How many times are “too many” times to get up in the middle of the night to go to the bathroom? I know if I cut out beverages before I go to bed, I’ll reduce this, but I wonder if it’s abnormal to get up at all.

How many times are bothersome to you? Nocturia is the medical term for getting up to urinate overnight. It is very common for many people to get up a time or two overnight, especially as we get older. It is true that many people can go through the entire night without the need to urinate. Needing to urinate at night can be caused by many issues, including: excess fluid intake especially before bedtime, poorly controlled diabetes, certain medications like diuretics, bladder obstruction/over activity, benign prostate hypertrophy or urinary tract infections. Sleep problems such as sleep apnea can also lead someone to get up to urinate. Limiting fluids two to three hours before bed can be very beneficial. Particularly bothersome are alcohol and caffeinated drinks. Those with diabetes will benefit from tighter control of their blood sugars. If fluid restriction and treating other underlying conditions do not help, there are medications available to help.

Why is it so difficult to get Sudafed at a pharmacy? You practically have to sign your life away.

Sudafed, generic name pseudoephedrine, is a popular over-the-counter decongestant. In 2005, the Combat Methamphetamine Epidemic Act reclassified pseudoephedrine as a scheduled medication, which is why it must be purchased from behind the pharmacy counter. The reason for this is because pseudoephedrine is a main ingredient used in the manufacturing of methamphetamine. Because of this there are drugs marketed under the “Sudafed” brand that actually contain a different decongestant called phenylephrine. This can be purchased from the shelf without a signature, but if you want actual pseudoephedrine, you must sign.

What’s the difference between a name-brand drug and a generic equivalent? My insurance company wants me to get a generic but I’m skeptical. Is it OK?

Generally speaking, generic equivalents are just as effective and safe as their name brand counterparts and are subject to the same FDA scrutiny. Once a drug goes off patent, generic drug manufacturers can begin producing the same molecule, but without all the research and development money that was spent by the original drug maker, allowing them to sell it for far cheaper generally. There can be small differences in concentration between the same drug from different manufacturers, however, this is usually negligible. With certain meds however, such as levothyroxine for hypothyroidism, this difference can make a clinical difference and is why we recommend checking with your pharmacy that it is getting its stock from a consistent manufacturer. Some patients do swear that the name brand works better for them vs. the generic. If this is true for you, remember that your insurance may not pay for the name brand without proving the generic does not work well for you. But, in general, most prescribed drugs are generics, and do an equal job to the name-brand med.

When you gain weight, where does it go first? Do you always get a big stomach or could it go somewhere else?

Where we put weight on is actually a fairly complex interplay between genetics, hormone levels, receptor sensitivities and habits. Excess fat in our bodies are stored in something called adipose tissue, which can be located mostly in two places: under the skin (subcutaneously) or around our internal organs (visceral). It is known that high amounts of visceral fat, aka a big belly, is associated with cardiovascular risks such as diabetes, sleep apnea, dyslipidemia and high blood pressure. This increased risk is not as pronounced with increased subcutaneous fat.

Genetics play a huge role in where we tend to add pounds, but increased alcohol intake, cigarette smoking, and childhood obesity is associated with increased visceral fat distribution. You have likely noticed that there seems to be a difference between women and men in where they store fat. While men tend to put weight on around the middle primarily and can have their arms/legs relatively thin, women will put weight on in the hips, thighs, butt and upper arms more than men do.

There is differences in hormone levels, as well as receptor and enzyme concentrations that help to explain this difference. In general, low testosterone in males leads to increased central fat accumulation, as does high levels of cortisol. The important thing to remember is that increased fat in the midsection is the more dangerous type and, unfortunately, we don’t get much of say in where it goes.

Is there an advantage to using cloth diapers over disposable ones?

From a medical perspective, there is usually no advantage to cloth or disposable diapers. All you have to do is Google this topic to find plenty of blogs and opinion pieces on why you should utilize one vs. the other. There are certain advantages of cloth, including cost (although initial costs are higher), less environmental impact, and are less likely to cause any skin irritation. Disadvantages include: less convenient than disposable, they need to be changed more often, and they need to be laundered properly. Travel with cloth diapers can be challenging. As a doctor, all I ask is that you change them with enough frequency to protect their skin and utilize clean diapers, whether cloth or disposable.

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