DEAR DR. DONOHUE: We went to some expense to have a hot tub installed in our home. I find it relaxing. My wife, however, listens to a screwball friend who tells her that hot tubs are unhealthy. She’s been reluctant to use it. If you would allay her fears, I would be deeply appreciative. – R.T.

ot tubs are safe and relaxing if people are careful to follow directions on keeping the water chlorinated, watching water temperature and checking the acidity of the water. Follow the instructions that must have been given you, and you’ll not run into health problems.

Chlorine eradicates germs that can live in hot tubs. One, in particular, is the pseudomonas germ. It thrives in water that has not been properly chlorinated. It causes an itchy, red rash. Keep the water chlorinated, and you won’t have a pseudomonas encounter.

The water temperature should not be higher than 104 F (40 C).

People taking high blood pressure medicine could get into trouble if they stay too long in the tub. The hot water dilates blood vessels, and that leads to a blood pressure drop. When a person stands to get out of the tub, blood pressure drops. The additive effect of blood pressure medicine, blood vessel dilation from warm water and blood pressure drop from standing can make a person woozy and even faint.

In the Nov. 15, 2003, issue of the American Journal of Epidemiology, there is an article that warns pregnant women of the possibility of miscarriage from hot tub use. Pregnant women, therefore, should ask their doctors if it is advisable for them to stay out of the tub.

DEAR DR. DONOHUE: I have tendinitis in both elbows. I got it from doing lawn work. I am an avid golfer, and I played as many as five days a week. I cut down the number of times I played, but I still had pain. I then had cortisone shots. The pain and stiffness remain in spite of ice therapy, massage and ibuprofen. I gave up golf entirely, and now I have just a little pain every now and then. My husband thinks I can pick up a golf club and begin to play. I tell him that the problem is still there. How will I know when I can play again? Is surgery an option if the pain returns? – B.S.

Tendinitis is tendon inflammation and tendon fraying, usually from overuse. It can also come from improper use due to an awkward golf stroke.

Cortisone shots don’t cure the problem, but they hasten the resolution of inflammation and pain. They should be used sparingly. Too many shots can weaken tendons.

A person can resume activities at a reduced level when the pain has gone and when the grip of the involved arm is as strong as the grip of the healthy arm. If both arms are involved, then a person has to judge if current grip strength is the same as it was before the tendinitis set in.

If you are trying to manage this problem on your own, don’t. A physical or occupational therapist can guide you in what kind of exercise would be most beneficial for you. Strengthening arm muscles prevents tendinitis relapses.

If pain lingers for six months to a year, an orthopedic surgeon should be consulted. Surgery might be beneficial. The times that an operation is called for are few, but in those few instances it can eliminate the pain that comes from chronically inflamed tendons.

DEAR DR. DONOHUE: I need your help in losing weight. I have begun an exercise program, and I know how many calories I burn from the exercise. I don’t know, however, what the daily calorie requirements are for a 30-year-old, average-sized woman. Can you tell me? – R.Q.

I have a complicated formula that gives people an estimate of their daily calorie need, but I am keeping it hidden. It’s too involved.

An average-sized woman who is sedentary needs about 1,800 to 2,000 calories a day to maintain her weight.

DEAR DR. DONOHUE: I am a 47-year-old man, and I think I have entered a second puberty. I am growing again! My shoe size has gotten larger, and so has my head. I can’t wear hats that I used to wear. My family doctor has me scheduled to see an endocrinologist because he thinks I might have acromegaly. What is it? – G.L.

Acromegaly is a dramatic illness and a rare one. It’s usually due to a noncancerous tumor of the pituitary gland. The tumor releases an excessive amount of growth hormone. Growth hormone, as its name implies, stimulates growth. Adults whose bones have solidly fused cannot grow taller, but their bones can thicken. The brow becomes prominent, and the chin juts. Facial features coarsen. A change in glove, shoe and hat size reflects the way these structures have widened.

Other symptoms that come from too much growth hormone include excessive sweating, carpal tunnel syndrome (finger pain coming from pressure on a nerve passing through the wrist), heart enlargement and increased size of the tongue and thyroid gland. Headaches are a common feature.

The diagnosis is confirmed with a brain scan that shows the tumor.

Treatment includes surgery, radiation or drugs. A skilled surgeon can remove the tumor. The cure rate with surgery is 90 percent. The gamma knife is another option. The “knife” is a narrow beam of high-dose radiation focused on the tumor. Medicines include drugs such as Sandostatin (octreotide) or the Parkinson’s drug Parlodel (bromocriptine).

Which of the above treatments best suits an individual depends on the nature of the tumor and that person’s overall health.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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