Posted: Sat Nov 12, 2005 4:57 pm Post subject: Health and Healing
Chronic Pain and Depression: A Chicken or the Egg Story
By Rosalyn Carson-DeWitt, MD
A variety of recent medical studies have drawn a strong association between chronic pain and a diagnosis of major depression. The two conditions seem to go hand-in-hand in a large percentage of unfortunate patients, who suffer the debilitating effects of both chronically painful conditions and persistent mood problems.
Which Came First?
Do patients who are depressed perceive pain more acutely than people who aren’t depressed? Or does chronic pain have a debilitating effect on not just the body, but also the psyche, resulting in depression?
Researchers still don’t know whether there is a cause-and-effect relationship between chronic pain and depression, and if there is, which condition causes the other. Some research suggests that insufficiently treated, ongoing pain may cause changes in the chemical environment of the brain, thereby increasing the likelihood of depression. Similarly, other research suggests that insufficiently treated, ongoing depression causes changes in the chemical environment of the brain such that it increases an individual’s perception of painful sensations.
Who’s at Risk?
Some patients are at increased risk for both chronic pain and depression. For example, women and elderly patients are more likely to report both symptoms of chronic pain and symptoms of major depression. (Older adults, however, tend to report somatic or physical symptoms of depression rather than typical symptoms.) Researchers don’t fully understand why this is true.
Patients whose pain interferes with their independence, their mobility, or their ability to actively participate in their usual social activities are at a particularly high risk for depression.
Symptoms of Chronic Pain and Depression
Certain areas of the body are more likely to cause painful symptoms in patients with both chronic pain and depression. The types of chronic pain most commonly reported by depressed patients include:
Neck and back pain
Pain in the musculoskeletal system (muscles, bones)
The symptoms that lead to a diagnosis of depression include:
Low or sad mood
Inability to enjoy usual activities
Under- or over-eating
Difficulty sleeping or sleeping too much
Sense of guilt
Negative thought patterns
Complications of Chronic Pain and Depression
Both chronic pain and depression interfere with daily functioning at school, at work, and within relationships.
The most serious complication of depression is suicide. Patients who have both chronic pain and depression have a much higher risk of feeling suicidal, acting on those suicidal feelings, and successfully committing suicide. Treatments that both improve depression and relieve chronic pain may decrease the risk of suicide in patients.
Diagnosis of Chronic Pain and Depression
Unfortunately, depression can be a slippery diagnosis. When someone is already suffering from chronic pain, it may seem obvious that some degree of depression is likely. Depression may even worsen the physical symptoms of chronic pain. Similarly, untreated chronic pain may cause a cycle of distress and depression. Diagnosing the presence of both chronic pain and depression may be the first step toward breaking this cycle and improving both pain and depression.
And yet, depression is not an inevitable result of every chronic pain condition. Nor is chronic pain an inevitable result of depression. However, until researchers unravel the complex interactions between depression and chronic pain, it is important that both healthcare providers and patients be aware that these two conditions frequently co-exist. Diagnosing and treating only one of them could result in serious complications, debilitation, or decreased functioning.
A thorough evaluation by your healthcare provider should always include an inquiry into the presence of any chronic pain, as well as screening questions designed to uncover the presence of a mood disorder. A questionnaire called the SF-36 Health Status Survey is particularly helpful at uncovering the dimensions of chronic pain and the presence of depressive symptoms.
Treatment of Chronic Pain and Depression
The good news is that there are medications available that treat both depression and chronic pain. Certain medications traditionally used for depression also have a significant effect on decreasing chronic pain. This association has been tested in individuals who suffer from chronic pain without depression; when these patients are asked to fill out rating scales that describe the intensity of their chronic pain, those patients who are given antidepressants rate their pain as significantly decreased. But these medications are prescribed by your doctor and can have side effects. Consult with your doctor about what would be best for you.
The antidepressant medications that have been successfully used to decrease chronic pain include:
Selective serotonin reuptake inhibitors
***Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern - mostly SSRIs (Selective Serotonin Re-uptake Inhibitors) - are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.
What else can I do?
Psychotherapy, referred to commonly as therapy, in which a person with depression talks to a licensed and trained mental healthcare professional, can also be helpful for patients who are struggling with both chronic pain and depression.
In addition, a variety of other treatments are available that can improve pain and lessen depression, such as:
Finally, keeping a pain diary might also help you recognize which interventions help and which situations exacerbate your pain and/or depression. Or, you can try getting involved with a support group, which can put you into contact with other people who are meeting similar challenges. It may also give you an opportunity to learn from the experiences of others, and to share your own coping strategies with people who could use your support.
The secret to lasting youth may not lie in a pill or potion, but in produce! Carrots, spinach, and broccoli—among other vegetables—contain compounds known as antioxidants, which research suggests may be powerful weapons in the war against the effects of aging. "I think the evidence is very compelling, although not definitive, that as you increase your intake of certain antioxidants, you do increase the benefits," says Dr. Jeffrey Blumberg, chief of the Antioxidant Research Lab at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University.
Antioxidants and Free Radicals in the Body
As the body uses oxygen, byproducts called free radicals—oxygen molecules that are missing electrons—are formed. These free radicals steal electrons from healthy cells, causing damage to these cells. This cell damage is thought to be cumulative, and scientists theorize that this may lead to aging and disease. Everything from cancer and heart disease to wrinkles and cataracts may be attributed to the action of free radicals. Environmental factors such as exposure to radiation and tobacco smoke may also increase the number of free radicals in the body.
Antioxidants are compounds that work to deactivate free radicals, thus preventing cell damage. The three best-known antioxidants are vitamins E and C and beta carotene, but there are many others, including selenium, lutein, and lycopene.
Research Shows Mixed Results
A study involving 30,000 participants in China demonstrated that over the course of five years, those participants who received a daily supplement containing vitamin E, selenium, and beta carotene had a 13% lower rate of cancer than those study participants who received a placebo (or sugar pill). In the United States, a study of 1,795 nurses who had a history of heart problems showed that those nurses who consumed larger amounts of vitamins C and E and beta carotene showed the greatest cardiac improvement and reduced their chances of further heart damage.
A study reported in the May 20, 1993 issue of The New England Journal of Medicine reported a significant decrease in the incidence of coronary artery disease in men and women who consumed 100 international units (IU) of vitamin E daily. The current recommended intake for vitamin E is 15 mg per day (22.5 IUs).
Although it's tempting to take these kinds of results to heart, some critics have argued that studies like these have not ruled out other reasons for the study subjects' improvements, such as increased exercise or other dietary changes. In other words, maybe the effect is entirely unrelated to the supplement.
In January 2000, The New England Journal of Medicine reported the results of a 4 ½-year study of more than 9500 men and women aged 55 and older with risk factors for heart disease. Half of the participants were given 400 international units of vitamin E from natural sources, while other participants received a placebo, or sugar pill. Over the length of the study, there was no significant difference in the number of cardiac events or cardiac deaths in either group.
Why do these results contradict the results from other studies? The researchers themselves note that perhaps the study wasn't long enough to demonstrate any effect. They also suggest that perhaps the findings were influenced by the fact that they used vitamin E supplementation alone, without any other antioxidants. It may be that vitamin E requires other factors to have a beneficial effect.
Too much of a good thing?
Some studies have suggested that for certain people, over-consumption of antioxidants can be harmful. Studies of beta-carotene in humans were stopped in 1994, after results suggested that people at risk for cancer were at even greater risk after taking high doses of synthetic beta-carotene. A 2005 meta-analysis (an analysis of the results of multiple studies) suggests that taking more than 400 IU/day of vitamin E may also be harmful to health.
Benefits of Dietary Changes Are Clear
Dr. Blumberg cautions that research is ongoing. He cites new studies of the benefits of lesser-known antioxidants such as lycopene, which may reduce prostate cancer risk, and lutein, which is strongly associated with a decrease in age-related macular degeneration and prostate cancer. Studies of high-risk groups, such as the nurses with heart disease, suggest the greatest benefit from increased consumption of antioxidants is realized by those at the greatest risk of disease.
Though the jury is still out on the role of antioxidant supplements as disease and age fighters, consuming more antioxidant-rich fruits and vegetables has well-documented benefits in improving health, aside from their antioxidant contents.
Antioxidant Recommended Amount* Good Food Sources
Vitamin C Women: 75 mg
Men: 90 mg
Smokers: extra 35 mg Citrus fruits, cruciferous vegetables such as broccoli, cauliflower, and cabbage
Vitamin E 15 mg Fortified cereals, vegetable oils, nuts, spinach and kale, mangoes, and wheat germ
Selenium 55 micrograms (mcg) Onions, garlic, mushrooms, wheat germ, and rice bran
Vitamin A Women: 700 RAE**
Men: 900 REA As retinol:
Eggs, liver, vitamin A-fortified milk As beta-carotene:
Yellow-orange or dark-green leafy vegetables and fruits, such as kale, beet greens, spinach, carrots, sweet potatoes, pumpkin, papaya, apricots, parsley, and basil
*Recommended amounts are given as dietary reference intakes (DRIs), which replace recommended dietary allowances (RDAs); these are the government's recommendations for good health.
**REA = retinol equivalents; a measurement of vitamin A that includes the two major forms of vitamin A found in foods: retinol and beta-carotene. There is no separate DRI set for beta-carotene.
Are Supplements Necessary?
The problem for many people lies in consuming enough of these foods to receive any kind of benefit. "Few people meet the recommended intakes for all nutrients," Dr.Blumberg says. "And people eat less as they grow older. As their appetite decreases, they don't change how they eat, they just eat less." Instead of adding more fruits and vegetables to their diets, many older people eat smaller portions of the same kinds of foods they've eaten for years, which are often high in fats, starches, and sugars.
Smokers, heavy drinkers, people with impaired immune systems, and those on calorie-restricted diets may also have difficulty getting the nutrients they need from food alone. For these people in particular, supplements may be the only way for them to fulfill their nutrient needs. In addition, vitamin E is found in a limited number of foods, making it difficult to get enough of it in the average diet. While consuming more vegetables and fruits is still the best way to get essential nutrients, a good multivitamin can fill in any nutrient gaps.
The American Heart Association and the American Cancer Society do not endorse antioxidant supplements for the general population, but they do recommend a diet with plenty of antioxidant-rich fresh fruits, vegetables, and whole grains. Please also discuss any antioxidant use with yout doctor before you begin it.
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Miller ER 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005 Jan 4;142(1):37-46.
Stanner SA, Hughes J, Kelly CN, Buttriss J. A review of the epidemiological evidence for the 'antioxidant hypothesis'. Public Health Nutr. 2004 May;7(3):407-22.
Toxic tears: how crying keeps you healthy
by Charles Downey
Humans are the only animals who shed tears of emotion. Why do we cry? Are there any physical or health benefits from crying?
Years of tears
"Until the Industrial Revolution, crying in public was pretty normal, even for men," says Tom Lutz, Ph.D., an associate professor of English at the University of Iowa and author of Crying: The Natural and Cultural History of Tears. "Heroic epics from Greek times through the Middle Ages are soggy with weeping of all sorts," Dr. Lutz says. "Through most of history, tearlessness has not been the standard of manliness."
For instance, when Roland, the most famous warrior of medieval France died, 20,000 other knights wept so profusely they fainted and fell from their horses. Long before that, the Greek warrior Odysseus cries in almost every chapter of Homer's Iliad while St. Francis of Assisi was said to have been blinded by weeping. Later, in the 16th century, sobbing openly at a play, opera or symphony was considered appropriately sensitive for men and women alike.
The industrial age needed diligent, not emotional, workers. Crying was then delegated to privacy, behind closed doors. Children learned that weeping itself was the problem and not the result of a problem. People everywhere became more uncomfortable with public tears.
In 1972, public crying was still so unacceptable that candidate Edmund Muskie was driven out of the U.S. presidential race when he shed tears during a speech.
The purpose of crying
Throughout history and in every culture, people cry. "Weeping often occurs at precisely those times when we are least able to fully verbalize complex, overwhelming emotions and least able to fully articulate our feelings," Lutz writes.
Crying can also be an escape; it allows us to turn away from the cause of our anguish, and inward toward our own bodily sensations. Scientists feel that weeping is probably necessary because no human behavior has ever continuously evolved unless it somehow contributed to survival.
"Science has proven that stress is terrible for the health of your brain, heart and other organs," says William Frey II, Ph.D., biochemist and tear expert of the Ramsey Medical Center in Minneapolis, Minnesota. "It isn't proven yet, but weeping has most likely served humans throughout our evolutionary history by reducing stress."
Studying the waterworks
In one oft-quoted study, Frey studied five different groups of people. The people kept records of all emotional and irritant crying episodes for a period of 30 days. Information such as date, time, duration, reason for crying, thoughts, emotions and physical components, such as "lump in throat," watery eyes vs. flowing tears, etc.
Frey found that 94 percent of the females had an emotional crying episode in the 30-day recording period, as compared with only 55 percent of the males. Eighty-five percent of women and 73 percent of men reported feeling better and more relieved after a good cry. Dr. Frey's lab also chemically examined tears produced by onions and compared them with emotional tears. While chemical tears (caused by onions) were 98 percent water, emotional tears contained more toxins.
Though there was no difference between men and women in average duration of crying episodes, men and women cry differently. Men cry quietly and their eyes brim neatly with tears. Women, on the other hand, make lots of crying noises as the tears stream down their cheeks. "Our testing revealed that men weep an average of 1.4 times a month while women cry about 5.3 times monthly," says Dr. Frey.
Why do people produce tears?
Some people believe that the rapid breathing associated with sobbing would quickly dry out the sensitive mucous membranes if tears did not keep them moist and that mucosal dehydration in the absence of tears could increase the risk of infection. While this may be one of the functions of emotional tearing, the clinical experiences of Dr. Frey and others indicate that sobbing is not a component of all crying and tearing episodes. And humans don't excrete tears while running or engaging in other forms of rigorous exercise where rapid breathing is also increased.
Tears are secreted through a duct, a process much like urination or exhalation. Frey believes that like these other processes, tearing may be involved in removing waste products or toxic substances from the body. Perhaps that is why so many people report feeling better after crying. Not only is the venting of emotions liberating, but the actual chemical composition which is known to be different from tears produced from cutting onions may be involved in this increased feeling of well-being.
"Crying is natural, healthy and curative," according to Barry M. Bernfeld, Ph.D., director of the Primal Institute in Los Angeles. "[But] crying which should be the most natural, accepted way of coping with pain, stress, and sorrow is hardly mentioned in psychiatric literature. Now we seem finally to recognize that crying is good for people."
Are times changing?
"In just a few short decades, we've gone from the view that crying is just a loss of control and a sign of weakness to a common perception that there might be some value in open emotional crying," says Dr. Frey.
For instance, a weeping, unashamed New York Yankee Darryl Strawberry fell into the arms of manager Joe Torre on national television. Gwyneth Paltrow was so tearful on national television that she could barely speak when awarded her Oscar for best actress. President Clinton routinely sniffles openly, and presidential candidate Bob Dole choked up while recalling how people in his home state helped him with his war injuries.
"Today, it might even be a plus for politicians to cry," says Dr. Frey. "People now like the idea that our leaders can be open about their feelings."
One of the main obstacles to good mental health is that by stifling crying, a person must also hide or shut down valid feelings and emotions. When legitimate emotions are not fully recognized and expressed, insensitive acts from rudeness to school shootings can result.
For Better Health: Five Easy Pieces
by Lori P Marcotte, RD, CNSD
Although "an apple a day keeps the doctor away," and "eat your veggies" may sound like folklore, it turns out that these maxims may have scientific backing. The only catch is that just one apple or one vegetable serving a day isn't enough. In fact, to maximize your health, you need a combination of at least five a day.
The underlying causes of deaths from heart disease and cancer include behaviors that, unlike genetic factors, can be prevented or changed. For example, better dietary and exercise patterns can contribute significantly to a reduced risk for heart disease, stroke, diabetes, and cancer, and could prevent 300,000 deaths annually.
A recent scientific literature review ascertained that approximately 35% of all cancer deaths in the United States are related to poor dietary habits. Research also points to high intakes of fruits and vegetables as the most consistent factor associated with decreased cancer risk.
For years, epidemiologic studies have shown lower rates of chronic diseases in countries that have high per capita intakes of fruits and vegetables. Although this may sound compelling, the information is too isolated to prove a cause and effect relationship in and of itself.
However, recent studies have strengthened the argument for fruit and vegetable consumption. In these studies, people who ate large amounts of fruits and vegetables had lower rates of cancer compared to people who ate one or fewer servings a day. Five servings a day is the minimum number demonstrated to reap health benefits.
Despite such strong evidence, many Americans still don't realize the importance of fruits and vegetables in the diet. According to baseline data used to set the Healthy People 2000 National Health Promotion and Disease Prevention Objectives, average fruit and vegetable intake was approximately four servings per day. In fact, only 32% of US adults met the recommended five a day.
A 1991 survey revealed that only 8% of American adults knew how many fruits and vegetables to eat. In response to this lack of knowledge, the National Cancer Institute (NCI) in cooperation with the Produce for Better Health Foundation launched the 5 A Day—for Better Health program.
What Is The 5 A Day Program?
The 5 A Day program seeks to increase the number of fruits and vegetables consumed by Americans. The program's goal is to inform Americans that fruits and vegetables can easily become a part of the daily diet, improve health, and may reduce the risk of cancer and other chronic diseases.
Peter Greenwald, M.D., Dr.P.H., Director of NCI's Division of Cancer Prevention and Control, summed up the situation by saying, "In the last several years, consumers have been bombarded with food and nutrition messages—many of which have been confusing and sometimes frightening. The 5 A Day message is simple and positive: Eat more of something that tastes great and improves your overall health."
Fruits and vegetables readily fit the bill; they provide fiber, beneficial vitamins such as A and C, minerals, and other compounds that may help to fight cancer. While single-dose nutrients receive much press, it appears that the combination of nutrients in fruits and vegetables probably holds the key to disease prevention. A bonus for the weight conscious is that most fruits and vegetables (except avocados and olives) are naturally low in fat and calories, have no cholesterol, and taste delicious.
This simple, straightforward message—eat five a day—has successfully increased public awareness of the dietary guidelines. The actual number of people meeting the goal is unknown at this time, but awareness is a good predictor of consumption.
Where Do You And Your Family Fit In?
Children mimic the dietary habits of adults. Only 20% of American children consume the recommended five a day. Though children are not concerned with developing diseases such as cancer, they need healthful diets to promote growth and development. And dietary habits formed in childhood usually last a lifetime.Conversely, older Americans who have developed healthful eating patterns consume the most fruits and vegetables, while women manage to eat more fruits and vegetables than do men.
What Can Be Done?
To help motivate people to eat more fruits and vegetables, the NCI urges Americans to take the "5 A Day Challenge." The challenge encourages people to engage in a healthy competition that will prove easier than the Olympic games, and allows more people to feel like winners. Ultimately, fruits and vegetables can become part of a health routine that can make everyone feel good. (You can get more information on their website: http://www.5aday.gov.)
Start Your Own 5 A Day Challenge
To start your own 5 A Day Challenge, begin at home by striving to eat five servings of fruits and vegetables today. Continue your success each day, each week, and soon you will have a more healthful diet.
Take your challenge into the streets by organizing a friendly competition among neighbors. End the week with a potluck and ask everyone to bring his/her favorite fruit or vegetable dish.
Need some help getting started? For recipe ideas, try the recipes from the National Cancer Institute's 5 A Day web site.
Take the opportunity to beat the boss and suggest a 5 A Day Challenge at work. Teams can offer the best support as you share ideas in the lunch room. If your workplace has a cafeteria, invite the food service manager to help the challenge by offering daily specials on fruits and vegetable dishes.
Eating five a day is easier than most people think. A serving is:
a medium piece of fruit
1/2 cup cooked or raw fruit or vegetable
3/4 cup (6 ounces) juice
1 cup leafy greens
1/4 cup dried fruit
1/2 cup cooked beans or peas (such as lentils, pinto beans, kidney beans)
Eat five a day
At breakfast, enjoy a six ounce glass of 100% fruit juice and a medium piece of fruit. Two servings already!
At lunch, bring along some carrot or celery sticks; five sticks is a vegetable serving.
For dinner, try a salad with dark, leafy greens and tomato, and a medium baked potato with your meal for two more vegetable servings.
Voila! Not counting any fruit or vegetable snacks, you've already made your 5 A Day goal.
Buy five a day
In the grocery store, buy fresh fruits and vegetables that are in season. Locally grown produce is usually less expensive than produce that has been shipped, and it is fresher.
Softer fruits and vegetables, such as peaches and berries, or tomatoes and mushrooms, don't last as long as harder fruits and vegetables, such as apples and oranges, or carrots and potatoes.
Canned and frozen fruits and vegetables are good to have on hand so that you never run out.
Find five a day on the road
Most fast food chains serve 100% fruit juice, and convenience stores stock both juice and fresh fruit.
Enjoy a breakfast waffle or pancake with strawberries instead of syrup, or have an omelet stuffed with tomatoes, mushrooms, peppers, and onions.
Bring along dried fruit or raisin packs for a transportable snack.
At the deli, take advantage of vegetable sandwich toppings and try a bowl of vegetable soup on the side.
For your evening meal, include the vegetable side choices, or try a vegetarian-based meal such as chili. Don't forget that a tomato pizza also counts towards your vegetable intake!
Don't stop at five a day!
While we would see real health benefits if all Americans increased their intake of fruits and vegetables to five a day, this target is only a first or baseline level. More recent recommendations suggest that women should aim for seven servings, and men for nine. Five is great, but more is better!
Krebs-Smith SM, et. al. US adult's fruit and vegetable intakes, 1989 to 1991: A revised baseline for the Healthy People 2000 Objective. Am J Public Health. 1995;85:1623-29.
Krebs-Smith SM, et. Al. Fruit and vegetable intakes of children and adolescents in the United States. Arch Pediatr Adolesc Med. 1996;150:81-86.
National Research Council, US Committee on Diet and Health. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: National Academy Press. 1989.
Steinmetz KA. Vegetables, fruit, and cancer, I: Epidemiology. Cancer Causes Control 1991;2:325-357.
US Department of Agriculture, US Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans, 4th edition. Washington, DC: US Government Printing Office; 1995. Home and Garden Bulletin 232.
US Department of Health and Human Services. Healthy People 20000: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Government Printing Office;1990.
The Connection Between Allergies and Asthma
by Rebecca A. Seguin, MS, CSCS
According to the Asthma and Allergy Foundation of America, 17 million Americans have asthma, and a staggering 40–50 million suffer from allergies. Additionally, asthma is the most common chronic childhood disease—affecting nearly nine million Americans under the age of 18. Because asthma and allergies are so common and frequently occur together, most parents will want to understand what is currently known about preventing or avoiding these conditions.
“Allergen” is the word that doctors use to describe a substance in the environment to which our bodies may react with an allergic or asthmatic reaction. Common allergens include pollen, mold, dust mites, latex, certain foods, bee stings, certain plants, and medications. We are all exposed to at least some allergens all the time, but many of us can encounter these troublemakers without experiencing any symptoms at all. For most people, their body simply doesn’t react to allergens. However, for millions of people, an excessive immune response to allergens triggers a cascade of unpleasant symptoms. Such symptoms are sometimes mild, but they can be severe, or rarely, even fatal. Allergic symptoms most commonly include: itching of the eyes, throat, or skin; sneezing; nasal congestion; coughing; wheezing; or rash.
Typically, allergic substances enter the body in one or more of the following ways:
Absorption through the skin (e.g., poison ivy)
Inhalation through the mouth or nose (e.g., pollen, dust mites)
Ingestion (e.g., foods, medications)
Injection (e.g., insect sting)
Asthma is a condition in which the lungs react to some kind of irritation by producing mucous and inflammation along your breathing pathway. This reaction may occur moments after exposure to an irritant or after several hours have passed. Allergy is a common cause of asthmatic reactions, but similar symptoms can be produced by non-allergen sources such as irritant chemicals, viral infections, or other lung irritants. Asthma is usually reversible with treatment. This means that in between “attacks,” or after treatment, the lungs return almost completely to normal. An asthma episode most commonly manifests as difficulty breathing, shortness of breath, cough, or other respiratory symptoms.
Exposure to tobacco smoke is a very common cause of asthma in children. This is often an irritant reaction rather than a true allergy. Other asthma triggers include exercise, cold air, viral infections, and allergens. The allergens that most commonly cause an asthma episode are dust mites, mold, pollen, and animal dander. Food allergies can also trigger an asthma episode in some individuals. Foods that are relatively common asthma triggers include shellfish and peanuts.
The Allergy-Asthma Connection
It is possible for you or your children to have allergies but not asthma, or to have asthma without allergies. However, the two conditions often occur together. Nearly all children and many adults who suffer from asthma have other allergies of one type or another. Eczema (allergic skin inflammation) and hay fever are the two most common allergies associated with asthma.
For the minority of individuals who suffer from allergies and asthma, the connection between them lies in the similar biologic responses they provoke to what are, for the most part, harmless environmental triggers. If you have allergies and/or asthma, your body, for not fully understood reasons, is attempting to protect itself from substances it wrongly perceives to be dangerous. Unfortunately, this intentionally protective reaction triggers the release of body chemicals that cause unpleasant results—those of either allergies (sneezing, nose congestion, itchy red eyes, skin rash) and/or asthma (wheezing, shortness of breath, cough). With allergic asthma, the allergic reaction is confined to the airways, whereas other forms of allergy may affect the skin, eyes, or ears.
Putting Knowledge Into Action
You can't change your child's genetics, but you can do a number of things to safeguard your home and family against allergies and asthma. While developing allergies and/or asthma may be inevitable for some, following these simple recommendations may lessen the severity and frequency of episodes.
Exposure to certain substances affect whether a child develops asthma. For instance, infants born to mothers who smoked during pregnancy are more likely to experience wheezing. Early exposure to secondhand smoke also increases a child’s risk for developing asthma. Other early interventions include:
Avoid Group Day Care
Avoiding group daycare for very young children will limit exposure to respiratory infections and may reduce wheezing during childhood. On the other hand, some studies suggest that children who have early daycare experiences may be less likely to have asthma later in life than children who avoid early respiratory infection. The relationship between early infection and asthma has been called “the hygiene hypothesis” and is still precisely that: a hypothesis. Some scientists and pediatricians think that early exposure to infections (and perhaps animals) is protective against later asthma. Parents may be interested in this hypothesis, but they should know that it remains controversial, and there is still much to be learned about the relationship between early childhood experience and later allergies and asthma.
If you or your child has asthma or allergies, talk to your doctor about controlling exposure to dust mites and other indoor allergens. Dust mites are microscopic creatures that are found in large quantities in your home. They tend to live in bedding but are far too small to be seen or otherwise detected. Some research shows that early exposure to dust mites in children with a genetic predisposition to allergies and asthma significantly increases their risk of developing one or both conditions. Reducing exposure to mites may make susceptible children (primarily those with allergic or asthmatic parents) less likely to develop asthma or allergies. Strategies to reduce exposure to mites include:
Wash all linens in hot water every seven days.
Place zippered, plastic covers on pillows and mattresses.
Vacuum carpeting and upholstered furniture frequently.
Keep indoor relative humidity below 50%.
Plan ahead to avoid environmental triggers. Bee stings, latex gloves, shellfish, and pollen are all potential triggers for allergies, asthma, or both. Some are easier to avoid than others, but awareness and planning can help. Simple strategies include:
For food allergies, prepare foods at home, always read ingredients panels on prepackaged items carefully, and ask servers for ingredient information before ordering food in restaurants.
For bee, wasp, and other insect sting allergies, become knowledgeable about the plant and environments they’re attracted to and avoid them. Also, carry appropriate medication (e.g., EpiPen®) at all times.
For pollen and related allergies, keep windows closed and use air conditioning, avoid being outdoors during peak pollen seasons, and be diligent in following allergy-related medication recommendations to avoid asthma episodes.
Knowing the underlying types, causes, and triggers of both asthma and allergies is the foundation of putting effective prevention and treatment strategies into action. It is essential that your health care provider direct medication-related strategies, but being knowledgeable and proactive will go a long way towards avoiding or reducing the negative effects of these conditions in yourself and your children.
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Questions and Answers About Arthritis Pain
Adapted from the National Institutes of Health
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What Is Arthritis?
The word arthritis literally means joint inflammation, but is often used to refer to a group of more than 100 rheumatic diseases that can cause pain, stiffness, and swelling in the joints. These diseases may affect not only the joints but also other parts of the body, including important supporting structures such as muscles, bones, tendons, and ligaments, as well as some internal organs. This fact sheet focuses on pain caused by two of the most common forms of arthritis-osteoarthritis and rheumatoid arthritis.
What Is Pain?
Pain is the body's warning system, alerting you that something is wrong. The International Association for the Study of Pain defines it as an unpleasant experience associated with actual or potential tissue damage to a person's body. Specialized nervous system cells (neurons) that transmit pain signals are found throughout the skin and other body tissues. These cells respond to things such as injury or tissue damage. For example, when a harmful agent such as a sharp knife comes in contact with your skin, chemical signals travel from neurons in the skin through nerves in the spinal cord to your brain, where they are interpreted as pain.
Most forms of arthritis are associated with pain that can be divided into two general categories: acute and chronic. Acute pain is temporary. It can last a few seconds or longer but wanes as healing occurs. Some examples of things that cause acute pain include burns, cuts, and fractures. Chronic pain, such as that seen in people with osteoarthritis and rheumatoid arthritis, ranges from mild to severe and can last a lifetime.
What Causes Arthritis Pain? Why Is It So Variable?
The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain.
The pain of arthritis varies greatly from person to person, for reasons that doctors do not yet understand completely. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint. In addition, activities affect pain differently so that some patients note pain in their joints after first getting out of bed in the morning whereas others develop pain after prolonged use of the joint. Each individual has a different threshold and tolerance for pain, often affected by both physical and emotional factors. These can include depression, anxiety, and even hypersensitivity at the affected sites due to inflammation and tissue injury. This increased sensitivity appears to affect the amount of pain perceived by the individual.
How Do Doctors Measure Arthritis Pain?
Pain is a private, unique experience that cannot be seen. The most common way to measure pain is for the doctor to ask you, the patient, about your problems. For example, the doctor may ask you to describe the level of pain you feel on a scale of 1 to 10. You may use words like aching, burning, stinging, or throbbing. These words will give the doctor a clearer picture of the pain you are experiencing.
Since doctors rely on your description of pain to help guide treatment, you may want to keep a pain diary to record your pain sensations. On a daily basis, you can describe the situations that cause or alter the intensity of your pain, the sensations and severity of your pain, and your reactions to the pain. For example: "On Monday night, sharp pains in my knees produced by housework interfered with my sleep; on Tuesday morning, because of the pain, I had a hard time getting out bed. However, I coped with the pain by taking my medication and applying ice to my knees." The diary will give the doctor some insight into your pain and may play a critical role in the management of your disease.
What Will Happen When You First Visit a Doctor for Your Arthritis Pain?
The doctor will usually do the following:
Take your medical history and ask questions such as: How long have you had this problem? How intense is the pain? How often does it occur? What causes it to get worse? What causes it to get better?
Review the medications you are using
Conduct a physical examination
Take blood and/or urine samples and request necessary laboratory work
Ask you to get x-rays taken or undergo other imaging procedures such as a CAT scan (computerized axial tomography) or MRI (magnetic resonance imaging).
Once the doctor has done these things and reviewed the results of any tests or procedures, he or she will discuss the findings with you and design a comprehensive management approach for the pain caused by your osteoarthritis or rheumatoid arthritis.
Who Can Treat Arthritis Pain?
A number of different specialists may be involved in the care of an arthritis patient-often a team approach is used. The team may include doctors who treat people with arthritis (rheumatologists), surgeons (orthopaedists), and physical and occupational therapists. Their goal is to treat all aspects of arthritis pain and help you learn to manage your pain. The physician, other health care professionals, and you, the patient, all play an active role in the management of arthritis pain.
How Is Arthritis Pain Treated?
There is no single treatment that applies to all people with arthritis, but rather the doctor will develop a management plan designed to minimize your specific pain and improve the function of your joints. A number of treatments can provide short-term pain relief.
Medications-Because people with osteoarthritis have very little inflammation, pain relievers such as acetaminophen (Tylenol) may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti- inflammatory drugs (NSAIDs)such as ibuprofen (Motrin or Advil).
Heat and cold-The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.
Joint Protection-Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.
Transcutaneous electrical nerve stimulation (TENS)-A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception.
Massage -In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are very sensitive so the therapist must be very familiar with the problems of the disease.
Acupuncture -This procedure should only be done by a licensed acupuncture therapist. In acupuncture, thin needles are inserted at specific points in the body. Scientists think that this stimulates the release of natural, pain-relieving chemicals produced by the brain or the nervous system.
Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. Following are some sources of long-term pain relief.
Nonsteroidal anti-inflammatory drugs (NSAIDs)-These are a class of drugs including aspirin and ibuprofen that are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis.
Disease-modifying anti-rheumatic drugs (DMARDS)-These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include methotrexate, hydroxychloroquine, penicillamine, and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.
Corticosteroids-These are hormones that are very effective in treating arthritis. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. Because frequent injections may cause damage to the cartilage, they should only be done once or twice a year.
Weight reduction-Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.
Exercise -Swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit.
Surgery-In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one. Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.
What Alternative Therapies May Relieve Arthritis Pain?
Many people seek other ways of treating their disease, such as special diets or supplements. Although these methods may not be harmful in and of themselves, no research to date shows that they help. Nonetheless, some alternative or complementary approaches may help you to cope or reduce some of the stress of living with a chronic illness. If the doctor feels the approach has value and will not harm you, it can be incorporated into your treatment plan. However, it is important not to neglect your regular health care or treatment of serious symptoms.
How Can You Cope With Arthritis Pain?
The long-term goal of pain management is to help you cope with a chronic, often disabling disease. You may be caught in a cycle of pain, depression, and stress. To break out of this cycle, you need to be an active participant with the doctor and other health care professionals in managing your pain. This may include physical therapy, cognitive-behavioral therapy, occupational therapy, biofeedback, relaxation techniques (for example, deep breathing and meditation), and family counseling therapy.
Another technique is to substitute distraction for pain. Focus your attention on things that you enjoy. Imagine a peaceful setting and wonderful physical sensations. Thinking about something that is enjoyable can help you relax and become less stressed. Find something that will make you laugh—a cartoon, a funny movie, or even a new joke. Try to put some joy back into your life. Even a small change in your mental image may break the pain cycle and provide relief.
The Multipurpose Arthritis and Musculoskeletal Diseases Center at Stanford University, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), has developed an Arthritis Self-Help Course that teaches people with arthritis how to take a more active part in their arthritis care. The Arthritis Self-Help Course is taught by the Arthritis Foundation and consists of a 12- to 15-hour program that includes lectures on osteoarthritis and rheumatoid arthritis, exercise, pain management, nutrition, medication, doctor-patient relationships, and nontraditional treatment.
You may want to contact some of the organizations listed at the end of this fact sheet for additional information on the Arthritis Self-Help Course and on coping with pain, as well as for information on support groups in your area.
Things You Can Do To Manage Arthritis Pain
Eat a healthy diet.
Get 8 to 10 hours of sleep at night.
Keep a daily diary of pain and mood changes to share with your physician.
Choose a caring physician.
Join a support group.
Stay informed about new research on managing arthritis pain.
Where Can You Find More Information on Arthritis Pain?
Prevention is key to living long and living well. Getting regular check-ups and preventive screening tests are among the most important things you can do for yourself. Take time to review these guidelines for screening tests. Use the chart below to remind yourself of when you need to see your health care provider based on your personal health profile. Make an appointment today!
Blood Pressure Measurement - Every one to two years
Breast Exams - Monthly self-exam; annual exam by a physician
Mammography - Every one to two years after age 40; see your doctor for your personal risk needs assessment
Cholesterol Levels - Every five years after age 18
Pelvic Exams/Pap Smears - Every one to three years after age 18, or when sexually active
Rectal Exams - Annually after age 50; earlier if you have inflammatory bowel disease or a first-degree relative with colon cancer
Blood Sugar Levels - Varies depending on family history and risk factors for diabetes
Skin Exams - Annual mole checks; check yourself for suspicious growths or changes.
Dental Exams - Twice a year for checkup and cleaning
HIV Test - If you had a blood transfusion between 1978 and 1985; have injected illegal drugs, had multiple sex partners, or had sex with a man who had sex with a man.
Tests for Sexually Transmitted Disease - If you have had multiple sexual partners or any sexually transmitted disease; recommended for all pregnant women at their first prenatal visit
Eye Exams - Every one to two years; yearly if you have diabetes or a family history of eye diseases
What to Expect With Preventive Screenings
Your provider will wrap a rubber cuff around your upper arm and inflate it. He or she will slowly release the air from the cuff, listening to the pulse beats in your arm with a stethoscope to measure your "systolic" and "diastolic" blood pressure levels. These levels correspond to the pressure when your heart contracts and when it relaxes.
Clinical breast exam
Your provider will look at your breasts for dimples, inverted nipples, or lumps. Then, he or she will manually examine your breasts using a circular motion, checking for lumps. Remember: You should also check your own breasts monthly.
The day of the exam you should not wear powder, cream, or deodorant on your upper body. If you experience breast tenderness before your period, you may want to schedule the test at a point in your menstrual cycle when your breasts are less sensitive. You will undress from the waist up. Your breasts will be pressed between plates and x-rays will be taken.
Since your blood travels throughout the body, blood samples can offer a wide range of information about your health. Usually blood is drawn from your arm with a needle connected to a tube. Less often, a finger prick test will collect drops of blood. Common blood tests are used to measure the levels of cholesterol, triglycerides (a form of fat), blood sugar, thyroid hormones, or other chemicals in your body. A test of your complete blood count (CBC) can indicate if you have anemia (low red blood cells), have an infection (high white blood cells), or a serious illness like leukemia. Some diseases, like hepatitis, syphilis, and AIDS, can also be detected through specifically ordered blood tests.
Pelvic exam and Pap test
During the pelvic exam, you lie on your back with knees bent and feet in stirrups. The doctor or nurse will feel your pelvic organs and use an instrument called a speculum to look inside your vagina at your cervix. He or she will also scrape a few cells from the cervix that will be sent to a lab to check for signs of cancer, disease, or infection.
These important exams screen for colorectal cancers—the third leading cancer killer of American women—and other possible problems in your digestive tract such as an ulcer or infection. Usually recommended after age 50, the most common are: fecal occult blood (looks for blood in a stool sample), flexible sigmoidoscopy, and colonoscopy (both inspect the colon with a light on the end of a flexible tube inserted through your rectum as you lie on your side, lightly sedated).
Urinalysis (urine test)
An analysis of a urine sample can indicate possible problems such as diabetes, kidney problems, liver problems, or bacterial infection. You will be asked to urinate in a special container.
Your dermatologist will examine your whole body, looking for suspicious moles that have uneven borders, more than one color, are asymmetrical shape, or are a size larger than a pencil eraser. Remember: You should do a self-check of your skin monthly.
Tests will depend on your age, medical history, and date of your last exam. You may need to read letters on a chart in the distance or at reading distance. You may get eye drops to numb your eye or dilate your pupil, to test for glaucoma and check your retina. Your ophthalmologist may test how your eye moves and responds to light.
Have you ever forgotten where you left your car keys, misplaced your eyeglasses, or forgotten a dental appointment? Of course you have, it's only human.
Are such lapses signs of an inferior memory? Definitely not. In fact, many people mistakenly believe that their memory is "bad" or on its way to becoming lost. It's usually not. And if you think about the millions of things each day that you do remember, you'll realize that your memory is really quite astounding.
For example, consider the routine act of meeting a friend for dinner. At minimum, you have to remember:
Your friend's name and face
The history of your relationship
The concept of time
The actual time of your dinner date
Which restaurant you'll be eating at
Directions for getting there
How to drive your car (or walk or flag a taxi)
How to read the menu
What the different food items taste like and whether you like them
To bring along money or a credit card, and a bevy of other details
It's All In Your Head
All of this information, along with the capacity to store, recall, and analyze it, is a mere fraction of what's stored in the roughly three pounds of tissue that make up your brain.
The basic building block of the brain is the nerve cell, or neuron. Your brain contains approximately 10 billion neurons. They connect with each other via electronic impulses sent and received through contact points called synapses. Each sound, image, feeling, or event we perceive activates a unique subset of these synapses. Each time the memory is recalled, that same pattern is reactivated, making the connections stronger and more indelible. Thus, the memories you recall most often become the most ingrained. To make something easier to recall, you can practice remembering it—a study technique used by many students.
Temporary Or Permanent?
Scientists talk about two different kinds of memory: working (short-term) memory and long-term memory. Information in short-term memory lasts twenty seconds or less and then is gone, unless that information is moved to long-term memory. A good example of working memory is looking up a phone number and remembering it just long enough to dial it, and then it's gone.
The decision to move something into long-term memory is handled by a structure deep in the brain called the hippocampus. The hippocampus acts like a filter, letting certain bits of information through and discarding others. Information that has emotional significance to you, such as your child's birth date, is likely to be passed on to long-term memory. Details that are related to information already stored in your memory such as a sign announcing an early bird special at your favorite restaurant usually make the cut as well. That's because the brain seems to store and retrieve things by their associations.
What would happen if your hippocampus stopped functioning for some reason? You'd still be able to carry on a perfectly intelligent conversation with a new acquaintance. But if the person you were chatting with left the room and came back five minutes later, you wouldn't remember ever having met her, let alone having spoken with her just minutes before.
You may wonder if your memory will inevitably weaken as you age. Although some eighty-year-olds have sharper memories than their children, experts agree that the ability to form and recall memories does change somewhat with age. The good news is that barring Alzheimer's disease or some other condition that affects brain function, the change in your memory abilities is likely to be small. As we age, we continue to form new memories, but the memories tend to include less detail. For example, you might remember that you saw a friend one morning, but perhaps not recall what he was wearing.
You can improve your ability to recall information by doing one, simple thing: pay attention. Often we're thinking about other things when other people are speaking. Or we're so distracted by everyday life that we're not able to focus on the details. By forcing yourself to pay attention to something, you'll be much more likely to remember it.
What about supplements? You've probably seen them advertised in magazines or heard about them from friends: pills that claim to improve memory. The most widely available of these are ginkgo biloba (an herb), vitamin E (an antioxidant), and DHEA (a hormone). Although all of the evidence isn't in yet, there is no consensus that these supplements boost memory function in healthy adults.
As much as scientists have learned about memory, there's much more to be discovered. "Space is not the last frontier," says Epstein, "It's the space between our ears that's the last frontier." Meanwhile, rest assured that when you misplace your keys, it's not a sign that your memory is failing. You were probably just distracted and didn't pay attention when you put them down.
Ginkgo Biloba: Brain Power in a Bottle?
by Jennifer Pitzi Hellwig
Is ginkgo biloba a mental health miracle or just another yet-to-be-proven-effective dietary supplement? The answer lies somewhere in between.
Chances are you've heard of ginkgo biloba–the dietary supplement with the strange-sounding name–even if you don't know exactly what it is or what it does. Advertisements call the herb "the thinking person's supplement," and claim that it improves memory and concentration and enhances mental focus.
An extract made from the leaves of the ginkgo biloba tree, ginkgo has been used medicinally by Chinese herbalists since as early as 3000 B.C. The tree itself is so primitive that it doesn't produce flowers, and so hardy that one tree actually survived atomic destruction at Hiroshima. The key to ginkgo's efficacy seems to be a substance that scientists have dubbed EGb 761.
Ginkgo is the most popular botanical extract in Europe, and there are more than 400 scientific studies attesting to its ability to increase blood flow and protect the nervous system. In Germany the extract has been the subject of hundreds of scientific studies. These studies show that among other things, EGb 761 helps keep platelets in the blood from clumping together. That's why ginkgo extract is prescribed in low doses (40 mg a day) in Europe for patients with circulatory problems. Much higher doses (240 mg a day) are used to treat cognitive deficits, such as memory loss.
Ginkgo and Alzheimer's
Public interest in the medicinal powers of ginkgo was fueled in the United States in the fall of 1997 when a study published in the prestigious Journal of the American Medical Association (JAMA) reported that ginkgo had a positive effect on the mental status of people with dementia, including those with Alzheimer's disease.
The researchers studied men and women with mild to moderate dementia that resulted either from stroke or Alzheimer's disease. The subjects were given either daily ginkgo supplements or a placebo. Results indicated that approximately 26% of the patients taking ginkgo showed an improvement in mental status (roughly equivalent to a delay of six months' progression of the disease), compared with 15% taking placebo. And 37% of those taking ginkgo exhibited improved social functioning, compared with 23% in the placebo group. The effect was most pronounced in the subjects who were the least impaired, suggesting that if Alzheimer's is treated early enough, dementia might be postponed.
This study, although seemingly favorable, should be considered with caution. When it was published, critics questioned the methods used to assess improvement, and even the researchers warned that ginkgo will not cure dementia or prevent Alzheimer's disease. The unanimous consensus is that although the results appear promising, it is premature to consider ginkgo a treatment for Alzheimer's disease; more research will be necessary to determine its effects.
Improvement for Forgetfulness?
Meanwhile, millions of generally healthy Americans are losing their keys and forgetting phone numbers daily. Will ginkgo work for them, as the advertisements seem to imply? The answer is an unequivocal maybe.
"Ginkgo is not a smart pill," according to Varro E. Tyler, Ph.D., dean emeritus of the Purdue University School of Pharmacy and a leading U.S. expert on herbal remedies. However, in Germany, where ginkgo is a top-selling herb, studies have shown it to be effective in some people for improving short-term memory loss and concentration.
Short-term memory loss and decreased concentration, which we've all experienced to some degree, can have several different causes. One factor is decreased blood flow to the brain. This is where ginkgo may help, because it acts as a blood thinner, thereby improving blood flow and oxygen transport to the brain.
But how do you know if blood flow is your problem? Unless you've received a diagnosis from a physician, you don't. But since studies on ginkgo show it to be safe, it might be worth giving it a try. The recommended dose is 40 mg three times a day, but if after a month you see no improvement in memory with this dosage, you likely won't see any improvement at all.
In August, 2002, a study published in JAMA found that ginkgo did not improve memory or concentration in healthy older adults with no mental function decline. In this study, subjects took 40 mg of ginkgo (Ginkoba brand) or a matching placebo three times daily for six weeks. The results showed no difference in memory or concentration changes between the two groups. These findings suggest that people with normal mental function probably won’t benefit from taking ginkgo.
What to Look for When Buying Ginkgo
Be aware that not all ginkgo products are the same. Many do not contain all the active ingredients. Avoid bargain prices. If it's the real thing, the label should read at least 24% "flavonoids" or "ginkgo flavone glycosides" and six percent "ginkgolides" or "terpene lactones." There are no known side effects beyond stomach upset, but again, Dr. Tyler advises against the use of any herb by pregnant or nursing women. Those taking blood thinners–aspirin, garlic, vitamin E, ginger, or Coumadin (among others)–should use ginkgo only under a doctor's supervision.
Symptoms of Sinusitis
by Rosalyn Carson-DeWitt, MD
Symptoms of sinus infection are very similar to those of the common cold, however when due to a cold virus, such symptoms typically improve after a few days. If you continue to have nasal symptoms ten days after having a cold, then you may have developed a sinus infection.
Nasal discharge that may be
Headache (in acute sinusitis)
Toothache (dental pain)
Facial pain and pressure that increases when you lie down or lean over
Facial fullness or congestion
Nagging cough that may get worse when lying down
Decreased energy or fatigue
Unpleasant taste in your mouth
Decreased sense of smell
Most experts believe that sinus infection does not cause chronic headaches. However alteration in sinus pressure associated with weather changes might provoke migraine headaches in susceptible people.
American Academy of Otolaryngology – Head and Neck Surgery
Conn’s Current Therapy, 54th ed. W.B. Saunders Company;2002.
National Institute of Allergy and Infectious Diseases
Medicine today has the power to prolong life in two different ways. Many of us will live longer and fuller life spans because of medical advances, lifesaving interventions, and new prevention knowledge. Others of us will find our last days and months prolonged—sometimes in an unwelcome way—by life support technology and practices that enhance neither the quality of our lives nor our deaths.
Life support can breathe for us, eat for us, and substitute for vital organs. Sometimes a partial (or full) recovery from a terminal illness or incapacitated state is possible; but even when there is no hope of revival, doctors may sometimes take extraordinary measures. Some say that these choices derive from doctors’ training in resisting death at any cost, others point to liability risks if any potentially curative intervention is overlooked. But increasingly, doctors, along with patients and family members, fail to recognize when curative technology is no longer indicated and a different technology—end of life care—should be brought into play.
Talk of dignity, quality, and sanctity of life has been heard ever more frequently in hospitals, medical schools, and the media. These terms have different meanings for each of us, and can sometimes be used as arguments for or against life support. At the same time, dignity and quality of life are important to all of us, especially when we are very ill and potentially near the end of our lives. So who should decide what care is life-saving as opposed to death-prolonging? You.
There are a great many considerations to end of life care, including: emotional and philosophical concerns, deciding where to receive care, and legal options. The one thing that everyone agrees on is that each of us should ponder, discuss, and legally establish our approach to the management of life-threatening illness before a medical crisis occurs.
Emotional and Philosophical Matters
You can begin by asking yourself some tough emotional questions. What are your fears: pain, loss of dignity, machines keeping you alive, or dying in a strange place? Fill in the blank: “My life is only worth living if I can ___”. Is life defined by a heart beat or a working brain? Whom do you want to make decisions for you if you are not able to communicate? Discuss options with your doctor. Seek guidance from your religious leader. Talk with family. Above all, make sure that family members know what your choices would be under a variety of serious situations; if possible, put your choices and values into writing.
The last days of life can be spent in your home, a nursing facility or a hospital. These facilities generally seek to cure, rehabilitate, or support life. If you are seeking curative care or aggressive medical treatment, a hospital is usually the best choice. Today many hospitals are adept at balancing curative and palliative care when the end of life approaches. Palliative care, perhaps most often given in the hospice setting, provides treatment that enhances comfort and quality during the last days of life. This type of care seeks neither to hasten nor to postpone death, but rather to provide relief from pain and discomfort. While services may vary from community to community, in many parts of the country palliative care can be supplied either in a hospice facility or in your home.
For most of us it is very hard to imagine how we are likely to feel when faced with a serious and potentially fatal illness or injury. It is perhaps only human nature to prefer to wait until the crisis is upon us and then communicate our intentions to the nurses and doctors providing our care. Unfortunately, there are many scenarios that can interfere with one’s ability to communicate. For example, it is impossible to tell a doctor your treatment decision while on a ventilator (mechanical breathing apparatus) or when unconscious. Fortunately, there are legal solutions to this problem. Among these legal solutions are:
Health care proxies
Do not resuscitate orders
Here is some information about each of the above:
Advance directives are written legal documents that state your wishes if you can no longer speak for yourself. With these documents in place, medical personnel and loved ones don’t have to guess what you would prefer or make decisions you would not want for yourself.
A Health Care Proxy names someone to make medical decisions for you when you are not able to make such decisions. This person should be someone you trust, who knows what treatments you would want or would reject, and who will respect these preferences. Your proxy does not have to receive specific instructions from you and can make decisions as if she or he were in your situation, but conscious and able to communicate.
A Living Will states your requests regarding life-sustaining medical treatment (for example, a feeding tube, breathing tube, or surgery) and is only effective if you are unable to communicate. These instructions for treatment or refusal of treatment can be made as broad or specific as you wish. For example, you can ask that your life be prolonged as long as possible whatever your state of consciousness, or you can state that you do not want extraordinary treatment to maintain life if as a result you will need constant care or not have an existence that seems of adequate quality to you. You can also address specific circumstances that commonly arise at the end of life (dementia, trauma, or coma).
A Do Not Resuscitate order instructs medical personnel not to bring you back to life if you stop breathing or your heart stops.
Each of these four legal solutions requires that you complete a document that will become part of your personal medical file. This way, you or your family members can ensure that, in the event of a hospitalization, all of your caregivers know about your written wishes and incorporate them into your care plan. For further information, you can talk to a lawyer, explore the numerous books written on this topic, or use the internet resources listed below.
It is important to note that advance directives are not iron clad, and no single one of the four choices above can anticipate every situation that may occur at the end of life. Since it is difficult to anticipate every medical possibility, a living will might not precisely address what actually happens to you. Additionally, no matter how carefully you try to think about what might happen to you as you write your living will, you still run the risk of this document being misinterpreted by doctors or family. So, even with a living will in place, it is still essential to have someone you trust—preferably named as a health care proxy—to make decisions for you in the case of unforeseen circumstances. Your proxy should know you well and spend considerable time discussing your philosophies, expectations, and values. Combining a living will with a designated proxy is a particularly smart way to prepare for your end of life care.
No one wants to think about the unpleasantness of life-support: whether its end result is to prolong our lives or to prolong our deaths. But when life support no longer offers hope of quality living, decision must be made. No one can make such decisions better than you. Choose your options while you can speak for yourself. The questions are tough, but the issues are life and death: yours.
In Her Own Words: Living With Alzheimer’s Disease
As told to Virginia Mansfield
Margaret* was diagnosed with Alzheimer’s disease ten years ago, at the age of 79. Here, her daughter describes her mother’s condition, which led she and her sister to the difficult decision of admitting her to the Alzheimer’s unit at a nursing home. Margaret worked in hospital administration for 32 years and spent many of her retirement years volunteering at the hospital and staying active in church and community activities.
What was your first sign that something was wrong? What symptoms did your mother experience?
She was forgetting more and more. She also became insecure in doing things she had always done, like paying bills, responding to her mail, fixing meals, normal things. She would say, “I just can't do that.” She couldn't put things together in her mind anymore. It kept getting worse. She would be in the car going to the grocery store and realize she didn't know where she was. She would call my daughter or me and we would have to try to figure out where she was and talk her through getting back home. She had also started getting up in the middle of the night at 2:00 or 3:00 in the morning, she'd get her coat on, get her purse, and walk the streets.
What was the diagnosis experience like?
I was taking her to her doctor appointments at that time, and I told the doctor about how forgetful she had become. He wanted to understand what was going on, so he asked me for examples. I told him about how she was wandering out in the night, how she would get lost when she was driving, and sometimes, she would even forget where she was going.
The family doctor recommended that I take her to the nursing home for an Alzheimer’s evaluation. They evaluated her and confirmed that she had Alzheimer’s. At first they put her in a regular room, but within a few weeks, she started to wander off, so they had to put her in the locked area of the Alzheimer’s unit.
What was your initial and then longer-term reaction to the diagnosis?
When we first took her to the nursing home she said she didn't want to be there, and wanted us to take her home. We told her, “ Mother, we fear for your safety. We're afraid someone could hurt you, or you could hurt someone else.” We told her she needed to stay there for a while to see if she could get stabilized to where she wouldn't wonder off. But the Alzheimer’s just consistently got worse, so she ended up staying there for the long term.
It's been ten years since she was first admitted. She would cry a lot and get frustrated with herself and with us, but we would tell her that she needed to be there for her own protection. It was a few years before she settled down, and seemed content at the nursing home. Now, I think she would be uncomfortable if we took her out of the home—she feels safe there.
How is Alzheimer’s disease treated?
My mom is on medications, but I'm not exactly sure what they are giving her now. There are certain medications I don't want her to have because of the side effects. They also do play therapy with the Alzheimer's patients. They have one room that has been made into a playhouse. Mom spends quite a bit of time in there just playing in the play kitchen and playing with the dolls. The staff will do play activities with them, like tossing a balloon back and forth or kicking a ball around on the floor with their feet. These activities help with their motor development.
They also have music therapy where they sing and move to the music. It's amazing that these people can't remember who they are, but can remember all the words to a song. I hardly ever find my mother in bed. She's always up doing some kind of activity, which I guess is a good thing.
Did your mother have to make any lifestyle or dietary changes in response to Alzheimer’s disease?
The first big change was taking her driver’s license away. She was so angry, but it was necessary. It was a few months later that we had her evaluated and admitted to the nursing home. She didn't really make any dietary changes for a while, but in the past year, she has to have her food pureed to prevent her from choking. Other than that, she eats a healthy, well balanced diet.
Did your mother seek any type of emotional support?
My sister and I are probably her main support system. My sister visits her three to four times a week and I usually visit her twice a month. Some of the grandkids are in town, and they visit her occasionally. She also has visitors from her church that see her off and on. Actually, I would consider the staff at the nursing home a good support system. They have really been good to mother. When we first took her there, one of the nurses told us that it would be a good idea to buy her a doll, or teddy bear, or some kind of stuffed animal. We bought her a doll, and she carries that doll around with her all the time and is very protective. She gets mad if anyone else picks it up or even touches it.
Does Alzheimer’s disease have an impact on your family?
My sister and I were having to do a lot more for her, like paying her bills, answering her mail, and picking up groceries. We didn't mind of course, but it was hard to see her having to be more dependent on us. It was a difficult decision to have to put her in a nursing home. We knew how important her home was to her, but it got to the point where it just wasn't safe anymore. My sister had a harder time with it than I did. Until mother started walking the streets at night, my sister wouldn't even talk about a nursing home. She couldn't admit that mother was sick.
Sometimes mother will get hostile and moody. One time my sister bent over to kiss her goodbye, and mother slapped her face. My sister was so upset, but I told her she can't take it personally—mother can't be accountable for her behavior, she’s sick. When she does things like that, she doesn't realize what she's doing. I think now both my sister and I feel relieved. We know she's in a safe place, and that her needs are being met. We don't worry about her getting out and wandering the streets at night or getting lost. She was so vulnerable. It's amazing nothing bad happened to her.
What advice would you give to anyone living with Alzheimer’s disease in their family?
The most important thing is that you keep them safe and healthy, even if that means putting them in a nursing home. It's best if the family can stay united. You can't think about what you want, but you have to think about what is best for them. You also have to keep your sense of humor.
Reducing Your Risk of Kidney Stones
by Jean Baker, MS, RD
Once a kidney stone has been removed or has passed on its own, the focus shifts to prevention—steps that you can take to minimize your chances of developing another stone. While your specific prevention strategy depends on what kind of kidney stone you had and why it developed, some general guidelines are outlined below.
Drink plenty of fluids
Watch your diet
Talk to your doctor about medications for prevention
Drink Plenty of Fluids
One of the goals of preventive therapy is to keep your urine as dilute as possible. This helps to keep the substances that could potentially form a kidney stone, including calcium and oxalate, moving quickly through your urinary tract.
Try to drink at least two quarts (12 cups) of fluids a day. Water is best, although juice and other beverages can add to the total. Limit your intake of caffeine-containing beverages like coffee, tea, and cola to one or two cups a day, since caffeine acts as a diuretic, causing your body to lose fluids too quickly.
A good gauge of whether or not you are drinking enough fluids is urine color. Except for the first thing in the morning—when urine tends to be more concentrated—it should be pale in color. If your urine is dark yellow, that's an indication to drink more fluids.
If you are hesitant to drink too much during the day because you have a bladder control problem, discuss this concern with your doctor.
Points to remember:
Drink at least 12 cups of fluids each day
Limit your intake of caffeinated beverages
Your urine should be pale in color
Watch your diet
Whether or not diet can help you avoid another kidney stone depends on what kind of stone you had and what caused it to form in the first place. If your stone was made up of calcium oxalate, calcium phosphate, or uric acid, what you eat—or don't eat—can help prevent a recurrence.
Note that these are only guidelines. People taking some kinds of medications may need to avoid certain foods. Always follow the advice of your doctor or registered dietitian in making any diet changes.
Nutrients to consider include:
Eat a diet that includes the recommended dietary intake of 1000 to 1200 milligrams of calcium, but try to get it from foods rather than from supplements. It might seem to make more sense to avoid calcium if you suffer from recurrent calcium stones, but research shows that reducing your calcium intake prompts the body to make more oxalate available, the very substance that people who suffer from calcium oxalate stones are trying to avoid.
Good sources of calcium include milk, cheese, yogurt, sardines, and broccoli. Many foods such as orange juice, breakfast bars, and cereals now have added calcium. For more information on foods rich in calcium, click here.
Oxalate is a substance found in certain plant foods that binds with calcium and other minerals in the intestine. If your body is not absorbing and using calcium correctly, you could end up with too much oxalate in your urine. You can reduce the level of oxalate in your system by avoiding these foods:
A diet high in animal protein—from meat, chicken, and fish—may cause your body to release too much calcium into your urine. If you consume a lot of these foods, you may be asked to plan meals that include less meat and more of other kinds of foods, such as fruits, vegetables, grains, and beans.
Likewise, a diet that includes a lot of salt (sodium) can cause your body to excrete too much calcium into your urine. You may be asked to reduce your intake of salty foods and to not use salt in cooking or at the table. Check with your doctor before using a salt substitute.
Foods high in salt include:
Lunch meats, cured meats like ham, sausage, and bacon
Prepared salad dressings, mustard, catsup, soy sauce, barbecue sauce
Pickled foods, olives
Canned soup, bouillon
Alkaline Ash Diet
In some cases, the best way to avoid another stone is to manipulate the pH balance of the urine. Uric acid, calcium oxalate, and cystine stones form more readily in acidic urine, so this prevention strategy hinges on keeping the urine slightly alkaline. This is usually done with medication, but your doctor might ask you to help it along by making some dietary changes as well.
Ask for a written list of instructions if your doctor wants you to follow this diet. Generally, all fruits (except for cranberries, prunes, and plums) and all vegetables (except for corn and lentils) make the urine more alkaline.
Points to remember:
You may be asked to make some changes to your diet
You may need to avoid some foods while taking certain medications
Follow the advice of your doctor or dietitian in making any diet changes
Talk to your doctor about medications for prevention
There may be some medications that can help you from forming another kidney stone. It will depend on what kind of kidney stone you had and why it developed. Talk with your doctor to determine if there are any medications that may be helpful for your particular situation.
Krause’s Food, Nutrition, and Diet Therapy, 10th edition. W.B. Saunders;2000.
Current Trends in Alternative Medicine Use
by Maria Borowski, MA
In today’s world, it seems as if alternative therapies are everywhere. Advertisements for herbal remedies are nearly as prevalent in health magazines and on television as ads for FDA approved medications. Once considered unconventional, yoga, massage, and acupuncture have become nearly mainstream. Judging from the amount of marketing, one might assume that most Americans are using some form of alternative medicine.
What exactly is “alternative” medicine? “Alternative and complementary medicine,” or CAM— the official title, according to the National Institutes of Health, can be defined as any therapy or treatment that is not part of conventional medicine. This broad definition includes interventions as simple as taking an herb, like echinacea or ginseng, to fight off a cold, or as complicated as acupuncture or chiropractic care.
A study published in the January/February 2005 issue of Alternative Therapies compared the results of two surveys to determine if the prevalence of alternative medicine use changed between 1997 and 2002.
About the Study
This study analyzed the results from two national surveys of alternative medicine use by adults. The first survey took place in 1997, and the second in 2002. All of the respondents were age 18 or over, and were interviewed either in person or by phone. The surveys consisted of questions regarding the use of 15 different complementary and alternative therapies during the previous 12 months:
Folk remedies/folk medicine
High dose vitamins
Chelation (use of the amino acid EDTA for cardiovascular disease)
Special diets (including vegetarian, Atkins®, the Zone®, and others)
While the two surveys were not identical, the researchers only compared results for the 15 therapies that were determined to be comparable. The respondents were also asked if any of the therapies they used were covered by insurance.
The results of the study revealed that although the prevalence of some treatments increased and others decreased, overall use of alternative medicine remained stable from 1997 to 2002. The greatest increase in use between 1997 and 2002 was seen for herbal medicine and yoga, and the greatest decrease was for chiropractic care. Nevertheless, chiropractic care remained one of the most common treatments used in 2002, along with herbal therapy and relaxation techniques. Respondents who were most likely to use an alternative therapy were non-Hispanic white females between the ages of 40 and 64, with a household income of $65,000 or higher.
The authors concluded that the prevalence of complementary and alternative medicine use has remained stable from 1997 to 2002. Approximately 72 million Americans use complementary and alternative medicines.
How Does This Affect You?
More than 10 years ago, when it was first discovered that a surprising number of Americans reported using alternative therapies, many critics predicted it was only a fad. This study strongly suggests otherwise. Many people feel comfortable using some form of alternative medicine. Indeed, the results of this study reveal that nearly one in three US adults are willing to seek out their own unconventional therapy for health problems. While most of these therapies are far safer than many conventional treatments, their lack of regulation raises some concern.
The use of herbal therapies increased by 50% between 1997 and 2002, the largest increase of all the therapies investigated. There is currently no system in place in the United States to determine the relative safety and effectiveness of herbal treatments. Currently the FDA places most herbal remedies in the category of dietary supplements, which is somewhere between drugs and foods. Classifying a product as a dietary supplement means that its manufacturer is not legally required to prove that it is safe and effective before being marketed. This means that the Echinacea you take for your cold may be helpful, may do nothing, or may be harmful. Unfortunately, because many alternative therapies are marketed as “all natural,” they may be perceived as safe.
The fact is, most of these therapies are safe, and some studies have supported their effectiveness. However, when considering an alternative therapy, it is important to remember that just like prescribed drugs, they can be helpful or harmful. As with any new drug or therapy, it is important to talk with your doctor before starting, to find the best way to integrate an alternative therapy into your life.
Cell Phones and Risk for Brain Tumors
by Julie Martin, MS
Cell phones have become a mainstay of personal communication around the world; in the United States, more than 170 million people subscribe to cell phone service. Recent media reports indicating a possible link between cell phones and brain tumors have caused speculation about whether or not cell phone users need to worry about their health.
Like all electrical devices, cell phones emit electromagnetic radiation. Cell phone radiation is in the form of radio-frequency (RF) energy, which, at high levels, can heat living tissue enough to cause biological damage. Cell phones do not emit the high-energy, “ionizing” radiation that has been linked to cancer. Whether the tiny amount of low-energy radiation emitted from a cell phone antenna could cause harm is the subject of debate.
Currently, there is no clear scientific evidence showing negative health effects, but some recent studies have suggested a possible link. A 13-nation study called the Interphone Project is further investigating whether a relationship exists between exposure to RF energy and brain tumors. Researchers in Denmark completed their phase of the study and reported their findings in the April 12, 2005 issue of Neurology.
About the Study
This study was designed to determine whether cell phone use increased the incidence of two types of brain tumors: gliomas and meningiomas. Between September 2000 and August 2002, researchers enrolled Danish people, aged 20–69, and assessed their past cell phone use. Participants included 252 people with gliomas, 175 with meningiomas, and 822 people without disease.
Because this was a “case-control” study, researchers compared patterns of cell phone use in the people with brain tumors (the “cases”) to people from the general population who didn’t have brain tumors (the “controls”), in order to identify a possible link.
The findings of this study do not indicate any association between cell phone use and the development of gliomas or meningiomas. People with these tumors did not use their cell phones more often than people without these tumors. This study will likely contribute to more significant findings when its results are considered in the context of the larger Interphone Project.
There are several limitations to this study. First, widespread use of cell phones is relatively new, and very few of the cases or controls had used cell phones for longer than ten years. As a result, the researchers were unable to examine long-term health effects of cell phone usage.
Second, although case-control studies are convenient and relatively inexpensive to carry out, they are considered preliminary forms of research, designed to identify possible causes of disease. This is because these kinds of studies are associated with certain biases and confounding factors that are difficult to control. In this case, for example, assessment of cell phone use depended on the memory of the subjects, some of whom were quite sick with brain cancer.
How Does This Affect You?
Although there is no proof that cell phones are without any risk, there is no consistent evidence—at least so far—that they are dangerous. Given the nature of the low-energy radiation they emit, however, it is reasonable to speculate that cell phones will turn out to be safe. If you are still concerned, make sure you use digital service, since analog service involves higher RF exposure.
In reality, the real risk posed by cell phones has more to do with the user than the phone itself. Far more people have been harmed from motor vehicles accidents linked to cell phone conversation behind the wheel. The predominant safety message concerning cell phones, therefore, should have less to do with radiation and more to do with eliminating cell phone usage while driving.
World Health Organization
International Commission on Non-ionizing Radiation Protection
Cell phone facts: consumer information on mobile phones. FDA, FCC, 2005. Food and Drug Administration and Federal Communications Commission website. Available at www.fda.gov/cellphones. Accessed April 11, 2005
Christensen, H. Collatz, J. Schuz, and M. Kosteljanetz, et al. Cellular telephones and risk for brain tumors: A population-based, incident case-control study. Neurology 2005; 64:1189–1195.
Inskip PD, Tarone RE, Hatch EE, et al. Cellular telephone use and brain tumors. N Engl J Med 2001;344:79–86.
Muscat JE, Malkin MG, Thompson S, et al. Handheld cellular telephone use and risk of brain cancer. JAMA 2000;284:3001–3007.
Nordenberg, Tamar. Cell phones and cancer: no clear connection. US Food and Drug Administration. FDA Consumer Magazine, 2000; November/December. Available at www.fda.gov/fdac.2000/600_phone.html. Accessed April 11, 2005.
Tips for Safely Using Medications
by Laurie LaRusso, MS, ELS
Whether it's a drug prescribed by a health care professional or just a bottle of Tylenol, medications require some special care.
The U.S. Food and Drug Administration and the American Pharmaceutical Association provide some tips for safely using and storing medications. And remember, these rules apply to nonprescription drugs, such as ibuprofen and cold medicine, as well as prescription drugs.
Know your medications
If a medication is in your house, know what it is for. Whether the doctor prescribed it or it's just an over-the-counter drug, if you don't know what it's for, find out. Read the label and if you don't understand anything you read, take the bottle to the pharmacy and ask the pharmacist. Here's what you need to know about any drug you take:
What it is for
When to take it
How much to take
When to stop taking it
Any special instructions for taking it (for example, with food, without food, before bed only, etc.)
What the potential side effects are
What food, drink, or other medications it interacts with
Store medications in a dark, cool, dry place
Medications can degrade if they get too hot, too moist, or too cold. When a medication degrades it may become less effective, totally ineffective, or possibly even dangerous to take.
Note: The bathroom cabinet is not a cool, dry place.
The bathroom may be a convenient place to keep medications, but it is probably the moistest room in the house, so don't keep your medications there. Try putting them in a kitchen cabinet. And don't leave them in your car where they will be exposed to extreme temperatures.
Keep medications in their original containers
This is the only way to ensure that you know what medication is in the container. Plus, if you have side effects or a bad reaction to a medication, the medical personnel who try to help you need to know what you have taken.
Throw away expired medications
Check expiration dates and throw away expired medication by flushing it down the toilet. Pour the medicine itself down the toilet, but wash out the container and throw that away in the trash. Do not use any medications after they expire. All medications expire, even aspirin and cold medicine. When a medication expires it may become less effective or totally ineffective, or it may even degrade to a point where it is dangerous to take.
Never take someone else's medicine
If a medication is not prescribed for you, don't take it. You don't know how the drug will affect you, and you don't know how it will interact with other drugs you take or food and drink you consume.
Take your medicine as directed—all of it!
Sometimes when symptoms clear up and you're feeling better, you're tempted to stop taking a medication. If your doctor prescribes a medication, take all of it as directed. Many medications, such as antibiotics, do much more than relieve symptoms. They are working inside your body, whether you are aware of it or not. Stopping medications early can cause your illness to relapse, or even worse, it can lead to more virulent infections.
Report medication problems to your health care provider
If a medication is causing unpleasant side effects or is not working for you, tell your doctor. There may be other medications you could take or medications that can control the side effects. Don't suffer though unpleasant side effects, but don't just stop taking the medication either.
Adapted from the National Institute of Neurological Disorders and Stroke
It's 5:00 p.m. and your boss has just asked you to prepare a 20-page briefing paper. Due date: tomorrow. You're angry and tired and the more you think about the assignment, the tenser you become. Your teeth clench, your brow wrinkles, and soon you have a splitting tension headache.
Tension headache is named not only for the role of stress in triggering the pain, but also for the contraction of neck, face, and scalp muscles brought on by stressful events. Tension headache is a severe but temporary form of muscle-contraction headache. The pain is mild to moderate and feels like pressure is being applied to the head or neck. The headache usually disappears after the period of stress is over. Ninety percent of all headaches are classified as tension/muscle contraction headaches.
By contrast, chronic muscle-contraction headaches can last for weeks, months, and sometimes years. The pain of these headaches is often described as a tight band around the head or a feeling that the head and neck are in a cast. "It feels like somebody is tightening a giant vise around my head," says one patient. The pain is steady, and is usually felt on both sides of the head. Chronic muscle-contraction headaches can cause sore scalps--even combing one's hair can be painful.
Many scientists believe that the primary cause of the pain of muscle-contraction headache is sustained muscle tension. Other studies suggest that restricted blood flow may cause or contribute to the pain.
Occasionally, muscle-contraction headaches will be accompanied by nausea, vomiting, and blurred vision, but there is no preheadache syndrome as with migraine. Muscle-contraction headaches have not been linked to hormones or foods, as has migraine, nor is there a strong hereditary connection.
Research has shown that for many people, chronic muscle-contraction headaches are caused by depression and anxiety. These people tend to get their headaches in the early morning or evening when conflicts in the office or home are anticipated.
Emotional factors are not the only triggers of muscle-contraction headaches. Certain physical postures that tense head and neck muscles--such as holding one's chin down while reading--can lead to head and neck pain. So can prolonged writing under poor light, or holding a phone between the shoulder and ear, or even gum-chewing.
More serious problems that can cause muscle-contraction headaches include degenerative arthritis of the neck and temporomandibular joint dysfunction, or TMD. TMD is a disorder of the joint between the temporal bone (above the ear) and the mandible or lower jaw bone. The disorder results from poor bite and jaw clenching.
Treatment for muscle-contraction headache varies. The first consideration is to treat any specific disorder or disease that may be causing the headache. For example, arthritis of the neck is treated with anti-inflammatory medication and TMD may be helped by corrective devices for the mouth and jaw.
Acute tension headaches not associated with a disease are treated with muscle relaxants and analgesics like aspirin and acetaminophen. Stronger analgesics, such as propoxyphene and codeine, are sometimes prescribed. As prolonged use of these drugs can lead to dependence, patients taking them should have periodic medical checkups and follow their physicians' instructions carefully.
Nondrug therapy for chronic muscle-contraction headaches includes biofeedback, relaxation training, and counseling. A technique called cognitive restructuring teaches people to change their attitudes and responses to stress. Patients might be encouraged, for example, to imagine that they are coping successfully with a stressful situation. In progressive relaxation therapy, patients are taught to first tense and then relax individual muscle groups. Finally, the patient tries to relax his or her whole body. Many people imagine a peaceful scene--such as lying on the beach or by a beautiful lake. Passive relaxation does not involve tensing of muscles. Instead, patients are encouraged to focus on different muscles, suggesting that they relax. Some people might think to themselves, Relax or My muscles feel warm.
People with chronic muscle-contraction headaches my also be helped by taking antidepressants or MAO inhibitors. Mixed muscle-contraction and migraine headaches are sometimes treated with barbiturate compounds, which slow down nerve function in the brain and spinal cord.
People who suffer infrequent muscle-contraction headaches may benefit from a hot shower or moist heat applied to the back of the neck. Cervical collars are sometimes recommended as an aid to good posture. Physical therapy, massage, and gentle exercise of the neck may also be helpful.
Getting to the Heart of a Healthful Diet: Sodium
by Karen Schroeder, MS, RD
American Heart Association recommendation: Eat less than 6 grams of salt (sodium chloride) per day (2400 milligrams of sodium).
Sodium intake may be a primary factor in the development of high blood pressure (hypertension), which is a major risk factor for heart attack.
About half of the people with hypertension and 30% of the general public are described as "salt sensitive." This means that their blood pressures are likely to increase when they eat a high-sodium diet, and conversely, their blood pressures may be lowered by limiting dietary sodium.
Salt sensitivity is difficult to accurately diagnose. Therefore, appropriate sodium recommendations are a subject of great debate among nutrition experts. Some believe that all people should limit their sodium intakes (to 2400 mg/day) to either treat or prevent hypertension, regardless of their present blood pressure level. Others, though, advise that only people with hypertension or those who are believed to be salt sensitive need to limit sodium in their diets.
Nutrition researchers are still trying to tease out the exact role of sodium in hypertension. A major study in this area is DASH—Dietary Approaches to Stop Hypertension. This study found that a diet rich in fruits, vegetables, and low-fat dairy products, and low in saturated fat, cholesterol, and saturated fat—now called the DASH diet—helped lower blood pressure. The second phase of the study found further reductions in blood pressure when the DASH diet was combined with a sodium intake of no more than 2400 mg/day.
Sodium is found in many foods. Some are obvious, but others may surprise you.
Major Food Sources
Table salt (sodium chloride; NaCl) is the major source of dietary sodium—about 1/3 to 1/2 of the sodium we consume is added during cooking or at the table.
Fast foods and commercially processed foods—canned, frozen, instant—also add a significant amount of sodium to the typical American diet. These include:
All food products contain a Nutrition Facts label, which states a food's sodium content. The following terms are also used on food packaging:
Food label term Meaning
Sodium free - Less than 5 mg/serving
Very low sodium - 35 mg or less/serving
Low sodium - 145 mg or less/serving
Reduced sodium - 75% reduction in sodium content from original product
Unsalted, no salt added, without added salt - Processed without salt when salt normally would be used in processing
Tips For Lowering Your Sodium Intake
Gradually cut down on the amount of salt you use. Your taste buds will adjust to less salt.
Taste your food before you salt it; it may not need more salt.
Substitute flavorful ingredients for salt in cooking, such as garlic, oregano, lemon or lime juice, or other herbs, spices, and seasonings.
Select fresh or plain frozen vegetables and meats instead of those canned with salt.
Look for low sodium, reduced sodium, or no salt added versions of such foods as:
Dried soup mixes
Condiments (ketchup, soy sauce)
Snack foods (chips, nuts, pretzels)
Butter and margarine
Cook rice, pasta, and hot cereals without salt or with less salt than the package calls for (try 1/8 teaspoon for two servings). Flavored rice, pasta, and cereal mixes generally already contain added salt.
Adjust your recipes to gradually cut down on the amount of salt you use. If some of the ingredients already contain salt, such as canned soup, canned vegetables, or cheese, you do not need to add more salt.
Limit your use of condiments such as soy sauce, dill pickles, salad dressings, and packaged sauces.
Reducing Your Risk of Viral Upper Respiratory Infections (Colds and Influenza)
by Ricker Polsdorfer, MD
There are a few steps you can take to reduce your risk of catching a cold or influenza. They include the following:
Wash Your Hands Often
Hand washing is the most neglected, yet most effective, method of disease containment. The primary means of spreading both colds and influenza is person-to-person contact. Effective ways to prevent respiratory infections include: 1) washing your hands thoroughly and often, and 2) avoiding hand-to-hand passage of germs and droplet sprays from sneezing and coughing.
Avoid Crowds During Influenza Season
This may not be a very practical suggestion for everyone. However, if you are at high risk of catching a cold or influenza, or at risk for developing complications from these infections, try to avoid crowded areas or people who are obviously sick during the winter influenza season.
Get a "Flu Shot"
Each year, the World Health Organization tries to determine which strains of the influenza virus will be most dangerous in the upcoming influenza season. Vaccines are developed for these strains.
Anyone may benefit from a flu shot, but vaccination is strongly recommended every fall for several groups of people people who are at the highest risk for complications. These include:
People over age 50
Infants aged 6-23 months
Residents of chronic care facilities and nursing homes
Those with chronic illnesses, especially of the heart, lungs, blood, and kidneys
People with a weakened immune system
Women more than three months pregnant during flu season
Health care workers who come in contact with sick patients
Caregivers or household members of persons in high risk groups
Flu shots are available at doctors' offices, hospitals, local public health offices, and at some workplaces, stores or shopping malls. A possible side effect is a mild "flu-like" reaction including fever, aching, and fatigue. Up to 5% of people experience these symptoms after having the influenza vaccine.
If you are a high-risk patient, your physician may prescribe an anti-viral medication such as amantadine or rimantadine for the duration of the flu season. Anti-viral drugs are recommended for people with chronic illness who have not been vaccinated or received a vaccine after the start of a flu outbreak. Treatment with amantadine or rimantadine has been shown to be 70-100% effective in preventing influenza A infection. Some of the other anti-viral drugs are effective in preventing both A and B. Ask your health care provider about influenza prevention in the fall.
Drug Facts and Comparisons, 56th ed. Facts & Comparisons;2001.
Harrison's Principles of Internal Medicine, 14th ed. McGraw-Hill;1998.
The Merck Manual of Diagnosis and Therapy, 17th ed. Merck & Co.;1999.
Knowledge is of no value unless you put it into practice.
-Heber J. Grant
From "Learning to Speak Alzheimer's" by Joanne Koenig Coste:
Clinicians typically refer to three stages of Alzheimer's disease—early, middle, and late. Each stage may be as brief as one year or as long as ten years, and there are wide variations from individual to individual. The first changes that Alzheimer's patients tend to go through are listed in the table below, followed by changes that occur in the later stages.
Not remembering appointments
Not recognizing once familiar faces
Losing track of time
Not storing recent information or events
Having difficulty finding words
Misplacing needed items
Being unable to make decisions or choices
Finding it hard to concentrate
Acting accusatory or paranoid
Being unable to separate fact from fiction
Being unable to translate thoughts into actions
Misunderstanding what is being said
Making mistakes in judgment
Withdrawing, being frustrated and/or angry
Losing ability to sequence tasks
Speaking in rambling sentences
Misusing familiar words
Having difficulty writing
Requiring supervision for "activities of daily living"
Showing impaired computing abilities
Reacting less quickly
Losing fine motor skills (such as buttoning a shirt)
Having more serious difficulties with ADL
Not recognizing objects for what they are
Being unable to understand written words
Possibly displaying more sexual interests
Engaging in repetitious speech and action
Having hallucinations and delusions
Having problems with social appropriateness
Experiencing altered visual perception
Showing frequent changes of emotion
Having minimal attention span
Reacting catastrophically (overreacting, having outbursts)
Needing assistance with all ADL
Exhibiting frustration anger, or withdrawal
Walking with a shuffling gait
Being mostly unintelligible
Exhibiting a downward gaze
Being unable to separate or recognize sounds
Late or Final
Losing all language
Losing gross motor skills (sitting, walking)
Having swallowing difficulties
Needing total care
There are people who strictly deprive themselves of each and ever eatable, drinkable and smokable which has in any way acquired a shady reputation. They pay this price for health. And health is all they get for it. How strange it is. It is like paying out your whole fortune for a cow that has gone dry.
From "The Healing Secrets of Food" by Deborah Kesten:
Our current food worldview encourages us to look at food with binoculars. One moment we point them at protein, the next at carbohydrates, and then at fat—both in food and on our body. Viewed through such a restricted field of vision, we seed food solely from a singular, biological perspective of "isolated findings."
But toss away the binoculars and instead view food though a kaleidoscope, and the multidimensional healing secrets of socializing, feelings, mindfulness, appreciation, connection, and optimal food emerge. And then, with the simple turn of the kaleidoscope, suddenly the healing secrets are distilled into the "four facets of food" [biological, psychological, spiritual, and social nutrition]. In place of our interesting but limited binocular focus on food, stunning new nutrition insights are revealed: suddenly, subtleties that reflect physical, emotional, spiritual and social nourishment are manifested. Viewed from such an interactive, ever-changing, multifaceted vantage point, food and nutrition become integrated, interconnected, and whole.
Rather than thinking about the four facets of food as a new diet or as more dietary dogma, consider that they integrate our current nutrient-oriented view of food while also acknowledging the harder-to-measure healing dimensions of food, such as its link to emotions, spiritual well-being, and community. Once you begin to view food from this authentic, multifaceted framework, your entire relationship to food—and your perception about its power to heal holistically—will change at its core.
Is It Heartburn or a Heart Attack?
by Amy Scholten, MPH
Richard had been battling digestive problems for most of his life. So when the 78-year-old developed persistent discomfort in the chest, he assumed it was just another severe case of heartburn. For several weeks, he tried antacids and other treatments, without relief.
One day on the golf course, Richard complained about the discomfort. His golf partner, a retired cardiologist, urged Richard to seek immediate medical attention. Richard learned that what he thought was heartburn was actually angina, and that despite his low cholesterol level, he had two severely blocked coronary arteries. It was recommended that he have emergency bypass surgery.
Pain May Be Difficult to Distinguish
It’s not unusual for people to mistake symptoms of heart disease (such as angina and even a heart attack) for heartburn. Similarly, many people go to the emergency room each year out of fear that they’re having a heart attack, only to find out they have severe heartburn. The pain experienced during a heart attack and during a severe heartburn episode can be very difficult to distinguish. In fact, it often takes sophisticated medical testing to make the determination.
In addition to producing some similar symptoms, both heartburn and heart attacks are more likely to occur in people over the age of 40. Here are some possible differences between the two conditions.
Please note: if you have any chest pain, or any warning signs of a heart attack, seek immediate medical attention. Do not try to decide for yourself.
Possible Signs of Heartburn
A sharp, burning sensation below the breastbone or ribs
Burning sensation may move up toward the throat
Pain usually doesn’t radiate to the shoulders, arms, or neck, although it can
Pain often occurs after eating, particularly when lying down
Pain that increases when bending over, lying down, exercising, or lifting heavy objects
Bitter or sour taste at the back of the throat
Symptoms tend to respond quickly to antacids
Possible Signs of Angina or Heart Attack
A feeling of uncomfortable fullness, pressure, squeezing, tightness or pain in the center of the chest that lasts for more than a few minutes, or goes away and comes back
Pain or discomfort that spreads to one or both arms, the back, stomach, neck, or jaw
Pain often responds quickly to nitroglycerin
Shortness of breath
Other symptoms such as:
Breaking out in a cold sweat
Palpitations (feeling a rapid heart beat)
Other Causes of Chest Pain
Other problems that can cause chest pain include:
Other heart conditions, such as:
Pericarditis – inflammation of the sac surrounding the heart
Aortic dissection – a rare, but dangerous condition in which the inner layers of the aorta (a blood vessel that originates from the heart and supplies blood to most of the body) separate
Coronary spasm – arteries supplying blood to the heart go into spasm, temporarily limiting blood flow to the heart muscle
Panic attack – periods of intense fear accompanied by anxiety, chest tightness, rapid heartbeat, rapid breathing, profuse sweating, and shortness of breath
Pleurisy – inflammation of the lining of the chest and lungs, which causes chest pain that increases with coughing, inhalation, or deep breathing
Costochondritis – inflammation of the rib cage cartilage
Pulmonary embolism – a blood clot that gets lodged in the artery of the lung
Other lung conditions, such as
Muscle-related chest pain – often accompanies fibromyalgia and other chronic pain syndromes
Injured ribs, pinched nerves – bruised and broken ribs, as well as pinched nerves can cause localized chest pain
Shingles – infection of a nerve root, caused by reactivation of the chickenpox virus
Gallbladder or pancreas problems – gallstones, or inflammation of the gallbladder or pancreas can cause abdominal pain, which can radiate to the chest
Disorders of the esophagus (swallowing tube) – swallowing disorders such as esophageal spasms and achalasia (failure of esophageal muscle to relax)
Cancer – cancer involving the chest or that has spread from another part of the body
Seeking Medical Attention for Chest Pain
Chest pain can be difficult to interpret. It could be something as benign as heartburn or as severe as a heart attack. You should seek emergency medical attention if you have any chest pain, and particularly if you have other signs and symptoms of a heart attack. A visit to the emergency room could save your life.
Brain Pain: Understanding Migraine Headaches
by Anne Martinez
Splitting, pounding, and throbbing are three words used that describe headaches. Over 23 million Americans will experience the intense pain of a migraine headache; three-quarters of that group will be women.
What Does a Migraine Feel Like?
The hallmark of a migraine headache is pulsating head pain. The pain is often localized to one side of the head and frequently occurs behind the eye or near the temple. You may also vomit or feel nauseated; become hypersensitive to light, sound, or smells; feel dizzy; or experience visual disturbances. Symptoms are aggravated by movement. Migraine intensity ranges from uncomfortable to completely disabling and can last anywhere from an hour to several days.
Some people experience an "aura" before a migraine strikes. An aura is an unexplained sensation that affects sight, taste, touch, hearing, or smell. Visual auras are the most common, characterized by flashing lights, jagged lines, blurred vision, or blind spots. Auras can affect other senses as well, causing temporary numbness of a body part, odd smells, ringing in the ears, or difficulty talking. Only 15% to 20% of migraine sufferers experience warning auras.
Other medical conditions can also cause these symptoms. Therefore, it's important to see your health care professional to determine whether your head pain and associated symptoms is, in fact, due to a migraine.
What Causes Migraines?
No one knows for sure. At one time doctors believed that migraines were caused by swelling and expansion of the blood vessels surrounding the head and neck. As the vessels expanded, they caused the nearby brain tissues to become inflamed. This inflamation was thought to be responsible for the pain and the aura. This theory, although dated, is still at least partly correct. But scientists no longer think that migraines are caused by simple swelling of blood vessels. A new theory has come into vogue that says migraine triggers initiate a wave of electrical activity across the brain that eventually reaches a remote part of the brain called the trigeminal nerve. There, substances called neuropeptides are released that cause blood vessels to swell and leak, spurring inflammation and migraine headache.
But what causes the swelling? Although it varies from one person to another, certain factors have been generally linked with the onset of migraines. The list of identified triggers includes:
foods containing tyramine or alcohol
strong odors such as perfumes or cigarettes
excessive noise or bright lights
Researchers report that the genes you inherited from your parents play a significant role too; a hereditary influence can be found in 70% to 80% of migraine sufferers.
There seems to be a strong correlation between hormonal fluctuation and migraines in women. According to the National Headache Foundation, approximately 65% of females experience migraine-like headaches just before, during, or immediately after menstruation. "Both rising and falling estrogen levels can cause headache," says Stephen D. Silberstein, M.D, co-director of the Comprehensive Headache Center of the Germantown Hospital and Medical Center in Philadelphia. "Falling estrogen levels tend to bring on migraines with no aura, while rising estrogen levels usually induce migraine with aura," says Silberstein.
Taking birth control pills or hormone replacement therapy can trigger an increase in migraines. If this occurs consult with your provider. Post-menopausal women who take estrogen may be able to get by with a lower daily dose to keep hormone levels as balanced as possible.
Eating foods that contain tyramine, monosodium glutamate (MSG), or nitrites may also bring on an attack. Wine, aged cheeses, soy sauce, liver, and sadly, chocolate, all contain tyramine. MSG is a flavor enhancer often used in canned soups, Mexican and Chinese foods, corn chips, and meat tenderizer and seasonings. Nitrites are found in processed or cured meats, including hot dogs, bologna, and beef jerky.
But don't scrutinize your eating habits too much when it comes to the connection between food and migraines. "The role of diet is overstated," says Silberstein. "Don't starve, don't go overboard with MSG or nitrates, and drink less wine. If a certain food or beverage gives you a headache, avoid it, but don't ruin your life by not eating," he says.
What Can I Do To Prevent Migraines?
Keep a journal of your headaches. Note when a migraine occurred, what you were doing at that time and shortly before, and what foods you ate in the 24 hours prior to the headache. Reviewing your entries may reveal a pattern linking migraine onset to certain foods or activities that you can then avoid.
Investigate biofeedback therapy or other relaxation techniques. Biofeedback is a relaxation technique that can correct emotional triggers such as stress and anger. Electrodes that track changes in pulse or skin temperature are used to help you relax. The goal of biofeedback is to teach you how to release tension and increase blood flow on your own without using the machine.
Other relaxation techniques include stress management and relaxation training. In its recent guidelines, the U.S. Headache Consortium said that stress management, relaxation training, and biofeedback may benefit some migraine sufferers.
You can obtain more information about biofeedback, stress management, and relaxation training at your local library or bookstore.
If you sense a migraine coming on, you may be able to head it off. "Get out of any noisy, smelly environment, lay down, take a couple of single or combination analgesics, and put a cold, damp cloth on your head," advises Silberstein.
What About Medications?
The medicines currently used to treat migraines fall into three categories:
If you find that your life is becoming unmanageable because of migraines, your doctor may prescribe a prophylactic medication. Their purpose is to ward off migraines, or at least reduce the frequency and severity. They are taken daily, whether or not you are experiencing symptoms. Prophylactic medications include:
beta blockers, such as propanolol (Inderal, Inderal LA)
calcium-channel blockers, such as diltiazem (Cardizem) and nifedipine (Procardia)
antidepressants, such as amitriptyline (Elavil) and sertraline (Zoloft)
some seizure medicines, such as carbamazepine (Tegretol) and phenytoin (Dilantin)
Standard pain relievers are the first line of abortive treatment for migraines. These are taken when the patient first feels a migraine coming on. These include:
over-the-counter drugs, such as aspirin, acetominophin, or ibuprofen
or prescription medications such as ketorolac (Toradol), naproxen (Anaprox), or mefenamic (Ponstel)
To halt an acute migraine in progress that has not responded to standard pain relievers, health care providers often prescribe ergotamine (Cafergot, Wigraine). Ergotamines can be administered either orally or by injection. Excessive amounts of ergotamines can actually induce headaches, so monitor your usage and review drug use with your physician.
Sumatriptan (Imitrex) is an abortive-type medication. It can be taken orally or given by injection. If you have frequent migraines, you can learn to do the injections yourself. Imitrex reportedly helps 70% to 80% percent of the migraine sufferers who use it.
Although there is currently no "cure" for migraines, there are ways to obtain significant relief. Both medications and lifestyle changes can significantly reduce the number and severity of your headaches. To initiate this relief, however, you need to visit your health care provider or a headache clinic to work out a treatment plan. You won't be alone; according to one Philadelphia headache center, head pain is one of the leading reasons people visit their doctor.
In Her Own Words: Living With Chronic Migraines
As told to Michelle Badash, MS, RD
Patricia is a 32-year-old criminology professor at a state university. She is married and has a five-year-old son and a three-year-old daughter. They live in the suburban area where her husband grew up.
What was your first sign that something was wrong? What symptoms did you experience?
I first had a problem in graduate school when I developed a rapid pulse rate and high blood pressure for no understandable reason. I would also get hot flashes. Shortly thereafter, I developed the worst headache I’d ever had behind my right eye and on the right side of my head. I went to the university clinic to see a doctor there. After an initial exam, he concluded I had a migraine, along with other problems. He prescribed some medication that helped a bit.
What was the diagnosis experience like?
I saw various doctors at the university clinic. I had insurance that only covered my visits to the clinic and really did not cover specialists. I was referred to a cardiologist eventually, but not a neurologist or headache specialist until just about 6 months ago (I’m now in a new state with new insurance).
What was your initial and then longer-term reaction to the diagnosis?
I had heard of migraines, and discovered that my mother experienced “painless migraines”. I was very uninformed and just assumed it was a headache, something I’d deal with from time to time. Now I realize that migraines are not just headaches, and dealing with chronic migraines is more of a challenge than I’d ever have imagined.
How do you manage your disease?
I am currently managing this disease, but not very well. I have tried several types of medication: five migraine abortives, eight rescue pain medications, and five migraine preventives. I am currently taking two preventives—Prozac and Atenolol. I use two abortives—Amerge and Relafen (which is more of a rescue) when a migraine hits, and I use either Darvocet or Fioricet as a rescue, but only 2 times a week—same for the Amerge and Relafen.
Recently, I began to have menstrual migraines for the first time. For this type of migraine, I am now trying Relafen 2 times a day starting 2-3 days before I expect the headache (which is hard for me because I am irregular). I also use Benadryl (generic), ginger, and/or Reglan (generic) for nausea. Now I can knock out the nausea within an hour, which is a new and wonderful thing!
I am also trying “alternatives”—I recently started taking 500 mg of feverfew every day, and I do see some improvement. I also take magnesium and vitamin B2. Since I am prone to stomach ulcers, I have to be careful with the feverfew, B2, and Relafen. So I also take ginger for nausea or upset stomach, and drink chamomile tea when my stomach hurts. I take Tums during the day if necessary, but not within two hours of taking any medication.
Without my husband, I couldn’t do what I do. He’s learned what to do when a migraine hits: he immediately gets me coffee or diet coke, makes toast for me to eat when I take medication, etc. And even my five-year-old son will trot over with sunglasses, because light (even from the television) hurts my eyes.
I joined two on-line support groups to get and give support. I did not realize there were so many people struggling with the same disease. I have done a lot of research—books, websites, journal articles—on migraine, stroke, epilepsy, anything I can get my hands on.
Most importantly, I was referred to a headache clinic and work with a doctor and nurse practitioner who specialize in migraines and work closely with me. I’ve had to take my health firmly into my own hands and help direct my care. I’m not particularly assertive, but this disease has made me so, at least as far a migraine care is concerned.
Did you have to make any lifestyle or dietary changes in response to your illness?
I’ve made LOTS of changes. I go to bed at the same (early) time every night now. I get up early in the morning to avoid any “sleeping in” headaches that can morph into a migraine. I drink just about the same amount of caffeine every day—not too much, not too little—to avoid caffeine withdrawal headache and allow the caffeine to help me. I kept a food journal for four months, trying to identify a food trigger (to no avail). I drink almost no alcohol now because I fear it might trigger a headache. I try to exercise almost daily to release endorphins that might help.
I cut back on committee work on campus to avoid very heavy stress, since stress is the only trigger I identified. I also make sure to drink as much water as I can every day, because that seems to help. And mostly, I just try to stay healthy. I take a lot of vitamins now. I recently bought some books on meditation and relaxation and plan to look into this as well.
Did you seek any type of emotional support?
I seek emotional support from my family and from the two online support groups. Sometimes people who do not have this disease do not understand it. They have the attitude, “take some aspirin and get over it.” But it’s not that easy. So it’s really helpful to know others have the same problem and go through the same stuff.
Did/does your condition have any impact on your family?
Well, both my five year old and three year old know what a migraine is. I have missed some birthday parties (for their friends), trips to the theater, school parties or events, trips to the zoo… all because of the migraines. That can upset my kids, but all in all, they handle it well. My husband is nothing but supportive, though I don’t think he really understands the disease—but then, neither do I. The rest of my family lives far away, and I don’t think they have any idea what migraines have been like for me.
What advice would you give to anyone living with this condition?
I would tell anyone living with this condition several things:
Read as much as you can about this disease so you can have an informed conversation with your doctors.
Find a specialist right away—not just a neurologist, but a headache/migraine specialist.
Listen to that specialist—give the medications and/or therapy a try no matter how bizarre it sounds.
Most importantly, trust yourself. If a medication is making you sick or making things worse, tell your doctor firmly that you need to discontinue it.
Try alternative therapies like herbs, acupuncture, etc. under the direction of your doctor (or at least informing him/her).
Tell your family and friends what migraines are like so they can have some understanding of what you are going through.
Know your rights at work, in case you need to take a step back and slow down.
Find people who will listen to you and not judge you—online support groups are really great that way!
True Acupuncture No More Effective Than Sham Acupuncture for Migraine—But Both More Effective Than No Treatment at All
by Urmila R. Parlikar, MS
Migraine headaches are characterized by intense pulsing or throbbing pain on one side of the head. They are often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Studies suggest that up to 7% of men and 18% of women suffer from these disabling headaches.
Migraine sufferers plagued by frequent episodes often take a two-pronged approach to their condition: preventing attacks and relieving symptoms during attacks. Beta-blockers, calcium channel blockers and tricyclic antidepressants can reduce the frequency of migraine attacks, but they are not always effective or well tolerated.
As a result, many migraine patients turn to alternative therapies such as acupuncture. Acupuncturists insert fine needles into specific points on the body with the aim of preventing or relieving a variety of symptoms, including pain. Though some acupuncture studies over the past decade have shown promising results, acupuncture has not been convincingly established as an effective way to prevent migraine headaches.
In an article published in the May 4, 2005 Journal of the American Medical Association, researchers report that true acupuncture was no more effective than sham acupuncture in reducing the number of moderate to severe migraine headaches. Interestingly, however, both true and sham acupuncture were significantly more effective at preventing migraine headaches, compared to no treatment at all.
About the Study
The researchers recruited 302 patients (88% of whom were women) who suffered from migraine headaches.
The participants were randomly assigned to one of three treatment groups:
-True acupuncture. Twelve 30-minute sessions over a period of eight weeks. Needles were placed at defined acupuncture points.
-Sham acupuncture. Twelve 30-minute sessions over a period of eight weeks. Needles were placed in at least five out of ten predefined non-acupuncture sites.
-Waiting list control group. Twelve weeks of no treatment, followed by true acupuncture as described above.
Practitioners who were trained and experienced in acupuncture administered both the true and sham acupuncture. Although the practitioners knew whether the patients were receiving true or sham acupuncture, the patients did not.
All patients maintained a headache diary from four weeks before the start of treatment, through 12 weeks after the start of treatment, and then at weeks 21-24 after the start of treatment. They noted all migraine attacks and rated the pain intensity of each one.
Finally, patients reported any adverse effects.
Between the four weeks preceding the start of treatment and weeks nine to 12 after the start of treatment, the number of days with a migraine of moderate to severe intensity decreased by an average of 2.2 days in both the true acupuncture and sham acupuncture groups.
On the other hand, patients in the waiting list control group experienced a decrease in moderate to severe migraines of only 0.8 days (from a baseline of 5.4 days) during the same time period. This differed significantly from both the true and sham acupuncture groups.
The researchers also measured the proportion of responders, or patients whose moderate to severe migraines decreased by more than half. They found that 51% of true acupuncture patients and 53% of sham acupuncture patients were responders, compared to only 15% of patients in the waiting list group.
Patients receiving true or sham acupuncture were also significantly less likely than patients in the waiting list group to need medication, experience other symptoms associated with migraines, or have their activities impaired by migraines. There were no significant differences between the true and sham acupuncture groups in these areas.
None of the patients receiving true or sham acupuncture reported any serious adverse effects.
This study is limited by the fact that subjects were primarily recruited through newspaper advertisements, which means they may have had a more positive attitude towards acupuncture than the average migraine sufferer.
How Does This Affect You?
This study found no significant differences between true and sham acupuncture in the reduction of moderate to severe migraine headaches. Interestingly, however, both true and sham acupuncture were significantly more beneficial than no treatment at all.
But if true acupuncture fared no better than sham acupuncture, then why should both—or either—be more effective than no treatment at all? The study authors speculate that although their sham acupuncture was designed not to elicit a response, it may have stimulated an unintentional physiolologic response that helped prevent migraines.
Another possibility is that true and sham acupuncture may have a powerful placebo effect. In medication trials, a person taking a placebo is simply swallowing a pill. But with acupuncture, even the sham acupuncture patient is interacting frequently with a practitioner, and is experiencing the ritual associated with acupuncture. As a result, the benefit of the overall experience, if not the acupuncture itself, may be profound enough to have a clinically important impact.
While true acupuncture was no more effective than sham acupuncture in this study, this form of therapy does appear to have some benefit. And, unlike with medications, the risk of adverse effects is minimal. If you decide to try acupuncture, the National Center for Complementary and Alternative Medicine recommends the following:
Ask your primary health care provider if he or she can recommend a practitioner.
Find out about the practitioner’s license and credentials, and where they received their training.
Ask you insurer whether they will cover the cost of therapy.
Also, when you meet with the acupuncturist, be sure to discuss his or her treatment plan up front. Like many medications, the effectiveness of acupuncture can only be determined after a trial period. A competent acupuncturist will be able to estimate the number of sessions required during this period. It is also essential that you discuss all migraine treatments you are receiving with both your primary care provider and your acupuncturist.
You may think of antibiotics as a magic bullet against many deadly bacterial diseases. But because of persistent overuse, we have actually encouraged the growth of difficult-to-treat bacteria that are resistant to antibiotics.
"My pediatrician's great," a mother boasts. "When my daughter gets a cold, I call him for an antibiotic and he phones in the prescription right away."
Actually, the pediatrician may not be doing this mom any favors. Her daughter's cold is probably a viral infection—not bacterial—so an antibiotic will have no effect. What's more, the antibiotic will kill off substantial amounts of normal, friendly bacteria in the little girl's body, encouraging the growth of antibiotic-resistant bacteria that may create havoc later.
Twentieth Century Lifesavers are Wearing Out
In the 1940's, penicillin—the first widely used antibiotic—began saving countless lives from bacterial diseases. Antibiotics have enabled physicians to treat many of the scourges of humanity, including tuberculosis, pneumonia, meningitis, tetanus, syphilis and gonorrhea.
But we overdid it. We used antibiotics too casually—confident we'd always have another one to try if the first didn't work. We were heedless that bacteria naturally mutate and eventually become drug-resistant in direct relationship to their exposure to antibiotics.
Between 20% and 50% of all antibiotics prescribed for human use each year are unnecessary, according to the Centers for Disease Control and Prevention (CDC). Patients are demanding antibiotics for conditions that do not require an antibiotic, such as the common cold, and physicians feel pressured to write prescriptions. This is a waste of money, however, and lessens the effectiveness of the antibiotics for the times we really need them.
A Worldwide Problem
Huge amounts of antibiotics are used in the dairy, poultry and livestock industries, allowing drug-resistant bacteria to find their way into our kitchens. In developing countries, antibiotics are available over-the-counter, increasing the likelihood that they will be used without proper supervision. And jet plane travel makes it possible for resistant bacteria to travel from continent to continent with ease.
"Just Give Me Something to Make Me Feel Better"
In the United States, we like to be proactive. We like a quick fix for our illnesses. So we're likely to ask the doctor for antibiotics to treat viral infections like colds, the flu and bronchitis.
But viruses and bacteria are different. Antibiotics have no effect on the common cold or flu, which usually resolve without treatment in a matter of days. The table below shows viral infections that can be mistaken for those caused by bacteria. Of course, your doctor should make the actual diagnosis.
Physicians often write a prescription for an antibiotic even when they believe the patient's condition doesn't warrant it. At a recent seminar, Dr. Stuart B. Levy of Tufts University School of Medicine in Boston, Massachusetts reported that more than 80% of the physicians present admitted to having written antibiotic prescriptions on demand against their better judgment. Time constraints imposed by the current health care system make it easier for physicians to take 30 seconds to write a prescription than to spend 10–15 minutes explaining to a patient why an antibiotic isn't needed.
The Price of Antibiotic Overuse: Tougher Bacteria
The human body normally is home to millions of bacteria. These "friendly" bacteria found on the skin, in the mouth, lining the digestive tract—virtually all over our bodies—are harmless and many are necessary for the normal functioning of the body.
Use of antibiotics disrupts the ecology of your body. Whether an antibiotic is taken appropriately for a bacterial infection or taken inappropriately for a viral infection, antibiotics kill off thousands of friendly bacteria. With less competition from the harmless, "friendly" bacteria, the newly mutated, antibiotic-resistant "super germs" can proliferate more freely. These organisms can make you ill or hang around to bother you later.
The consumer group, Center for Science in the Public Interest, estimates that 20% of the U.S. population is at risk for infections because of weakened immune-defense systems. This population group includes children, the elderly, people on cortisol-like medications, cancer patients and people with AIDS. A person infected with an antibiotic resistant super germ will need a stronger antibiotic that may have unpleasant side effects and may need to be administered intravenously. In extreme cases, there are no effective antibiotics. You can also pass these super germs on to classmates and coworkers. No wonder drug-resistant bacteria have become a major public health concern!
What You Can Do
Be smart with antibiotics
When you or your child is sick, tell the doctor that you are not expecting to receive an antibiotic unless it's necessary. Surveys show that doctors often prescribe antibiotics because they assume you will be disappointed if you don't get one. Surveys also show that most patients don't want unneeded antibiotics and welcome a simple explanation.
Take antibiotics exactly as prescribed
If you do need a prescription, take all the pills as directed. Even if you feel better, continue to take the full prescribed dose.
Don't take leftover antibiotics and don't borrow antibiotics or give antibiotics to another person.
Manage without antibiotics
Your doctor can suggest ways to help manage a viral infection and its symptoms. In most cases, a viral infection resolves on its own. Of course, always contact your physician if the illness seems to worsen or has the usual characteristics of a bacterial infection.
Here are some suggestions from Breaking the Antibiotic Habit: A Parent's Guide to Coughs, Colds, Ear Infections and Sore Throats:
saltwater nose drops
elevate head while sleeping
drink adequate fluids
blow nose as needed
moist air (humidified)
warm liquids (soup, tea)
popsicles and ice chips
medicated throat lozenges
honey served in warm tea
analgesics or analgesic spray
Use Common Sense around Food
Reduce the chances of picking up illnesses through food. Avoid drug-resistant bacteria and residues of antibiotics on food by following these steps:
Wash hands, utensils and surfaces with warm, soapy water before and after food preparation.
Wash raw fruits and vegetables thoroughly before eating.
Separate raw meat, poultry, eggs and seafood from ready-to-eat foods.
Cook food completely. Cook eggs until both the yolk and white are firm.
Refrigerate or freeze perishables and leftovers within two hours.
Outlook for Antibiotics
In 1996, the World Health Organization warned that "the gap between [microbes'] ability to mutate into drug-resistant strains and man's ability to counter them is widening fast." Pharmaceutical companies continue to search for newer antibiotics that will overcome resistance. Scientists are also trying to modify existing antibiotics, like penicillin, to make them more effective. As long as we overuse antibiotics, however, resistance will continue to be a problem.
Take care of yourself and your family. Treat antibiotics as a precious resource to be used only when needed.
Picking a Pain Reliever: Which One Should You Take?
by Laurie LaRusso, MS, ELS
All pain relievers are not equal.
It sounds like the opening line of a commercial for a particular brand of pain reliever, but it’s true. Among nonprescription pain relievers, some are best for relieving menstrual cramps, while others do a better job with sprains and strains, and still others reduce fevers.
Your local drugstore probably has an entire aisle (or at least half of one) devoted to nonprescription pain relievers, such as aspirin, Tylenol (acetaminophen), Advil (ibuprofen), and so on. But which one should you take to stop that headache? Or relieve the pain of a sprained ankle? And which one is safe to give to your children? Or your elderly mother?
Aspirin is actually the first of a type of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). As the name suggests, NSAIDs reduce inflammation in addition to relieving pain. Aspirin is effective at relieving the pain of headaches, toothaches, muscular aches and pains, aches and fever due to colds, and minor aches and pains of arthritis.
The vast majority of people can take aspirin without experiencing any side effects. However, aspirin may upset your stomach. To minimize stomach upset, some aspirin products are "buffered" with an antacids or coated so the pills don't dissolve until they reach the small intestine. When taken long term in high doses, aspirin may cause more serious stomach problems, such as bleeding and ulcers in your stomach and intestines. For this reason, people with ulcers should not take aspirin. Drinking alcohol while taking aspirin increases your risk of bleeding and ulcers in your stomach and intestines.
Aspirin is not recommended for children and teens with a current or recent viral infection, because it can cause Reye’s syndrome, a rare disorder that may cause seizures, brain damage, and death. Check with your doctor before giving a child or teen aspirin. In addition, people with the following conditions should not take aspirin: asthma, nasal polyps, bleeding disorders (or those taking blood-thinning drugs), high blood pressure, kidney disease, and the third trimester of pregnancy.
Nonsteroidal Anti-Inflammatory Drugs (Other Than Aspirin)
Besides aspirin, other nonprescription NSAIDs include ibuprofen (Advil, Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis KT). These drugs are more potent pain relievers than aspirin, especially for menstrual cramps, toothaches, minor arthritis, and injuries accompanied by inflammation, such as tendinitis and sprains. They are also effective at reducing fever and inflammation.
Among the NSAIDs, however, there are some important differences. Ibuprofen is the fastest-acting NSAID and it is approved for use in children. Naproxen sodium provides the longest-lasting pain relief.
Like aspirin, the other NSAIDs may upset your stomach, but they are gentler on the stomach than aspirin. When taken long term in high doses, they may cause more serious stomach problems, such as bleeding and ulcers in your stomach and intestines. Ketoprofen carries the highest risk of this complication. People with ulcers, asthma, or bleeding disorders (or those taking blood-thinning drugs) should not take NSAIDs. Drinking alcohol while taking NSAIDs increases your risk of bleeding and ulcers in your stomach and intestines. People with kidney or liver problems, high blood pressure, or congestive heart failure should only take NSAIDs after consulting their healthcare provider.
NSAIDs are of particular concern for elderly people because of the risk of bleeding and ulcers in the stomach and intestines. Older adults who need to take NSAIDs regularly are often given prescription NSAIDs that are designed to be gentler on the stomach.
Acetaminophen relieves minor aches and pains, toothache, muscular aches, minor arthritis pain, headaches, and fever. However, acetaminophen does not reduce inflammation, which makes it less effective than NSAIDs at relieving the pain of sprains, muscles strains, and tendinitis.
Acetaminophen has virtually no side effects. However, when taken along with alcohol, acetaminophen increases the risk of liver damage. This includes taking the drug the morning after a night of heavy drinking.
Acetaminophen is the pain reliever and fever reducer of choice for children and pregnant and breast-feeding women. It does not cause stomach upset or increase the risk of Reye’s syndrome.
• Herbology, Western Herbal Medicine
Along with massage therapy, herbal treatment is undoubtedly one of the most ancient forms of medicine. By the time written history began, herbal medicine was already in full swing and being used in all parts of the world.
There are several major surviving schools of herbal medicine. Two of the most complex systems are Ayurveda (the traditional herbal medicine of India) and Traditional Chinese Herbal Medicine (TCHM). Both Ayurveda and TCHM make use of combinations of herbs. However, the herbal tradition in the West focuses more on individual herbs, sometimes known as simples. That is the form of herbology discussed here.
History of Herbal Medicine
Originally, herbal medicine in Europe was primarily a women’s art. The classic image of witches boiling herbs in a cauldron stems to a large extent from this period. Beginning in about the 13th century, however, graduates of male-only medical schools and members of barber-surgeon guilds began to displace the traditional female village herbalists. Ultimately, much of the original lore was lost. (So-called “traditional” herbal compendiums, such as Culpeppers Herbal, are actually of fairly recent vintage.)
Another major change took place in the 19th century, when chemistry had advanced far enough to allow extraction of active ingredients from herbs. The old French word for herb, “drogue,” became the name for chemical “drugs.” Subsequently, these chemical extracts displaced herbs as the standard of care. There were several forces leading to the predominance of chemicals over herbs, but one of the most important remains a major issue today: the problem of reproducibility.
When you purchase a drug, you generally know exactly what you are getting. Drugs are single chemicals that can be measured and quantified down to their molecular structure. Thus a tablet of extra-strength Tylenol contains 500 mg of acetaminophen, no matter where or when you buy it. Although a vitamin, not a drug, the same is true of a vitamin C tablet, provided that it is correctly labeled.
Herbs, however, are living organisms comprised of thousands of ingredients, and the proportions of all these ingredients may differ dramatically between two plants. Numerous influences can affect the nature of a given crop. Whether it was grown at the top or bottom of a hill, what the weather was like, what time of year it was picked, what other plants lived nearby, and what kind of soil predominated are only a few of the factors that can affect an herb’s chemical makeup. 1
This presents a real problem for people who wish to use herbs medicinally (as opposed to, say, for taste or fragrance). Since so much variation is possible, it’s difficult to know whether one batch of an herb is equivalent in effectiveness to another.
The desire to overcome this problem provided the main initial motivation for finding the active principles of herbs and purifying them into single-chemical drugs. However, by now most of the common herbs that possess an identifiable active ingredient have long since been turned into drugs. Today’s popular herbs do not contain any known, single active ingredients. For this reason, there’s no simple way to determine the effectiveness of a given herbal batch.
This difficulty can be partially overcome by a method called “herbal standardization.” 2 In this process, manufacturers make an extract of the whole herb and boil off the liquid until the concentration of some ingredient reaches a certain percentage. Contrary to popular belief, this ingredient is not usually the active ingredient; it is merely a “tag” or “handle” used for standardization purposes.
The extract is then made into tablets or capsules or bottled as a liquid, with the concentration of the tag ingredient listed on the label. This method is far from perfect because two products with the same concentration of tag ingredients may still differ widely in other unlisted or even unidentified active constituents. Nonetheless, this form of partial standardization is better than nothing, and it allows a certain amount of reproducibility. For this reason, we recommend that whenever possible, you should use standardized herbal extracts. Even better, use the actual products that were tested in double-blind studies.
Effectiveness of Herbs
There is no doubt that herbs can be effective treatments in principle, if for no other reason than that up through perhaps the 1970s, most drugs used in medicine came from herbs. Many of today’s medicinal herbs have been studied in meaningful double-blind, placebo-controlled trials that provide a rational basis for believing them effective. Some of the best substantiated include ginkgo for Alzheimer’s disease, St. John’s wort for mild to moderate depression, and saw palmetto for benign prostatic hypertrophy.
However, even the best-documented herbs have less supporting evidence than the majority of drugs for one simple reason: You can’t patent an herb; therefore, no single company has the financial incentive to invest millions of dollars in research when another company can “steal” the product after it is proved to work. In addition, the problem of reproducibility always makes it difficult or impossible to know whether the batch of herbs you are buying is as effective as the one tested in published studies.
Each herb entry in The Natural Pharmacist analyzes the body of scientific evidence for its effectiveness. We also note the traditional uses of each herb, but keep in mind that such uses are not reliable indicators of an herb’s effectiveness. For many reasons, it simply isn’t possible to accurately evaluate the effectiveness of a medical treatment without performing double-blind, placebo-controlled studies, and many herbs lack these. (For more information on why this is so, see Why Does The Natural Pharmacist Rely on Double-blind Studies?)
There is a common belief that herbs are by nature safer and gentler than drugs. However, there is no rational justification for this belief; an herb is simply a plant that contains one or more drugs, and it is just as prone to side effects as any medicine, especially when taken in doses high enough to cause significant benefits.
Nonetheless, the majority of the most popular medicinal herbs are at least fairly safe. The biggest concern in practice tends to involve interactions with medications. Many herbs are known to interact with drugs, and as research into this area expands, more such interactions will certainly be discovered. Each herb entry in The Natural Pharmacist lists what is known about all safety risks. See also the article on which herbs and supplements to avoid in pregnancy.
When the well’s dry, we know the worth of water.
From "Fit for God," by La Vita M. Weaver, pp. 68 & 72:
Water is so important for life that we can survive days, weeks, maybe months without food, but only days without water. The human body is about 55 to 70 percent water, and no bodily function takes place without water.
Water is the most important and most abundant natural resource, yet it is also the one we take for granted the most. If your throat isn’t dry and you don’t have sweat pouring off your forehead, you tend to take it for granted. But water does a lot more than just satisfy your thirst. Among its duties, it carries nutrients throughout the body, adds moisture to body tissues, softens stool, helps cushion your joints, and aides in the regulation of body temperature. Therefore, the human body continuously loses water throughout the day, and water molecules floating around in the atmosphere cannot be reabsorbed back into the body. We lose water through urination, stool excretion, respiration, sweating, and evaporation from the skin. Consequently, just as God planned a "water cycle" to replenish the water on earth, we need to create a "water cycle" for our bodies by making a conscious effort to ensure an ongoing intake of water.
Water helps tremendously with weight management. In nature, water cleanses and refreshes the earth and the atmosphere. In the Bible it symbolically washes away our sins (as in baptism). Drinking water washes our bodies of harmful products or toxins. This internal cleansing is very important for overall good health and weight management.
Do not wait until you are thirsty before you drink water. Thirst is actually a warning signal that you are not drinking enough water. To avoid dehydration and to maintain proper functioning of the body, you need to create a "water cycle" to constantly replace fluids you lose. The first step is to set a goal to drink at least eight to ten cups of water every day.
* * *
Also on Beliefnet:
Sweatin' to the Bible: An interview with La Vita Weaver
What you thought before has led to every choice you have made, and this adds up to you at this moment. If you want to change who you are physically, mentally, a spiritually, you will have to change what you think.
-Dr. Patrick Gentempo
From "One Minute Wellness" by Dr. Ben Lerner with Dr. Greg Loman:
You have more power than you realize. Real wellness can only be attained through Maximized Living. Maximized Living though nurturing your body toward good health and trusting in that power is the only real medicine. It’s healing, the only real cure. It’s science, the only real future for real wellness.
God made your body with the power to overcome. Real wellness is anything that removes interference with your body’s ongoing, natural balancing process. By restoring balance, you can reach your maximum level of health (optimum physical, mental, and social well-being), allowing you to get well if you are sick and helping you to stay well if you are not…
Let’s define Maximized Living.
What does Maximized Living really include? At this point you know that it doesn’t include the next blockbuster drug or plastic surgery. What it does include is exercise, a thoughtful diet, discovering a compelling purpose for your life, building strong relationships, and the use of nontoxic, noninvasive forms of health intervention, such as prayer, chiropractic care, supplementing missing nutrients, and rehabilitative techniques.
Maximized living is “real wellness.” You now should realize that you must change your paradigm from an outside-in, mechanical, medical, or wellness model in which you fight or treat disease and symptoms to an inside, out, vital, real-wellness model.
In the new model you: build health as the best prevention and defense of disease, nurture a nontoxic internal environment for your cells, cooperate with the intelligent design of your body, and embrace care that corrects the cause of issues by removing interference or eliminating dis-ease—all of which is the inherent consequence of a natural lifestyle that respects your body and falls into alignment with the ultimate intent God has for your life. Remember: health and happiness is your choice 98 percent of the time and an ever present reality through the tools of maximized living.
A hospital is no place to be sick.
From "One Minute Wellness" by Dr. Ben Lerner with Dr. Greg Loman:
While medicine has many lifesaving benefits, recent findings are revealing more and more that the cures may in fact be more dangerous than the diseases they were created to heal…
Every drug is to some degree a poison. Virtually any medication taken by the wrong patient, in the wrong dose, or at the wrong time has the ability to be harmful, if not fatal. The risk/benefit analysis of drug consumption—prescribed or otherwise—needs to be brought into focus for health and economic reasons.
Before you think that this view is alarmist in nature, consider the following facts about the use of one of the world’s most common pain-related drugs, acetaminophen (available under the product name Tylenol, for example). Acetaminophen use is the number one reason for acute liver failure in the United States. It is also responsible for 8 to 10 percent of the end-stage renal disease in the U.S. These statistics are associated with one extremely common, widely-used drug that is considered so safe it is available without prescription to anyone with the money to pay for it. If the “non-dangerous” drugs yield consequences of this nature, what is happening with products that require the restrictions of a prescription to obtain them?…
“Care, not treatment, is the answer,” says Dr. Joseph Mercola, (http://www.mercola.com) a Chicago-area osteopathic physician, in response to the health-care crisis. “Drugs, surgery, and hospitals are rarely the answer to chronic health problems. Facilitating the God-given healing capacity that all of us have is the key. Improving diet, exercise, and lifestyle are basic.”
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