers of brand-name drugs want to “brand” their identity — and the way to do that is through advertising. These companies pay large amounts of money to catch your attention, and that money factors into the cost you pay.

As far as how they compare in quality, here’s the scoop: The active ingredients — the things that make the brand-name drug work in the first place — are also found in the generic version. What might be different are the generic drug’s inactive ingredients — things that might affect how quickly a drug is released, the size and shape of the pill — there could be variation there.

There has been some anecdotal evidence suggesting some types of drugs may react significantly differently between the generic and brand. However, according to the FDA, they all undergo and meet the same strict regulations for safety and efficacy. Still, some docs may not want to risk even the small chance that a generic will react differently from the brand, so you need to have that conversation with your doctor to figure out what’s best for you.

If you do switch to a generic and notice you’re reacting differently, there are things you can do. You can try a different generic; there are often several versions of the same generic drug, like a two-tablet version of the same medication, instead of one. You can also have your doctor write “Dispense as Written” or “Do Not Substitute” on your prescription so that you can stay on the brand name, but you may end up paying more.

But remember, with most generics, you’re probably not going to see any difference at all, except you might find a bit more cash in your wallet.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

From Thespena in Crown Point, Indiana:

“My son is 3 this year and has outgrown the kiddie pool but I’m nervous about letting him swim in deeper water. I’ve heard toddlers can drown in water only a few inches deep. Is that true?”

Answer:

Hi Thespena,

Thanks for asking this question. As a parent of three small children, I completely understand and share your apprehension. You want to do everything you can to keep your son safe, but at the same time to give him as many beautiful life experiences as possible, swimming being a great one (especially as we’re heading into summer).

You’re correct about the drowning hazards for toddlers. In fact, just one inch of water is enough for a toddler to drown in, according to Safe Kids USA Part of the reason is because their little bodies are top-heavy, so they have a harder time maintaining their balance and getting back up when they fall. Every year, more than 800 kids in the United States under age 14 die as a result of unintentional drowning. For your 3-year-old, his risk rate is double that of any other age group; children 4 and under actually have the single highest drowning death rate according to the National Safety Council.

But that doesn’t mean you have to keep your child out of the pool altogether. The number one thing you can do is to keep a close watch on what’s happening when your child is in the pool. Try to stay no more than an arms-length away. Unlike the way we see drownings depicted in the movies, there’s usually no prolonged flailing of arms and crying out – sadly, it’s usually very quick and quiet, so you can’t just rely on being in earshot. You have to keep your eyes on your son at all times.

Also, don’t rely on floats or any other swimming aid to keep your child safe because those are not meant to replace your own supervision and can give parents a false sense of security. When you feel he’s ready, you should start taking your son to swimming lessons. It’s a great source of exercise and fun for kids, and the sooner he becomes comfortable and skilled in the water, the safer he’ll be as he grows older.

There are some other things that you yourself can do now to protect against the worst from happening. One of them is to learn CPR. You’ll feel more secure — and who knows when you might need those skills in some other part of your life?

Another thing to consider if you have a pool at home is to secure the pool itself. A 2001 study in the journal Pediatrics found that home swimming pools are the most common site for drownings. So, be sure to have a fence around the pool. That alone has been shown to reduce the incidence of pool drownings anywhere from 50 to 90 percent of the time. The fence should surround the pool on all four sides, instead of relying on the house to be one of the sides. You can also install a door alarm to notify you if your child walks out the back door, a pool alarm that detects any movement in the water, or even a self-locking mechanism on the gate so that your child can’t get into the pool area without you being there.

One more thing while we’re on the topic of pool safety. It’s actually something that many parents are really unaware of since it’s a newer development. A recent federal law has been enacted to require all public pools to switch over to a safe drain mechanism. You should have your home pool inspected too. The reason: some drains have a super-strong suction mechanism that can easily entrap a child or adult at the bottom of the pool, causing them to drown. Once you get stuck to the drain, it’s almost impossible to wrest a person away from that powerful force. A replacement drain – one that allows air to flow in between your hand and the bottom of the drain, so it doesn’t create that suction effect — will run you as little as $35 plus the cost of installation. It’s a small price to pay for the security you get.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

From Margaret, via comment on the Paging Dr. Gupta blog

“Do PTSD symptoms ever really go away?”

Answer:

Margaret, thank you for your question. Last week, I sat down with my producer and a flip cam and she started asking me questions about my time in Iraq. I hadn’t prepared for it at all, but the memories came flooding back. There was a hat that I used to wear during my 12 weeks out there. It was a camouflage wide brimmed hat, that was particularly effective for shielding me from the Iraqi desert sun. I brought that hat home, and hadn’t thought about it for a year until one day my wife and I were planning a hike. I pulled out the hat and put it on at the beginning of the trail. Inexplicably, I started to sweat, developed a pit in my stomach and almost threw up. At first, I thought it was something I ate, until I realized it was the smell and feel of that hat that immediately propelled me back to the battlefield. I had found a trigger. And, keep in mind, I was only there for three months, as compared to military personnel that have been on the battlefield for years.

As I researched this I learned the answer to your question. The symptoms of PTSD really never go away. Here is why: There is a profound psychological and physiological reaction to something traumatic. That traumatic event can’t be completely undone, though it can be diminished in the mind. Some of the symptoms include flashbacks, like I had. You may also have frightening thoughts, emotional numbness and depression. Many people will have problems sleeping, concentrating and will experience angry outbursts, to name a few.

The key to your question, I think, is to create a situation where someone who has persistent PTSD is still able to function normally. There are good treatments available, from counseling to immersion therapy. On an individual level, though, maintaining strong relationships with people who support you – they are often the first to notice the signs of PTSD – is very important. Also, talking to people who went through the same or similar experiences can be cathartic. And finally, try and remove things that trigger those memories. For my part, I threw away that hat.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

From Arthur
Birmingham, Alabama

“I saw your report earlier in the week the about high salt content in restaurant foods. I end up consuming salty foods at home too! My wife adds it to everything – even to the water she boils our pasta in. What are some alternatives I can suggest?”

Answer

Arthur, thanks for writing in!  Sodium content is often not something people look for on labels, or consciously think about when preparing their meals. Even many low-fat, low-calorie items have very high levels of sodium. Then, of course, the salt shaker sitting on most kitchen tables doesn’t help the matter. You see we’re all creatures of habit. If a person grows up always adding salt and pepper to each meal, it becomes second nature. Before even tasting a meal, many people add salt to without thinking twice.

Our bodies do need some sodium. It helps regulate your body’s fluid, aids in muscle function. But too much sodium can cause a siren to go off internally. When excess salt flows through your bloodstream, your kidneys get defensive. They release a hormone that triggers blood vessels to contract, which causes your blood pressure to rise. From there it’s a ripple effect on your health. High blood pressure can cause a heart attack or stroke among other conditions. Something as seemingly small as reducing sodium levels in your diet could save your life. In fact, the American Medical Association estimates that 150,000 lives could be saved in the United States annually if people cut their salt intake in half.

There are ways to cut back when cooking at home without losing flavor. Start by getting the salt shaker off the dinner table. As I mentioned earlier, people often add it to meals just because it’s there, not because the food needs it. Keep the shaker in the cabinet, and odds are your whole family will inadvertently use it less.

Also limit your intake of processed foods and canned vegetables. An estimated 77 percent of a person’s daily sodium intake comes from these items. One serving of canned food may have up to 1,000 milligrams of sodium! Fresh fruits and vegetables have a muchlower count by nature. Find out where the local farmer’s market is in your area and bring the family to pick out favorite fresh items each week. You’ll save money too. Local markets often have lower prices.

Have you been down the herb and spice isle at the grocery store lately? There are hundred of options to add flavor to meals with little to no sodium count. You and your wife will have fun experimenting with different spices to your favorite recipes – sans salt!

Arthur, the best advice is being mindful of  “hidden” sources of sodium. The American Heart Association recommends 2,300 milligrams of sodium a day for the average person. Sounds like a lot but it adds up quickly. A 12-oz glass of tomato juice has 1,000 mg of salt. One tablespoon of relish has about 250 mg. One hot dog has up to 800 mg. Many salad dressings – including fat free – have 500 mg of sodium in just two tablespoons.

Bottom line, salt is everywhere. Read the labels, look for low-sodium products and eat fresh food when possible.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

From CNN.com blogger, Dick:

“Hand sanitizer has been recommended but the bottles say, “Effective against bacteria,” with no mention of viruses. What gives?”

Answer:

That is a good question. There are not a lot of data actually on how effective those sanitizers are against viruses. There have been some studies done over the years and the conclusion is washing your hands with soap and water is still probably the best idea. If you are having a busy day and it is hard to get to a sink, then carrying a bottle of hand sanitizer would be a good idea.

In essence, it makes your hands very inhospitable to viruses. You put it on your hands and viruses simply don’t want to cling to it. So it does reduce the amount of a virus that can cling to your hand but it does not kill it. Alternatively, it also can’t harm you in any way. We get a lot of questions from concerned viewers asking if sanitizers could actually cause antibiotic resistance down the road. Many studies have looked into the issue and all evidence points to the answer being no.

At the end of the day, basic principles apply to avoid getting a virus. Avoid touching your mouth, eyes and nose as much as possible. If you cough or sneeze, cover your mouth and nose with a tissue or your sleeve. If you’re sick, stay home and avoid close contact with others. Some viruses can live for hours on surfaces such as ATMs, doorknobs, even money.

So be methodical about good hygiene, all year long! Remember that the number of 2009 H1N1 cases will most likely decrease over the summer months because viruses just don’t transmit that well in the heat. But in the fall and winter, we’re all going to have to remember what the new H1N1 strain was like and be extra vigilant so this doesn’t get out of control.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

From Suzy, Raleigh North Carolina

“Dr. Gupta, I saw you on “Dancing with the Stars” this week and it was great! I started dancing about three months ago and have lost about 10 pounds. I am having fun on the program but do worry about getting injured! What can I do to lower my risk?”

Answer:

Hi Suzy, thanks for writing in. It’s great to hear you started dancing as a way to get fit. It’s a great way to burn calories without it feeling like a chore. The key for anyone looking to get in shape is to find a fitness routine you enjoy! You’ll stick with it longer and may even inspire a friend or two to join you.

Many dancers say they feel longer and leaner from just a few months of classes. Exercises like dancing, or even Pilates for example, impact the density of your muscle versus the size of the muscle. The muscle fibers are engaged differently from the way they would be in a person lifting weights. It is a great body-shaping activity, keeping the core engaged the entire time and toning and strengthening your muscles.

Of course dancing burns a lot of calories too! Fast-paced dancing (swing, ballroom, or party dancing) can burn about 360 calories per hour. Slow-paced dancing (slow ballroom or a mambo) can burn about 240 calories per hour for the average person.

But for any fan of the hit TV show, “Dancing with the Stars,”you are well aware of the injuries that can develop. Just this season, five contestants have been hurt. Nancy O’Dell had a torn meniscus; Jewel suffered a leg fracture to name a couple. Their injuries are typical – majority of dancing injures develop in the lower extremities: hip, knee, leg, ankle, foot.

To avoid injury, be careful of overuse. Overuse injuries, the most common seen among dancers, occur when a person consistently does the same movement over and over again. The muscles begin to tire, bone begins to weaken, and an injury occurs.

Studies show that during a 90-minute organized dance class, a person lands on the same leg about 200 times! Each impact is about 10 times your body weight. Imagine doing that every night? Overtime, your muscles will break down and an overuse injury will result.

So let your body rest after dancing (or any other high-intensity workout) by spacing out your workouts. For example: Avoid doing two days in a row of the same activity. Remember, it’s the repetitive motions that often cause overuse injuries. And remember that a good workout makes you alert, energizes you for the day ahead. If you are feeling sluggish, you are most likely not getting enough sleep. Sleep deprivation impacts your reaction times and overall performance, which could lead to injuries as well.

The best bet for someone looking to start dance-for-fitness regime (and avoid injury) is to cross train versus solely dancing. By making dancing ONE of the activities you do to stay in shape – not the only one – you will have fun, tone up and avoid sitting on the sidelines. Keep up the great work, Suzy!

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

Asked by Sharon, Mays Landing, New Jersey

“My husband’s doctor told him to take an aspirin a day. Should I be taking one too?”

Answer:

Thanks for the question Sharon. Aspirin is a medication we often get questions about, probably because an estimated one-third of Americans take it every day. The popular pain reliever is easily accessible, inexpensive, and available at your local pharmacy. It is commonly used to treat arthritis, headaches and fever among other minor pains. But what is often confusing is whether taking it every day can help prevent ailments– a heart attack or stroke.

Most daily users were most likely prescribed aspirin to lower their risk of cardiovascular disease. But it is important to note that not all people will benefit from this treatment, and in some cases, it can be dangerous.

The U.S. Preventive Services Task Force is a group of independent health experts who review effectiveness and offer usage guidelines for medical treatments and drugs. Last month, the USPSTF updated its 2002 recommendations of who could benefit from a daily aspirin regime.

Men aged 45 to 79, and women aged 55 to 79 who are at high risk of heart attack may benefit from a daily aspirin as a prevention tool. The USPSTF concluded that aspirin is most effective in this group of men to prevent heart attack and for women to prevent stroke.

Being overweight, having high blood pressure, high cholesterol, and smoking cigarettes are all factors that put you at high risk for heart attack. The group added that even if you fit this age and risk factor category, aspirin is not recommended if you have a history of gastrointestinal bleeding.

Women under the age of 55, or men under the age of 45 who have never had a stroke or heart attack should not take daily dose of aspirin as a preventive measure. Additionally, USPSTF did not find a clear benefit or risk of a daily aspirin in adults over the age of 80.

Aspirin works by suppressing your body’s natural production of substances and blood cells that can cause swelling, pain and blood clots. It’s a type of drug known as salicylate. It is critical to discuss the risks with your doctor before beginning an aspirin regime. It can be dangerous for people with a history of ulcers and GI bleeds among others ailments. It can also interfere with certain prescription and over-the-counter drugs, so disclose to your doctor what meds you take.

The FDA warns that women who are pregnant or breastfeeding should not take aspirin (unless specifically prescribed by a doctor). Up to 8 percent of each aspirin dose can be transferred to the baby and may cause birth defects or complications with pregnancy.

So Sharon – you can see there is no clear answer to your question because many variables come into play. You and your husband can be the same age but have different health histories and risk factors that would impact the effectiveness of a daily dose of aspirin. Talk to your doctor, who can determine the potential risk vs. benefit specific to your health history.

One thing I know for sure is if you’re concerned about your risk of heart disease, eating a balanced diet and 45 minutes of moderate cardiovascular exercise a day is one of the best “medicines.”