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Dear Dr. Roach: Two weeks ago, I was unable to sleep. After I got in bed, a warm feeling flowed over my chest and arms, and my heart seemed to speed up. I had a nervous feeling in my stomach — a feeling of anxiety or agitation. I lay with my eyes closed for most of the night, and sleep refused to come. My doctor gave me a prescription for alprazolam 0.5 mg as needed. I don’t want to depend on drugs. It seems I suffer anxiety at bedtime.

S.B.

Dear S.B.: You may be right that you are suffering anxiety. Some of these symptoms are typical for an anxiety or panic attack. Alprazolam is a good treatment for the short term, but in my opinion, it has too many negative effects for long-term treatment.

More importantly, I’m not convinced that this is anxiety. The description of a warm feeling through the body and a fast heart rate always makes me nervous for a pheochromocytoma — a rare tumor of the adrenal gland that is seldom found, but won’t ever be found if it’s not considered. High thyroid hormone levels also may cause similar symptoms.

If a medical evaluation shows no evidence of these issues, then a different class of medication can be effective treatment. Or, in your case, since you want to avoid medication, counseling or cognitive behavioral therapy can be very effective.

Dear Dr. Roach: I am a 60-year-old woman in excellent health, no diabetes. At a recent annual physical, my urine test indicated some mild inflammation (positive urine nitrite and esterace, WBC 6-10,), for which I am asymptomatic. I was given a prescription for Cipro, as I am allergic to other antibiotics.

I do not want to take Cipro, so I have been drinking lots of water and tea, and eating lots of fresh (frozen) cranberries. Since I am asymptomatic, I don’t know if this is working. My doctor is a very kind man and we have a good relationship, but I am afraid to tell him that I don’t want to take Cipro. I think I’ll risk being labeled an uncooperative patient. I feel fine. Should I request a retest?

L.B.

Dear L.B.: First, I don’t think you should worry about being labeled “uncooperative.” It’s your body, and you get to make the choices. Wanting to avoid antibiotics is commendable. It’s OK to ask for alternatives, including self-care and no treatment.

In your case, I wouldn’t have recommended treatment. What you have is termed “asymptomatic bacteriuria,” and most experts recommend against treating it, except in pregnant women, people about to have urologic surgery and kidney-transplant recipients. Treatment in healthy people doesn’t prevent future infections, and if they do occur, they are more likely to be resistant.

There’s nothing wrong with increasing fluid intake, and cranberry juice does have some activity in preventing urine infections; however, it’s not necessary for you to do so. I wouldn’t get a retest unless you develop symptoms.

Email questions to ToYourGoodHealth@med.cornell.edu.

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