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Is there a better sleep aide i can get other than what I have been using over the counter


Is there a better sleep aide i can get other than what I have been using over the counter. I know getting Ambian is a big hassle but is here something in between? I've been using Ambian for about 10 years almost daily, if it matters.

Ambian is a one the brand names of Zolpidem. It's available in Russia. You can schedule appointment with neurologist (Dr. Maslak, for example) and doctor will do prescription for you ( for Zolpidem or maybe another sleeping pill).

Lump in my breast


I have noted the lump in my breast periodically appeared following breastfeeding my first child (as a result of plugged duct). I did an ultrasound, but it revealed nothing, as if everything was normal. I knead my breast periodically and feel pain at those moments. Now I am pregnant, due date is on 20th. What should I do?? When to examine my breasts, is it possible to perform the examination during pregnancy and lactation?

Ситько Елена Владимировна – рентгенолог клиники маммологии ЕМС. Эластография.
Doctor-radiologist, ultrasound doctor, specialist in the diagnosis of breast diseases

The "lump" in the breast cannot occur after feeding, even if it was the plugged duct. You should not "knead" the breasts. If there is a problem or even if you think it is – the breast should be examined. Pregnancy and breastfeeding are not contraindications for this. Under normal conditions for pregnant women we recommend a breast examination during 1 and 3 trimester (before childbirth). There are no contraindications for breast examination in your case. You are welcome at any convenient time for examination and advice on breastfeeding.



Whether LASIK fits everyone?

Элиас Раид – офтальмолог-хирург офтальмологической клиники ЕМС. Врачи.
Ophtalmologist, Director of the Ophthalmology Laser Surgery Center

The main age group for this operation are patients over 18 years with myopia, hyperopia and astigmatism. There are number contraindications for LASIC such as some chronic diseases, including eye diseases.

How soon I may drive after LASIC?


When can I ride a car after LASIK?

Элиас Раид – офтальмолог-хирург офтальмологической клиники ЕМС. Врачи.
Ophtalmologist, Director of the Ophthalmology Laser Surgery Center

Eyesight recovery is quite fast. Visual acuity is almost completely restored next morning, and most people can drive a car and get to work.



A child of 11 years old, suffers from cough for more than six months. The cough is dry, sometimes attack-like, mainly begins during the day, and often occurs before sleep. There is no cough at night. CBC is normal, glucose is 4.16, total IgE 111.80, Toxocara, Ascaride are negative, Cytomegalovirus, Mycoplasma are negative, PPD test is negative as well. A chest x-ray is normal. We have already consulted with a therapist, otolaryngologist, pulmonologist, neurologist, gastroenterologist... the cough is still present. What should we do?

Лопушанская Наталья Анатольевна - педиатр детской клиники EMC

First of all, there are no results of whooping cough testing among the results provided above. The disease cannot be ruled out, even if your child was vaccinated. The blood test for antibodies against the whooping cough germ is required (blood test for class M and G antibodies against Bordetella pertussis). Second, even a slight increase in class E antibodies is a reason to visit an allergist and to perform an evaluation of respiratory function with bronchodilator. This method will detect a latent bronchial spasm in your child. Even if the results of the test will be normal, allergologist mast rule out the allergic nature of the cough even if it's not obstructive syndrome. Third, this cough can be due to gastroesophageal reflux. It is difficult to draw any conclusions having no data of gastroenterologist’s consultation. 24-hour acidity monitoring of the stomach and esophagus is carried out to confirm or exclude the presence of reflux. Fourth, you didn’t mention whether x-ray of nasopharynx and paranasal sinuses was done. Perhaps, after all, the pathology is associated with ENT organs.

A spot on the back and chest


I have a spot on the back and chest, what could it be?

Dermatologist, allergist-immunologist, cosmetologist, mycologist

A spot on the skin is one of the most common symptoms of various skin diseases. Infectious (viral, bacterial or fungal) as well as noninfectious skin including serious diseases and nevi (moles or birthmarks) can manifest as spots on the skin. You should go to the dermatologist for accurate diagnosis. The doctor will examine you and, if necessary, a special instrument (Dermatoscope, wood lamp) will be used. A skin scraping can also be done in the lesion for microscopy, cytology or culture. A treatment will be prescribed after diagnosis.

Uterine cancer


My mom was diagnosed with the uterine cancer. She is 68 years of age and has an obesity of 4th grade (the growth of 166 cm, weight 135 kg) and hypertension. Admission to the radiology department was recommended. What should we do? As far as I know the surgery is the only method for cancer of the uterus to be removed. Is it really so that this surgery is only possible for young and relatively healthy persons?

NOSOV Vladimir
Obstetrician and gynecologist, oncologist

It is not quite so. We can operate on any patient, but the issue is which complications can lead to patient’s death and which of them can just delay the recovery. From the anesthesiologist’s point of view, it is a major challenge to intubate patients with 4th degree obesity; the abdominal section is also possible, but there is a 100% risk of suture line disruption and inflammation, let alone the postoperative pneumonia, venous thrombosis, etc. There is another option such as vaginal hysterectomy which is more acceptable and relatively safe in obese patients. It is not a «treatment standard», however, as it allows not obtaining pelvic washings, but still there is a possibility of complete cure. Anesthesia remains a problem - both general and spinal. Radiation therapy without surgery is another acceptable treatment option besides vaginal hysterectomy. A chance of complete cure is still exists, but the survival rate is on average lower than in surgical treatment

MRI or CT scan


Please tell me what kind of examination is better in case of head injury - an MRI or CT scan. I have hit my head in June this year, and now I feel a discomfort at the site of the injury sometimes (there in no acute pain)?

Акимов Виталий Сергеевич – невролог клиники неврологии и нейрохирургии ЕМС. Лечение заболеваний нервов.
Neurologist, neurophysiologist

CT has advantages in the visualization of bone structures. MRI is better for soft structures imaging, including the brain substance. According to the description, the intracranial structures damage is unlikely. Why CT or MRI? An ultrasound of soft tissues in the area of injury is also applicable. The pain in the scull can also be associated with vessel, for example, cranial arteritis, or lymphadenitis, or muscle/enthesis, and then you might need certain blood tests. And maybe these tests are not required. I would recommend you to see the doctor and let him assess the case; he will take a decision concerning following examination as a result of consultation.



My mom had a mole (suspected for melanoma) removed in November 2015. Histology revealed lentigo melanoma in situ. We checked the slides back in the Netherlands, and the diagnosis was a superficial spreading melanoma of Clark 3 Т1а Beslow 0,8 stage; re-excision with capture of 1 cm of healthy skin is recommended. Is it possible to make re-excision and subsequent histology in your hospital? If so, how soon?

Василевская Ева Александровна - дерматовенеролог, косметолог клиники дерматовенерологии и аллергологии-иммунологии ЕМС. Диагностика ВИЧ-инфекции.

We absolutely agree with the opinion of the European colleagues: re-excision with a wider offset is required; according to the Russian Protocol it is necessary to move 2 cm from the peripheral edge. This is for counter insurance, as lentigo-melanoma is a favorable type, and previous surgery is likely to put an end to this story and the forecast is favorable. All the necessary manipulations for the study are possible in our Clinic; we have our own well-equipped laboratory with the possibility to ask the advice concerning the sample in Germany and Israel. You should make an appointment with the surgeon-oncologist (Marina Bissessar) in the nearest time to conduct the diagnostic re-excision. Hope to help!

Question about ultrasound


I am 36 years old. Thyroid gland ultrasound: topography: position is regular, the right lobe is enlarged W-24 mm, t-22 mm, l- 51 mm, the volume is 12.90 cm3, left lobe enlarged, W -23 mm, t-23 mm, l-56 mm, volume is 14,90 cm3, isthmus thickness is 5 mm, the total volume is 27.09 cm3, alignments are even, echostructure is inhomogenous, echogenicity is normal, focal masses are not seen, lymph nodes are not seen, conclusion; ultrasound signs of diffuse changes in the enlarged thyroid gland. TSH 2.10 mcIU/ml (normal range 0.30-4.00). The doctor prescribed Iodocomb 50/150 for 3 months. I have been taking the medicine for 2.5 months, but TG does not seem to diminish in size and I feel discomfort (it’s like a need to stretch my neck). Whether the treatment prescribed is correct? Are any additional tests needed? Should I have my thyroid gland diminished for those 2.5 months or it is too early to talk about it? Thank you!

Русс Ирина Сергеевна – диетолог, эндокринолог терапевтической клиники ЕМС. Лечение нарушений работы щитовидной железы во время беременности.
RUSS Irina
Endocrinologist, Dietologist

It's hard to advice any treatment by correspondence. The cause of the thyroid gland enlargement is still unclear based on the results provided. The most common cause is iodine deficiency and Iodocomb treatment is appropriate in this case. Another cause is a chronic autoimmune thyroiditis which requires different treatment. Endocrinologists at EMC will advise you and decide on the types of treatment and necessary doses.

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