Q. I've had type 2 diabetes for 12 years; I'm now 81. I take metformin plus Januvia. My doctor has never suggested that I monitor myself on a daily basis with a meter. My hemoglobin A1c has been creeping up and is now at 7. Should I be getting more aggressive in my treatment?

A. You have type 2 diabetes, which used to be called adult-onset diabetes. This type of diabetes is caused mainly by insulin resistance. Normally, insulin helps usher blood sugar (which is the same thing as glucose) out of the bloodstream and into cells where it is ...

Q. I have been told by a podiatrist that because of hammertoes, the fat pads on the ball of my foot have dissipated, causing pain when I walk or stand for long periods. I like to walk for exercise so this is a real bother. I am trying to figure out how to handle the foot and all of its idiosyncrasies.

A. The feet — they get some respect and attention, even adulation. But the toes? Not nearly enough. They help us keep our balance and are crucial to taking a good stride as we walk or run. And, as ...

Q. I have a plugged left ear problem. It usually starts about 4 p.m. and lasts about three to four hours. I cough, clear my throat, yawn, close my nostrils and blow — nothing seems to help.

A. It seems like you have had this problem for a while, so my first suggestion is to see a doctor and start the process that would lead to a diagnosis and proper treatment.

The diagnosis of almost any ear problem starts with a few basic questions. One of the most obvious is also one of the most important: have you lost any ...

Q. I am curious about tremors in adults. I know that people with Parkinson's disease get them, but I am not sure about other conditions.

A. Our muscles are programmed for various kinds of rapid alternating movements, from the hands of a drummer to shivering when we get a chill. In fact, there's a background low-amplitude oscillation to all of our muscle movements called physiological tremor that's perfectly normal. Some conditions, such as overactive thyroid, exaggerate this tremor so it becomes obvious — for instance, when the person holds out a hand. Correction of the thyroid condition eliminates this kind ...

Q. Some years ago, you published an article saying that ginkgo biloba might slow down dementia. I was 59, and I started taking it. I think it has helped me and know others who think likewise. But I read that a recent study says it doesn't help. Your thoughts?

A. Ginkgo biloba — or just ginkgo, for short — is an herbal supplement made from the fan-shaped leaves from the tree of the same name. Ginkgo trees — maidenhair is another name — are native to China, but they can now be found all over the world, including the United ...

The editor in chief of the Harvard Health Letter introduces this year's edition of a special issue comprised entirely of "By the way, doctor" letters from readers.

Is it safe for children to drink soy milk? Read More »

We have screening tests for other cancers. How about pancreatic cancer?

Q. I‘ve been having PET-CT scans to look for any growth or spread of previously removed tumors. Are they as reliable in detecting breast cancer as a regular mammogram?

A. The short answer is no, PET-CT scans are not suitable substitutes for mammograms. Mammograms take advantage of the fact that most of the female breast is fat tissue, so it's relatively transparent to the low doses of radiation used in mammography. Very subtle changes in tissue architecture are apparent on a mammogram, as are small deposits of calcium that may in some cases signal the growth of a tumor. Today's ...

Q. I read in an earlier issue that one of the nutrition experts eats five servings of fish a week. Why so much? And isn't there a risk from the contaminants?

A. I believe research has shown that eating fish has a variety of benefits, but for me, the science came much later than my love of fish did.

I grew up on a potato farm on the East End of Long Island. My childhood home there was on a farm on Bunker Hill that overlooked the ocean about three-quarters of a mile away. A fish factory that processed menhaden, ...