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
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.
RESOURCES:
American Cancer Society
Cellular Phones
http://www.cancer.org/
Federal Communications Commission
RF Safety Program
www.fcc.gov/oet/rfsafety
Food and Drug Administration
Cell Phone Facts; Consumer Information on Wireless Phones
www.fda.gov/
National Institute of Environmental Health Sciences
www.niehs.nih.gov
World Health Organization
International Commission on Non-ionizing Radiation Protection
www.who.int/
Sources:
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.
Health and Healing
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:
The name
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.
RESOURCES:
U.S. Food and Drug Administration
http://www.fda.gov/
American Pharmacists Association
http://www.aphanet.org/
Sources:
U.S. Food and Drug Administration
American Pharmaceutical Association
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:
The name
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.
RESOURCES:
U.S. Food and Drug Administration
http://www.fda.gov/
American Pharmacists Association
http://www.aphanet.org/
Sources:
U.S. Food and Drug Administration
American Pharmaceutical Association
What Are Muscle-Contraction Headaches?
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.
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).
Here's Why:
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.
Here's How:
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:
Beef broth
Ketchup
Commercial soups
French fries
Gravies
Olives
Pickles
Potato chips
Salted snack foods
Sandwich meats
Sauces
Sauerkraut
Tomato-based products
Sodium occurs naturally in:
Eggs
Fish
Meats
Milk products
Poultry
Shellfish
Soft water
Other sources of sodium in the diet:
Baking powder
Baking soda
Monosodium glutamate (MSG)
Sodium alginate
Sodium citrate
Sodium nitrate and nitrite
Sodium propionate
Sodium sulfite
Soy sauce
Reading Food Labels
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:
Canned vegetables
Vegetable juices
Dried soup mixes
Bouillon
Condiments (ketchup, soy sauce)
Snack foods (chips, nuts, pretzels)
Crackers
Bakery products
Canned soups
Butter and margarine
Cheeses
Canned tuna
Processed meats
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.
RESOURCES
American Dietetic Association
www.eatright.org
The Nutrition Source
Harvard School of Public Health
http://www.hsph.harvard.edu/nutritionsource/
by Karen Schroeder, MS, RD
American Heart Association recommendation: Eat less than 6 grams of salt (sodium chloride) per day (2400 milligrams of sodium).
Here's Why:
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.
Here's How:
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:
Beef broth
Ketchup
Commercial soups
French fries
Gravies
Olives
Pickles
Potato chips
Salted snack foods
Sandwich meats
Sauces
Sauerkraut
Tomato-based products
Sodium occurs naturally in:
Eggs
Fish
Meats
Milk products
Poultry
Shellfish
Soft water
Other sources of sodium in the diet:
Baking powder
Baking soda
Monosodium glutamate (MSG)
Sodium alginate
Sodium citrate
Sodium nitrate and nitrite
Sodium propionate
Sodium sulfite
Soy sauce
Reading Food Labels
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:
Canned vegetables
Vegetable juices
Dried soup mixes
Bouillon
Condiments (ketchup, soy sauce)
Snack foods (chips, nuts, pretzels)
Crackers
Bakery products
Canned soups
Butter and margarine
Cheeses
Canned tuna
Processed meats
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.
RESOURCES
American Dietetic Association
www.eatright.org
The Nutrition Source
Harvard School of Public Health
http://www.hsph.harvard.edu/nutritionsource/
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.
Medication
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.
Sources:
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.
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.
Medication
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.
Sources:
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.
The Three Stages of Alzheimer's Disease
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.
Early
Not remembering appointments
Not recognizing once familiar faces
Losing track of time
Not storing recent information or events
Getting lost
Having difficulty finding words
Misplacing needed items
Middle Early
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
Late Early
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
Early Middle
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
Middle Middle
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
Late Middle
Being incontinent
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
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.
Early
Not remembering appointments
Not recognizing once familiar faces
Losing track of time
Not storing recent information or events
Getting lost
Having difficulty finding words
Misplacing needed items
Middle Early
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
Late Early
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
Early Middle
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
Middle Middle
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
Late Middle
Being incontinent
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
Viewing Food Through a Kaleidoscope
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.
-Mark Twain
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.
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.
-Mark Twain
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
Nausea
Lightheadedness
Fainting
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
Collapsed lung
Pulmonary hypertension
Severe asthma
Pneumonia
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.
RESOURCES:
American College of Gastroenterology
http://www.acg.gi.org
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
Nausea
Lightheadedness
Fainting
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
Collapsed lung
Pulmonary hypertension
Severe asthma
Pneumonia
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.
RESOURCES:
American College of Gastroenterology
http://www.acg.gi.org
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:
hunger
menstruation
hormone therapy
foods containing tyramine or alcohol
strong odors such as perfumes or cigarettes
excessive noise or bright lights
stress
insomnia
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:
preventive agents (prophylactics)
abortive agents
pain relievers
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.
Resources:
Migraine and Cluster Headaches Page
http://www.centerwatch.com/studies/CAT100.HTM
Migraine Classification and Diagnosis Criteria
http://www.pitt.edu/~elsst21/mcldi.html
National Headache Foundation
http://www.headaches.org/
American Council for Headache Education (ACHE)
http://www.achenet.org
Sources:
Maizels M., Scott B., Cohen W., Chen W. "Intranasal Lidocaine for treatment of migraine," Journal of the American Medical Association. 1996; 276; 319-21.
Silberstein SD. Practice Parameter: Evidence-based guidelines for migraine headache. Neurology. 2000; 55: 754-762
Available at: http://www.aan.com/public/practiceguidelines/list.htm
******
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.
The Findings
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.
RESOURCES:
National Center for Complementary and Alternative Medicine
National Institutes of Health
http://www.nccam.nih.gov/
National Headache Foundation
http://www.headaches.org
National Institute of Neurological Disorders and Stroke
National Institutes of Health
http://www.ninds.nih.gov
Sources:
Linde K, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005; 293:2118-2125.
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:
hunger
menstruation
hormone therapy
foods containing tyramine or alcohol
strong odors such as perfumes or cigarettes
excessive noise or bright lights
stress
insomnia
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:
preventive agents (prophylactics)
abortive agents
pain relievers
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.
Resources:
Migraine and Cluster Headaches Page
http://www.centerwatch.com/studies/CAT100.HTM
Migraine Classification and Diagnosis Criteria
http://www.pitt.edu/~elsst21/mcldi.html
National Headache Foundation
http://www.headaches.org/
American Council for Headache Education (ACHE)
http://www.achenet.org
Sources:
Maizels M., Scott B., Cohen W., Chen W. "Intranasal Lidocaine for treatment of migraine," Journal of the American Medical Association. 1996; 276; 319-21.
Silberstein SD. Practice Parameter: Evidence-based guidelines for migraine headache. Neurology. 2000; 55: 754-762
Available at: http://www.aan.com/public/practiceguidelines/list.htm
******
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.
The Findings
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.
RESOURCES:
National Center for Complementary and Alternative Medicine
National Institutes of Health
http://www.nccam.nih.gov/
National Headache Foundation
http://www.headaches.org
National Institute of Neurological Disorders and Stroke
National Institutes of Health
http://www.ninds.nih.gov
Sources:
Linde K, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005; 293:2118-2125.
Antibiotics: Use with Caution
by Jeff Stone
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 self-prescribe
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:
Colds
saltwater nose drops
elevate head while sleeping
drink adequate fluids
rest
blow nose as needed
vitamin C
zinc
chicken soup
echinacea
Coughs
moist air (humidified)
adequate fluids
rest
warm liquids (soup, tea)
cough drops
Sore throats
saltwater gargles
cold drinks
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.
Resources
What is Antibiotic Resistance and Why Is It a Problem?
Alliance for the Prudent Use of Antibiotics
http://www.tufts.edu/med/apua/
Antibiotic Resistance
Centers for Disease Control and Prevention
http://www.cdc.gov
Four Steps to Fight BAC!
Partnership for Food Safety Education
http://www.fightbac.org/
by Jeff Stone
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 self-prescribe
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:
Colds
saltwater nose drops
elevate head while sleeping
drink adequate fluids
rest
blow nose as needed
vitamin C
zinc
chicken soup
echinacea
Coughs
moist air (humidified)
adequate fluids
rest
warm liquids (soup, tea)
cough drops
Sore throats
saltwater gargles
cold drinks
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.
Resources
What is Antibiotic Resistance and Why Is It a Problem?
Alliance for the Prudent Use of Antibiotics
http://www.tufts.edu/med/apua/
Antibiotic Resistance
Centers for Disease Control and Prevention
http://www.cdc.gov
Four Steps to Fight BAC!
Partnership for Food Safety Education
http://www.fightbac.org/
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
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 (Tylenol)
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.
RESOURCES:
US Food and Drug Administration
http://www.fda.gov/
Sources:
American Academy of Family Physicians
American Council on Science and Health
US Food and Drug Administration
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
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 (Tylenol)
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.
RESOURCES:
US Food and Drug Administration
http://www.fda.gov/
Sources:
American Academy of Family Physicians
American Council on Science and Health
US Food and Drug Administration
Herbal Medicine
Alternate Names
• Herbology, Western Herbal Medicine
Overview
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.
Herbal Medicine’s Greatest Problem: 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?)
Safety Issues
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.
Specific Herbs
The Natural Pharmacist has articles on all major herbal therapies. For detailed information, see http://www.beliefnet.com/healthandheali ... ?cid=33802.
References
1. Bratman S, Girman A. Mosby’s Handbook of Herbs and Supplements and their Therapeutic Uses. St. Louis, MO:Mosby, Inc.; 2003.
2. Schulz V, Hansel R, Tyler V. Rational Phytotherapy. A Physician’s Guide to Herbal Medicine. Berlin and Heidelberg:Springer-Verlag; 1998.
Alternate Names
• Herbology, Western Herbal Medicine
Overview
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.
Herbal Medicine’s Greatest Problem: 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?)
Safety Issues
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.
Specific Herbs
The Natural Pharmacist has articles on all major herbal therapies. For detailed information, see http://www.beliefnet.com/healthandheali ... ?cid=33802.
References
1. Bratman S, Girman A. Mosby’s Handbook of Herbs and Supplements and their Therapeutic Uses. St. Louis, MO:Mosby, Inc.; 2003.
2. Schulz V, Hansel R, Tyler V. Rational Phytotherapy. A Physician’s Guide to Herbal Medicine. Berlin and Heidelberg:Springer-Verlag; 1998.
Don't Wait Until You're Thirsty
When the well’s dry, we know the worth of water.
-Benjamin Franklin
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
When the well’s dry, we know the worth of water.
-Benjamin Franklin
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
You Have More Power Than You Realize
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.
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.
Can Certain Medications Do More Harm Than Good?
A hospital is no place to be sick.
-Samuel Goldwyn
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.”
A hospital is no place to be sick.
-Samuel Goldwyn
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.”
In Her Own Words: Living With Ovarian Cancer
As told to Virginia Mansfield
The Wednesday between her daughter's college graduation and her son's high school graduation, Jan was diagnosed with ovarian cancer. A rough ride on a horse, an assertive family doctor, and Jan's awareness of her symptoms led to an early diagnosis that has allowed Jan to live the past seven years of her life cancer free. She has beaten the 80% odds that she would not survive beyond two years. "I told myself that I had as much of a chance to be in the odds of those that survive as those that don't survive. You have to have hope!"
What was your first sign that something was wrong? What symptoms did you experience?
Starting in December of 1993, when I laid down at night, my stomach felt puffy. I just thought I was getting fat, but it was unusual for me because I never really had that problem before. Then, I was always exhausted, and I was typically a person who never got tired. The third thing was that I had pain on the right side (near the right ovary) when I had intercourse.
What was the diagnosis experience like?
My doctor thought I was pre-menopausal, but I knew there was more to it than that. So I thought I would go back to the doctor in six months. A few months later, I was riding a horse that bucked a lot, which led to a great deal of pain. So I went to my family physician and told him I thought I was having an appendicitis. He connected my pain with the other symptoms I had earlier, and that led to the diagnosis by him in a very quick manner that I had ovarian cancer.
Most doctors don't run tests for ovarian cancer, but he in fact, did use them. He did a trans-vaginal ultra sound and a CA 125 blood test. I was in so much pain that they admitted me to the hospital. We later discovered that the tumor had flipped upside down while I was riding the horse, and that's what caused the severe pain. By the next day, he had run all the tests and had called my family in to give us the news that I had ovarian cancer.
What was your initial and then longer-term reaction to the diagnosis?
My initial reaction (to myself) was that I would be dead in two years. I didn't know anyone that survived ovarian cancer. It was a shock because I had always been a very healthy person. I exercise a lot; try to eat the right foods; cancer doesn't run in my family. I just thought, "How can this be?"
The worst part of a cancer diagnosis is initially hearing that you have it. Then, you start to realize you have a huge challenge in front of you. I started thinking about who was the best doctor to treat ovarian cancer. So we started making a bunch of phone calls, and decided on the same doctor that my family doctor recommended. I didn't have a lot of time to do much research, because I was in so much pain. Once we decided on the doctor, we scheduled the surgery to be done in three days.
How is your ovarian cancer treated?
I had a complete hysterectomy (removal of the uterus) and an oophorectomy (removal of the ovaries). Then, one week later, I started chemotherapy. I had six treatments, three weeks apart. Each infusion treatment would take about eight hours. I was more afraid of the chemotherapy than of dying. Fortunately, I never got sick from the chemotherapy. I didn't feel wonderful for a few days right after, but I never got sick. I did lose my hair. I lost the hair on my head, my eyebrows, and the hair on my arms. That really bothered me. I was diagnosed in May, and had my last chemo treatment in November. I also had problems with constipation and some problems with my veins.
Every six months I have a blood test, and have my annual physical exam with my family doctor.
Did you have to make any lifestyle or dietary changes in response to having ovarian cancer?
The hysterectomy instantly threw me into menopause, so I had to learn to deal with waking up at night soaking wet. While I was going through treatment, it required a lot of slowing down. That was really hard for me. I wasn't able to exercise for several weeks after surgery to allow healing. The chemotherapy destroys growth cells and makes healing more difficult. It took a lot longer to recover than I was prepared for. Most people with ovarian cancer have an ongoing battle with treatment, but I was fortunate to not deal with that.
The dietary changes I've made are due to the constipation. I have a lot of scar tissue due to the surgery and chemotherapy, so I have to be sure that I eat lots of fiber, fruits, and vegetables to keep things functioning properly.
Did you seek any type of emotional support?
I think it's very important for anyone who has been diagnosed with a devastating illness to have emotional support. My husband was always there for me. I would tell others I was doing fine, because I knew I had my husband to tell how I was really feeling. One day I just told him I felt like crap! I knew I could always be honest with him, and not have to bring everybody else down. I needed to let my emotions out to someone. I would tell Dan, "I hate how I feel. I hate losing my hair. I hate what's going on." You need to let those emotions out.
My faith in God was also a great emotional support. Knowing that I was secure in my eternity and that God was in control. It was a great time for me to grow as a Christian.
I didn't end up going to a support group, but there were excellent ones in my community. I just had overwhelming support from friends, family, and neighbors. There were meals, calls, flowers, and cards. After each chemotherapy treatment, someone was always there to take over house and family stuff so I could just rest. I had a neighbor who would always bring me chicken noodle soup. It was one of the few things that tasted good to me.
Does ovarian cancer have any impact on your family?
My son really thought I was going to die. He kind of withdrew from me. He wanted to be supportive, but it was really difficult for him. My daughter was more into the "What can I do to help you?" mode. We tried to keep things as positive as possible with the kids.
The initial impact on my husband was fear. He played a huge protector role that I had never seen him in before or after. He wanted to take me away from all the stress. I didn't work one day during the time I was getting treatment. Even though I really thought I wanted to go back to work. It was the first time in 30 years of marriage that he did all the cleaning, cooking, and all the laundry. I think the job he assumed was that he would make me get better.
What advice would you give to anyone living with ovarian cancer?
The first thing you have to get a hold of is hope. You are not a statistic. Be secure in Jeremiah 29:11, which says, "I know the plans I have for you, says the Lord. They are plans for good and not for evil."
Secondly, arm yourself with education before you let anyone treat you, and learn everything you can about that particular kind of cancer. Make sure you are working with a specialist in that particular kind of cancer. It can be the difference between life and death. Treatment is changing fast so keep up to date on your options. Be sure you're getting the most current and recommended treatment.
Thirdly, keep a sense of humor. Look at the things that are happening around you and see the things that are funny about them. If you don't, you'll be miserable.
Fourthly, accept the gift of family and friends. People want to feel like they can do something for you. Enjoy the moment-it's a blessing during the time of stress.
And lastly, rely on your faith. God has given us so many good words of encouragement, hope, and promise. Take that time and use it to grow in your faith. It can be a very peaceful time in your life.
As told to Virginia Mansfield
The Wednesday between her daughter's college graduation and her son's high school graduation, Jan was diagnosed with ovarian cancer. A rough ride on a horse, an assertive family doctor, and Jan's awareness of her symptoms led to an early diagnosis that has allowed Jan to live the past seven years of her life cancer free. She has beaten the 80% odds that she would not survive beyond two years. "I told myself that I had as much of a chance to be in the odds of those that survive as those that don't survive. You have to have hope!"
What was your first sign that something was wrong? What symptoms did you experience?
Starting in December of 1993, when I laid down at night, my stomach felt puffy. I just thought I was getting fat, but it was unusual for me because I never really had that problem before. Then, I was always exhausted, and I was typically a person who never got tired. The third thing was that I had pain on the right side (near the right ovary) when I had intercourse.
What was the diagnosis experience like?
My doctor thought I was pre-menopausal, but I knew there was more to it than that. So I thought I would go back to the doctor in six months. A few months later, I was riding a horse that bucked a lot, which led to a great deal of pain. So I went to my family physician and told him I thought I was having an appendicitis. He connected my pain with the other symptoms I had earlier, and that led to the diagnosis by him in a very quick manner that I had ovarian cancer.
Most doctors don't run tests for ovarian cancer, but he in fact, did use them. He did a trans-vaginal ultra sound and a CA 125 blood test. I was in so much pain that they admitted me to the hospital. We later discovered that the tumor had flipped upside down while I was riding the horse, and that's what caused the severe pain. By the next day, he had run all the tests and had called my family in to give us the news that I had ovarian cancer.
What was your initial and then longer-term reaction to the diagnosis?
My initial reaction (to myself) was that I would be dead in two years. I didn't know anyone that survived ovarian cancer. It was a shock because I had always been a very healthy person. I exercise a lot; try to eat the right foods; cancer doesn't run in my family. I just thought, "How can this be?"
The worst part of a cancer diagnosis is initially hearing that you have it. Then, you start to realize you have a huge challenge in front of you. I started thinking about who was the best doctor to treat ovarian cancer. So we started making a bunch of phone calls, and decided on the same doctor that my family doctor recommended. I didn't have a lot of time to do much research, because I was in so much pain. Once we decided on the doctor, we scheduled the surgery to be done in three days.
How is your ovarian cancer treated?
I had a complete hysterectomy (removal of the uterus) and an oophorectomy (removal of the ovaries). Then, one week later, I started chemotherapy. I had six treatments, three weeks apart. Each infusion treatment would take about eight hours. I was more afraid of the chemotherapy than of dying. Fortunately, I never got sick from the chemotherapy. I didn't feel wonderful for a few days right after, but I never got sick. I did lose my hair. I lost the hair on my head, my eyebrows, and the hair on my arms. That really bothered me. I was diagnosed in May, and had my last chemo treatment in November. I also had problems with constipation and some problems with my veins.
Every six months I have a blood test, and have my annual physical exam with my family doctor.
Did you have to make any lifestyle or dietary changes in response to having ovarian cancer?
The hysterectomy instantly threw me into menopause, so I had to learn to deal with waking up at night soaking wet. While I was going through treatment, it required a lot of slowing down. That was really hard for me. I wasn't able to exercise for several weeks after surgery to allow healing. The chemotherapy destroys growth cells and makes healing more difficult. It took a lot longer to recover than I was prepared for. Most people with ovarian cancer have an ongoing battle with treatment, but I was fortunate to not deal with that.
The dietary changes I've made are due to the constipation. I have a lot of scar tissue due to the surgery and chemotherapy, so I have to be sure that I eat lots of fiber, fruits, and vegetables to keep things functioning properly.
Did you seek any type of emotional support?
I think it's very important for anyone who has been diagnosed with a devastating illness to have emotional support. My husband was always there for me. I would tell others I was doing fine, because I knew I had my husband to tell how I was really feeling. One day I just told him I felt like crap! I knew I could always be honest with him, and not have to bring everybody else down. I needed to let my emotions out to someone. I would tell Dan, "I hate how I feel. I hate losing my hair. I hate what's going on." You need to let those emotions out.
My faith in God was also a great emotional support. Knowing that I was secure in my eternity and that God was in control. It was a great time for me to grow as a Christian.
I didn't end up going to a support group, but there were excellent ones in my community. I just had overwhelming support from friends, family, and neighbors. There were meals, calls, flowers, and cards. After each chemotherapy treatment, someone was always there to take over house and family stuff so I could just rest. I had a neighbor who would always bring me chicken noodle soup. It was one of the few things that tasted good to me.
Does ovarian cancer have any impact on your family?
My son really thought I was going to die. He kind of withdrew from me. He wanted to be supportive, but it was really difficult for him. My daughter was more into the "What can I do to help you?" mode. We tried to keep things as positive as possible with the kids.
The initial impact on my husband was fear. He played a huge protector role that I had never seen him in before or after. He wanted to take me away from all the stress. I didn't work one day during the time I was getting treatment. Even though I really thought I wanted to go back to work. It was the first time in 30 years of marriage that he did all the cleaning, cooking, and all the laundry. I think the job he assumed was that he would make me get better.
What advice would you give to anyone living with ovarian cancer?
The first thing you have to get a hold of is hope. You are not a statistic. Be secure in Jeremiah 29:11, which says, "I know the plans I have for you, says the Lord. They are plans for good and not for evil."
Secondly, arm yourself with education before you let anyone treat you, and learn everything you can about that particular kind of cancer. Make sure you are working with a specialist in that particular kind of cancer. It can be the difference between life and death. Treatment is changing fast so keep up to date on your options. Be sure you're getting the most current and recommended treatment.
Thirdly, keep a sense of humor. Look at the things that are happening around you and see the things that are funny about them. If you don't, you'll be miserable.
Fourthly, accept the gift of family and friends. People want to feel like they can do something for you. Enjoy the moment-it's a blessing during the time of stress.
And lastly, rely on your faith. God has given us so many good words of encouragement, hope, and promise. Take that time and use it to grow in your faith. It can be a very peaceful time in your life.
Health Screening for Men
by Elizabeth Smoots, MD
In March 2000, the Commonwealth Fund, a private health research foundation, published the largest and most extensive study of its kind based on data from a Harris poll of 1,500 men and 2,850 women across the nation. Among its findings about the health care of men:
One in four men try to wait as long as possible before getting advice for a health problem
One in three do not have a regular provider to contact for medical advice
More than half do not get regular screenings or preventive care
Perhaps less vigilant medical care is one of the reasons that men have an average lifespan that is seven years shorter than women. Men also, according to an article in the January 2002 USA edition of the British Medical Journal, have a higher mortality rate than women for all 15 leading causes of death in this country.
But you can help buck these national trends by making sure to get the medical care you need. The first step is to choose your own primary care provider. This should be someone you respect and feel comfortable talking to about health concerns. The next step is to start getting regular preventive care. Why? Because many of the silent killers such as high blood pressure, high cholesterol, and the onset of cancer can only be detected during a checkup. The basic idea is to detect disease early while it is less advanced, much easier to treat, and a lot less likely to kill you.
Cancer Screening
Colorectal Cancer: Starting at age 50, consult your doctor about getting screened for colorectal cancer. Screening options include:
Stool testing for hidden blood - testing stool samples collected at home annually
Sigmoidoscopy – using a flexible, lighted tube to view the lower colon once every five years
Annual stool testing plus sigmoidoscopy every five years
Barium enema with double contrast - an x-ray test of the colon every five years
Colonoscopy - examining the entire colon with a long, flexible, lighted tube every ten years
Men at increased risk for colon cancer may need to begin screening earlier and have it done more frequently. Factors that increase risk include a family history of colon cancer or polyps, or a personal history of colon cancer, polyps, or inflammatory bowel disease.
Prostate Cancer: Each year starting at age 50, talk to your doctor about the possible benefits and harms of prostate cancer screening. Available tests include a blood test called prostate-specific antigen (PSA), or a rectal exam to check for lumps in the prostate.
Men at increased risk for prostate cancer may need to begin screening earlier and have it done more frequently. Factors that increase risk include black race and family history of prostate cancer.
Testicular Cancer: Beginning in your teens, learn to do a monthly self-exam. See your provider regularly for a testicular exam and call promptly if you find a lump. This cancer most commonly occurs in men ages 15–40 as well as in those with a family history of the disease, or who have a testicle that is out of normal position. Men at increased risk need more frequent screening.
Skin Cancer: Get a total body skin exam by your doctor every three years if you’re between the ages 20 and 39, or yearly after age 40. It’s also a good idea to learn to examine your own skin monthly for telltale signs of skin cancer.
Heart Disease Screening
Have your blood pressure checked at least every two years. Your doctor may recommend checking it more often if you’re at increased risk. Risk factors include a family history of high blood pressure, African American race, above-normal weight, or age greater than 50.
Have your cholesterol checked at least every five years, starting at age 35. Begin at age 20 and have it checked more often if you have risk factors for heart disease such as smoking, diabetes, high blood pressure, or a family history of heart disease.
Dental Screening
At least once or twice a year, have a dentist examine your teeth, gums, and mouth. Your dentist may also recommend periodic x-rays to check for cavities and other problems.
Vision Screening
After age 40, have your eyes checked periodically, especially if you have risk factors for eye disease. These include a personal or family history of eye disease, chronic disease such as diabetes or high blood pressure, or African-American race. After age 65 it’s especially important to make sure you’re having your eyes examined on a regular basis.
Miscellaneous Tests
Ask your doctor about a blood test to screen for diabetes if you have high blood pressure, high cholesterol, a family history or other risk factors for the disease, or are overweight.
Talk to your doctor to see whether you should be screened for sexually transmitted diseases such as AIDS.
Men of all ages can take advantage of regular preventive care. Doing so may help you live a longer, healthier, and more active life.
RESOURCES:
Agency for Healthcare Research and Quality
http://www.ahrq.gov
American Cancer Society
http://www.cancer.org
American Heart Association
http://www.americanheart.org
US Preventive Services Task Force
http://www.ahrq.gov/clinic/uspstfix.htm
by Elizabeth Smoots, MD
In March 2000, the Commonwealth Fund, a private health research foundation, published the largest and most extensive study of its kind based on data from a Harris poll of 1,500 men and 2,850 women across the nation. Among its findings about the health care of men:
One in four men try to wait as long as possible before getting advice for a health problem
One in three do not have a regular provider to contact for medical advice
More than half do not get regular screenings or preventive care
Perhaps less vigilant medical care is one of the reasons that men have an average lifespan that is seven years shorter than women. Men also, according to an article in the January 2002 USA edition of the British Medical Journal, have a higher mortality rate than women for all 15 leading causes of death in this country.
But you can help buck these national trends by making sure to get the medical care you need. The first step is to choose your own primary care provider. This should be someone you respect and feel comfortable talking to about health concerns. The next step is to start getting regular preventive care. Why? Because many of the silent killers such as high blood pressure, high cholesterol, and the onset of cancer can only be detected during a checkup. The basic idea is to detect disease early while it is less advanced, much easier to treat, and a lot less likely to kill you.
Cancer Screening
Colorectal Cancer: Starting at age 50, consult your doctor about getting screened for colorectal cancer. Screening options include:
Stool testing for hidden blood - testing stool samples collected at home annually
Sigmoidoscopy – using a flexible, lighted tube to view the lower colon once every five years
Annual stool testing plus sigmoidoscopy every five years
Barium enema with double contrast - an x-ray test of the colon every five years
Colonoscopy - examining the entire colon with a long, flexible, lighted tube every ten years
Men at increased risk for colon cancer may need to begin screening earlier and have it done more frequently. Factors that increase risk include a family history of colon cancer or polyps, or a personal history of colon cancer, polyps, or inflammatory bowel disease.
Prostate Cancer: Each year starting at age 50, talk to your doctor about the possible benefits and harms of prostate cancer screening. Available tests include a blood test called prostate-specific antigen (PSA), or a rectal exam to check for lumps in the prostate.
Men at increased risk for prostate cancer may need to begin screening earlier and have it done more frequently. Factors that increase risk include black race and family history of prostate cancer.
Testicular Cancer: Beginning in your teens, learn to do a monthly self-exam. See your provider regularly for a testicular exam and call promptly if you find a lump. This cancer most commonly occurs in men ages 15–40 as well as in those with a family history of the disease, or who have a testicle that is out of normal position. Men at increased risk need more frequent screening.
Skin Cancer: Get a total body skin exam by your doctor every three years if you’re between the ages 20 and 39, or yearly after age 40. It’s also a good idea to learn to examine your own skin monthly for telltale signs of skin cancer.
Heart Disease Screening
Have your blood pressure checked at least every two years. Your doctor may recommend checking it more often if you’re at increased risk. Risk factors include a family history of high blood pressure, African American race, above-normal weight, or age greater than 50.
Have your cholesterol checked at least every five years, starting at age 35. Begin at age 20 and have it checked more often if you have risk factors for heart disease such as smoking, diabetes, high blood pressure, or a family history of heart disease.
Dental Screening
At least once or twice a year, have a dentist examine your teeth, gums, and mouth. Your dentist may also recommend periodic x-rays to check for cavities and other problems.
Vision Screening
After age 40, have your eyes checked periodically, especially if you have risk factors for eye disease. These include a personal or family history of eye disease, chronic disease such as diabetes or high blood pressure, or African-American race. After age 65 it’s especially important to make sure you’re having your eyes examined on a regular basis.
Miscellaneous Tests
Ask your doctor about a blood test to screen for diabetes if you have high blood pressure, high cholesterol, a family history or other risk factors for the disease, or are overweight.
Talk to your doctor to see whether you should be screened for sexually transmitted diseases such as AIDS.
Men of all ages can take advantage of regular preventive care. Doing so may help you live a longer, healthier, and more active life.
RESOURCES:
Agency for Healthcare Research and Quality
http://www.ahrq.gov
American Cancer Society
http://www.cancer.org
American Heart Association
http://www.americanheart.org
US Preventive Services Task Force
http://www.ahrq.gov/clinic/uspstfix.htm
Managing Chronic Low Back Pain
by Richard Glickman-Simon, MD
If you never suffer from low back pain, consider yourself one of the fortunate few. Up to 85% of people living in industrialized countries will experience low back pain at some point in their lives, and 30% will say their backs hurt right now. Back pain is the most common reason for Americans under the age of 45 to limit their activity. It is the second most common reason for visits to the doctor, and the third most common cause of surgery.
There is some good news, though. With or without medical treatment, most people recover from an acute episode in a few days or weeks, and about 90% will be pain-free within three months. But for many people, low back pain becomes a chronic or recurrent condition, often resulting in considerable social and occupational disability.
Why So Common?
Many factors contribute to low back pain—inadequate fitness, heavy lifting, poor posture. But our evolutionary history is to blame for our susceptibility to this pain. At some point in the distant past, some of our ancestors decided to stand on two feet, presumably so their hands would be free to fashion tools and use them efficiently. While their reasons were good, going vertical was not without its drawbacks.
Walking around on all fours distributes the force of gravity evenly over the length of the spine. Standing up, however, concentrates this force in one location—the lumbosacral region, just north of the buttocks. Our vulnerability to low back pain is the price we pay for bipedal locomotion.
Several factors can contribute to persistent back pain:
Work-related injury, particularly if the work environment requires or allows use of improper body mechanics (e.g., bending or twisting when lifting)
Poor ergonomics for sedentary workers
Degenerative disease (e.g., arthritis) of the spine, with or without intervertebral disk disease
No Obvious Cause
Most cases of chronic back pain are idiopathic, meaning they have no clear explanation. Without a known cause, treatment is very difficult and often unsuccessful. This leads many people to alternative therapies. Below are among the most commonly used therapies to treat chronic low back pain:
Chiropractic
Acupuncture
Massage
There is some evidence that, at least in the short-term, each of these therapies may be effective at alleviating discomfort, improving function, and/or enhancing a sense of well-being. However, it is unclear if any one of them is superior to the other or to physical therapy, the standard conventional treatment; furthermore, it is not clear that any of these approaches provide more than short-term benefit.
More Is Better
So what then is the best treatment for chronic low back pain?
According to evidence, what seems to matter is not which one, but how many treatments you use. In a careful review of 10 studies totaling 1,964 subjects with low back pain, researchers found that intensive multidisciplinary biopsychosocial rehabilitation (MBR) was significantly better at restoring function and reducing pain than single-disciplinary approaches.
In other words, interventions that addressed not only the physical aspects of the pain, but also its psychological, social, and occupational influences, were the most effective. Biopsychosocial rehabilitation programs include the following:
Cognitive-behavioral therapy
Massage
Exercise
Relaxation
Hydrotherapy
Transcutaneous nerve stimulation (low energy electrical impulses delivered to nerves in the back)
Heat and cold application
Complex Solutions for Complex Problems
This combination of therapies makes a lot of sense. It is well known that an enormously complex range of factors, affecting many aspects of life, contribute to our experience of chronic pain. It is hard to imagine, then, that any single intervention—alternative or conventional—could succeed. An alternative therapy, therefore, should be part of a multidimensional treatment strategy.
Some people are skeptical of this comprehensive approach. Although review noted above found positive results, other studies have failed to find that even the most complex and expensive treatments make a great deal of difference. Chronic back pain is simply a difficult problem, and one that current medical techniques do not address with great success.
Where Do We Go From Here?
If you suffer from idiopathic chronic pain anywhere in your body consider the following steps:
Recognize that your condition is a complicated problem that cannot be treated in isolation. This is the first step to gaining control over your pain and your life.
Determine which facets of your pain have not been adequately addressed—psychological, social, occupational, and/or physical. Tackling this problem from only one perspective is unlikely to work.
Continue working with your primary care physician. He or she is in the best position to coordinate a comprehensive, multidisciplinary treatment plan, whether or not it includes alternative therapies.
Strive for restore function. Your goal should be to resume your normal activities, not only to reduce your pain. Although the two are closely linked, the evidence suggests that focusing on function is the key to recovery.
Look both ways. Look ahead to visualize what it will be like to have no pain or disability. But also look back to measure your progress. It is easier to succeed when you see how far you've come.
by Richard Glickman-Simon, MD
If you never suffer from low back pain, consider yourself one of the fortunate few. Up to 85% of people living in industrialized countries will experience low back pain at some point in their lives, and 30% will say their backs hurt right now. Back pain is the most common reason for Americans under the age of 45 to limit their activity. It is the second most common reason for visits to the doctor, and the third most common cause of surgery.
There is some good news, though. With or without medical treatment, most people recover from an acute episode in a few days or weeks, and about 90% will be pain-free within three months. But for many people, low back pain becomes a chronic or recurrent condition, often resulting in considerable social and occupational disability.
Why So Common?
Many factors contribute to low back pain—inadequate fitness, heavy lifting, poor posture. But our evolutionary history is to blame for our susceptibility to this pain. At some point in the distant past, some of our ancestors decided to stand on two feet, presumably so their hands would be free to fashion tools and use them efficiently. While their reasons were good, going vertical was not without its drawbacks.
Walking around on all fours distributes the force of gravity evenly over the length of the spine. Standing up, however, concentrates this force in one location—the lumbosacral region, just north of the buttocks. Our vulnerability to low back pain is the price we pay for bipedal locomotion.
Several factors can contribute to persistent back pain:
Work-related injury, particularly if the work environment requires or allows use of improper body mechanics (e.g., bending or twisting when lifting)
Poor ergonomics for sedentary workers
Degenerative disease (e.g., arthritis) of the spine, with or without intervertebral disk disease
No Obvious Cause
Most cases of chronic back pain are idiopathic, meaning they have no clear explanation. Without a known cause, treatment is very difficult and often unsuccessful. This leads many people to alternative therapies. Below are among the most commonly used therapies to treat chronic low back pain:
Chiropractic
Acupuncture
Massage
There is some evidence that, at least in the short-term, each of these therapies may be effective at alleviating discomfort, improving function, and/or enhancing a sense of well-being. However, it is unclear if any one of them is superior to the other or to physical therapy, the standard conventional treatment; furthermore, it is not clear that any of these approaches provide more than short-term benefit.
More Is Better
So what then is the best treatment for chronic low back pain?
According to evidence, what seems to matter is not which one, but how many treatments you use. In a careful review of 10 studies totaling 1,964 subjects with low back pain, researchers found that intensive multidisciplinary biopsychosocial rehabilitation (MBR) was significantly better at restoring function and reducing pain than single-disciplinary approaches.
In other words, interventions that addressed not only the physical aspects of the pain, but also its psychological, social, and occupational influences, were the most effective. Biopsychosocial rehabilitation programs include the following:
Cognitive-behavioral therapy
Massage
Exercise
Relaxation
Hydrotherapy
Transcutaneous nerve stimulation (low energy electrical impulses delivered to nerves in the back)
Heat and cold application
Complex Solutions for Complex Problems
This combination of therapies makes a lot of sense. It is well known that an enormously complex range of factors, affecting many aspects of life, contribute to our experience of chronic pain. It is hard to imagine, then, that any single intervention—alternative or conventional—could succeed. An alternative therapy, therefore, should be part of a multidimensional treatment strategy.
Some people are skeptical of this comprehensive approach. Although review noted above found positive results, other studies have failed to find that even the most complex and expensive treatments make a great deal of difference. Chronic back pain is simply a difficult problem, and one that current medical techniques do not address with great success.
Where Do We Go From Here?
If you suffer from idiopathic chronic pain anywhere in your body consider the following steps:
Recognize that your condition is a complicated problem that cannot be treated in isolation. This is the first step to gaining control over your pain and your life.
Determine which facets of your pain have not been adequately addressed—psychological, social, occupational, and/or physical. Tackling this problem from only one perspective is unlikely to work.
Continue working with your primary care physician. He or she is in the best position to coordinate a comprehensive, multidisciplinary treatment plan, whether or not it includes alternative therapies.
Strive for restore function. Your goal should be to resume your normal activities, not only to reduce your pain. Although the two are closely linked, the evidence suggests that focusing on function is the key to recovery.
Look both ways. Look ahead to visualize what it will be like to have no pain or disability. But also look back to measure your progress. It is easier to succeed when you see how far you've come.
Tips for Getting a Good Night of Sleep
by Mary Calvagna, MS
Have you been tossing and turning and wondering if you will ever fall asleep? You are not alone--more than half of adults have trouble falling alseep. Learn why sleep is so important and what you can do to get some.
Here's Why:
During sleep, the body repairs itself and revitalizes organs and muscles. In addition, sleep is important for proper functioning of the immune system and the nervous system. Lack of sleep can result in:
Increased feelings of stress
Impaired memory
Shortened temper
Lower motivation
Slower reflexes
More mistakes
But a good night of sleep can be elusive. A survey conducted by the National Sleep Foundation found that 60% of adults have problems falling asleep at least a few nights a week.
Here's How:
Keep regular hours - Try to go to bed at the same time each night and wake up at the same time each morning, even on weekends.
Develop a sleep ritual - Whether it is to take a hot bath, have a cup of herbal tea, or read a book, doing the same things each night just before bed cues your body to settle down for the night.
Exercise regularly - Exercise can help relieve tension. But be careful not to exercise too close to bedtime or you may have a hard time falling asleep.
Cut down on stimulants - Consuming stimulants, such as caffeine, in the evening interferes with falling asleep and prevents deep sleep. Instead, have a cup of herbal tea, which is non-caffeinated, before bed.
Don't smoke - Smokers tend to take longer to fall asleep, awaken more often, and experience disrupted, fragmented sleep.
Drink alcohol in moderation - You may fall asleep faster, but drinking alcohol shortly before bedtime interrupts and fragments sleep, leading to poor quality sleep.
Unwind early in the evening - Deal with worries and distractions several hours before going to bed. Make a list of things you need to do tomorrow, so you won't think about them all night. Try relaxation exercises, like slow rhythmic breathing, once in bed.
Sleep on a comfortable, supportive mattress and foundation - It's difficult to get deep, restful sleep on a bed that's too small, too soft, or too hard.
Create a restful sleep environment - A dark, quiet room is more conducive to sleep. Sudden, loud noises or bright lights can disrupt sleep. A room that is too hot or too cold can disturb sleep as well. The ideal bedroom temperature is between 60 and 65 degrees Fahrenheit.
Use the bedroom only for sleep and sex - Don't use the bedroom for things like paying bills, watching television, or discussing the problems of the day. Instead, use the bedroom just for sleep and sex.
Make sleep a priority - Say "yes" to sleep even when you're tempted to stay up late. You'll feel healthier, refreshed, and ready to take on the day
Take prescribed sleep medications as directed - Sleep medications should only be used temporarily and as a last resort. If you do use them., it is best to take prescribed sleeping pills one hour before bedtime, so they cause drowsiness by the time you lie down, and 10 hours before you plan on getting up, to avoid daytime drowsiness. Always talk with your doctor before taking sleeping pills, including over-the-counter brands. Tolerance can develop rapidly with these medications and some have the potential to become addictive.
RESOURCES:
A Good Night's Sleep
National Institute on Aging, National Institutes of Health
http://www.niapublications.org
National Sleep Foundation
http://www.sleepfoundation.org
Sources:
National Institutes of Health
http://www.nih.gov
National Sleep Foundation
http://www.sleepfoundation.org
by Mary Calvagna, MS
Have you been tossing and turning and wondering if you will ever fall asleep? You are not alone--more than half of adults have trouble falling alseep. Learn why sleep is so important and what you can do to get some.
Here's Why:
During sleep, the body repairs itself and revitalizes organs and muscles. In addition, sleep is important for proper functioning of the immune system and the nervous system. Lack of sleep can result in:
Increased feelings of stress
Impaired memory
Shortened temper
Lower motivation
Slower reflexes
More mistakes
But a good night of sleep can be elusive. A survey conducted by the National Sleep Foundation found that 60% of adults have problems falling asleep at least a few nights a week.
Here's How:
Keep regular hours - Try to go to bed at the same time each night and wake up at the same time each morning, even on weekends.
Develop a sleep ritual - Whether it is to take a hot bath, have a cup of herbal tea, or read a book, doing the same things each night just before bed cues your body to settle down for the night.
Exercise regularly - Exercise can help relieve tension. But be careful not to exercise too close to bedtime or you may have a hard time falling asleep.
Cut down on stimulants - Consuming stimulants, such as caffeine, in the evening interferes with falling asleep and prevents deep sleep. Instead, have a cup of herbal tea, which is non-caffeinated, before bed.
Don't smoke - Smokers tend to take longer to fall asleep, awaken more often, and experience disrupted, fragmented sleep.
Drink alcohol in moderation - You may fall asleep faster, but drinking alcohol shortly before bedtime interrupts and fragments sleep, leading to poor quality sleep.
Unwind early in the evening - Deal with worries and distractions several hours before going to bed. Make a list of things you need to do tomorrow, so you won't think about them all night. Try relaxation exercises, like slow rhythmic breathing, once in bed.
Sleep on a comfortable, supportive mattress and foundation - It's difficult to get deep, restful sleep on a bed that's too small, too soft, or too hard.
Create a restful sleep environment - A dark, quiet room is more conducive to sleep. Sudden, loud noises or bright lights can disrupt sleep. A room that is too hot or too cold can disturb sleep as well. The ideal bedroom temperature is between 60 and 65 degrees Fahrenheit.
Use the bedroom only for sleep and sex - Don't use the bedroom for things like paying bills, watching television, or discussing the problems of the day. Instead, use the bedroom just for sleep and sex.
Make sleep a priority - Say "yes" to sleep even when you're tempted to stay up late. You'll feel healthier, refreshed, and ready to take on the day
Take prescribed sleep medications as directed - Sleep medications should only be used temporarily and as a last resort. If you do use them., it is best to take prescribed sleeping pills one hour before bedtime, so they cause drowsiness by the time you lie down, and 10 hours before you plan on getting up, to avoid daytime drowsiness. Always talk with your doctor before taking sleeping pills, including over-the-counter brands. Tolerance can develop rapidly with these medications and some have the potential to become addictive.
RESOURCES:
A Good Night's Sleep
National Institute on Aging, National Institutes of Health
http://www.niapublications.org
National Sleep Foundation
http://www.sleepfoundation.org
Sources:
National Institutes of Health
http://www.nih.gov
National Sleep Foundation
http://www.sleepfoundation.org
How Do You Feed Yourself?
I feel about airplanes the way I feel about diets. It seems to me they are wonderful things for other people to go on.
-Jean Kerr
From "If the Buddha Came to Dinner: How to Nourish Your Body and Awaken Your Spirit" by Halé Sofia Schatz with Shira Shaiman:
Most of us let our eyes decide what our bodies need. Our ideas about what we eat are more important than the food itself, what our stomachs can hold, or what we need in this moment for good, strong energy. Our families, social situations, society, and marketing campaigns dictate the choices most people make about how they feed themselves. Sometimes we’re provided with very useful guidelines and models. But you need to stop and ask: Are you feeding yourself in ways that personally make sense to your body’s unique and ever-changing needs and rhythms?
In this country, food is available all the time. Unlike our ancestors who ate in harmony with seasonal cycles of abundance and scarcity, harvest and hunting, we east as though we’re constantly feasting. Really, we eat nonstop. We fill our stomachs until we’re uncomfortable, and we put more food in the shopping cart than we need. This abundance of food and our own fast-paced convenience culture keep us from recognizing our own personal rhythms. We eat for many reasons, not necessarily because we’re physically hungry or need certain nutrients to keep healthy.
With more and more processed foods in the marketplace, obesity in adults and children dramatically on the rise, and digestive problems increasingly more common, it’s clear that we’re facing a serious health crisis. The answer, however, isn’t to just put Americans on a diet. Reducing the intake of refined and processed foods and increasing fresh produce and whole grains certainly can improve one’s health. But we need more. We need to feed ourselves with a sense of purpose, focus, self-love, and passion for our lives.
* * *
I feel about airplanes the way I feel about diets. It seems to me they are wonderful things for other people to go on.
-Jean Kerr
From "If the Buddha Came to Dinner: How to Nourish Your Body and Awaken Your Spirit" by Halé Sofia Schatz with Shira Shaiman:
Most of us let our eyes decide what our bodies need. Our ideas about what we eat are more important than the food itself, what our stomachs can hold, or what we need in this moment for good, strong energy. Our families, social situations, society, and marketing campaigns dictate the choices most people make about how they feed themselves. Sometimes we’re provided with very useful guidelines and models. But you need to stop and ask: Are you feeding yourself in ways that personally make sense to your body’s unique and ever-changing needs and rhythms?
In this country, food is available all the time. Unlike our ancestors who ate in harmony with seasonal cycles of abundance and scarcity, harvest and hunting, we east as though we’re constantly feasting. Really, we eat nonstop. We fill our stomachs until we’re uncomfortable, and we put more food in the shopping cart than we need. This abundance of food and our own fast-paced convenience culture keep us from recognizing our own personal rhythms. We eat for many reasons, not necessarily because we’re physically hungry or need certain nutrients to keep healthy.
With more and more processed foods in the marketplace, obesity in adults and children dramatically on the rise, and digestive problems increasingly more common, it’s clear that we’re facing a serious health crisis. The answer, however, isn’t to just put Americans on a diet. Reducing the intake of refined and processed foods and increasing fresh produce and whole grains certainly can improve one’s health. But we need more. We need to feed ourselves with a sense of purpose, focus, self-love, and passion for our lives.
* * *
Acquired Immunodeficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV)
by Rick Alan
Definition
Acquired immunodeficiency syndrome (AIDS) is an illness that weakens the body's immune system. The immune systems of people with AIDS are not able to fight off certain infections and cancers.
Causes
AIDS is caused by the human immunodeficiency virus (HIV), which destroys important immune system cells. HIV is spread through contact with HIV-infected blood or other body fluids including semen, vaginal fluid, and breast milk.
HIV is spread through:
Sexual contact with an HIV-infected person, especially intercourse or anal sex
Transfer of HIV from a mother to child during pregnancy, childbirth, or breastfeeding
Being pricked by an HIV-contaminated needle
Blood transfusion with HIV-infected blood (rare today, due to testing of all donated blood for HIV infection beginning in 1985)
Rarely, HIV can be spread through:
Blood from an HIV-infected person getting into an open wound of another person
Being bitten by someone infected with HIV
Sharing of personal hygiene items with an HIV-infected person (razors, toothbrushes, etc.)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Multiple sexual partners
Sharing needles for injecting drugs
Regular exposure to HIV-contaminated blood or other body fluids (a concern for health care workers)
Infant born to an HIV-infected mother
Receiving donor blood products, tissue, organs, or artificial insemination
Immigrants from geographic locations with high numbers of AIDS patients (east central Africa and Haiti)
Sexual relationship with a high risk individual or a partner already infected with HIV
Symptoms
HIV may not cause symptoms for a number of years.
Early symptoms that you may experience a month or two after becoming infected may last a couple of weeks. These include:
Rapid weight loss
Dry cough
Recurring fever
Night sweats
Extreme, unexplained fatigue
Swollen lymph nodes in armpits, neck, or groin
White spots on the tongue or in the mouth or throat
Headache
Discomfort from light
Rash
Depression
Irritable mood
Memory loss or other neurological disorder
After these initial symptoms are gone, there may be no symptoms for months to years. Then, the following symptoms may occur over the course of 1–3 years:
Swollen lymph glands all over the body
Fungal infections of the mouth, fingernails, toes
Repeated vaginal infections (yeast and trichomonas)
Development of lots of warts
Exacerbations of prior conditions, such as eczema, psoriasis, herpes infection
Shingles
Night sweats
Weight loss
Chronic diarrhea
Once HIV has progressed to AIDS, the immune system has become quite weakened. Opportunistic infections are infections that people with a normal immune system don't usually get. These infections occur in patients with AIDS because the immune system isn't able to fight them off. Examples of opportunistic infections and other complications of AIDS include:
Thrush (an overgrowth of yeast)
Pneumonia (particularly Pneumocystis carinii pneumonia)
Invasive fungal infections (resulting in brain and/or lung infections)
Toxoplasmosis infection
Tuberculosis
Viral brain infection
Kaposi's sarcoma
Lymphoma
Cervical cancer
Eye disease due to cytomegalovirus infection
Intestinal infections, especially due to Shigella, Salmonella, and Campylobacter
Severe weight loss (wasting syndrome)
Severe skin rashes
Reactions to medications
Psychiatric problems, including depression and dementia
Diagnosis
The doctor will ask about your symptoms, medical history, and risk factors, and perform a physical exam.
A blood test called an ELISA test is used to detect HIV infection. If an ELISA test is positive, the Western blot blood test is usually done to confirm the diagnosis. The ELISA test may be negative if you were infected with HIV recently. Many people (95%) will have a positive test within three months. Most people (99%) will have a positive test within six months. If an ELISA test is negative, but you think you may have HIV, you should be tested again in 1–3 months.
Treatment
With medication, the development of AIDS can be prevented, delayed, or controlled in many people infected with HIV.
Drugs That Fight HIV
These drugs are often given in combination, referred to popularly as "AIDS cocktails." They include:
Nucleoside reverse transcriptase inhibitors:
AZT (zidovudine or ZDV)
ddC (zalcitabine)
ddI (dideoxyinosine)
d4T (stavudine)
3TC (lamivudine)
Non-nucleoside reverse transriptase inhibitors:
Delvaridine (Rescriptor)
Nevirapine (Viramune)
Efravirenz (Sustiva)
Protease inhibitors:
Ritonavir (norvir)
Saquinivir (invirase)
Indinavir (crixivan)
Amprenivir (Agenerase)
Nelfinavir (Viracept)
Lopinavir (Kaletra)
Drugs That Fight AIDS-related Infections and Cancers
People who have developed AIDS are treated with numerous drugs that help prevent:
Pneumonia
Thrush
Repeated herpes infections
Toxoplasmic brain infections
Prevention
To prevent becoming infected with HIV:
Abstain from sex or use a male latex condom. This includes intercourse and any other sexual acts that result in the exchange of bodily fluids.
Do not share needles for drug injection.
Limit your number of sexual partners.
Avoid sexual partners who are HIV-infected or injection drug users.
Avoid receiving transfusion of unscreened blood products.
If you are a health care worker:
Wear latex gloves and facial masks during all procedures.
Carefully handle and properly dispose of needles.
Carefully follow universal precautions (a detailed list of how to handle such things as needles and other biohazard materials).
If you live in a household with an HIV-infected person:
Wear latex gloves if handling HIV-infected bodily fluids.
Cover all cuts and sores (yours and the HIV-infected person's) with bandages.
Do not share any personal hygiene items (razors, toothbrushes, etc.).
Carefully handle and properly dispose of needles used for medication.
To prevent spreading HIV to others if you are HIV infected:
Abstain from sex or use a male latex condom. This includes intercourse and any other sexual acts that result in the exchange of bodily fluids.
Inform former or potential sexual partners.
Do not donate blood or organs.
Try not to get pregnant. If you are sexually active, ask for professional advice about contraception.
If you have a baby, do not breastfeed.
RESOURCES:
AIDS Action
http://www.aidsaction.org
American Foundation for AIDS Research
http://www.amfar.org
References:
Centers for Disease Control and Prevention
The Merck Manual of Medical Information. Simon and Schuster, Inc.; 2000.
National Center for HIV, STD, and Tuberculosis Prevention
by Rick Alan
Definition
Acquired immunodeficiency syndrome (AIDS) is an illness that weakens the body's immune system. The immune systems of people with AIDS are not able to fight off certain infections and cancers.
Causes
AIDS is caused by the human immunodeficiency virus (HIV), which destroys important immune system cells. HIV is spread through contact with HIV-infected blood or other body fluids including semen, vaginal fluid, and breast milk.
HIV is spread through:
Sexual contact with an HIV-infected person, especially intercourse or anal sex
Transfer of HIV from a mother to child during pregnancy, childbirth, or breastfeeding
Being pricked by an HIV-contaminated needle
Blood transfusion with HIV-infected blood (rare today, due to testing of all donated blood for HIV infection beginning in 1985)
Rarely, HIV can be spread through:
Blood from an HIV-infected person getting into an open wound of another person
Being bitten by someone infected with HIV
Sharing of personal hygiene items with an HIV-infected person (razors, toothbrushes, etc.)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Multiple sexual partners
Sharing needles for injecting drugs
Regular exposure to HIV-contaminated blood or other body fluids (a concern for health care workers)
Infant born to an HIV-infected mother
Receiving donor blood products, tissue, organs, or artificial insemination
Immigrants from geographic locations with high numbers of AIDS patients (east central Africa and Haiti)
Sexual relationship with a high risk individual or a partner already infected with HIV
Symptoms
HIV may not cause symptoms for a number of years.
Early symptoms that you may experience a month or two after becoming infected may last a couple of weeks. These include:
Rapid weight loss
Dry cough
Recurring fever
Night sweats
Extreme, unexplained fatigue
Swollen lymph nodes in armpits, neck, or groin
White spots on the tongue or in the mouth or throat
Headache
Discomfort from light
Rash
Depression
Irritable mood
Memory loss or other neurological disorder
After these initial symptoms are gone, there may be no symptoms for months to years. Then, the following symptoms may occur over the course of 1–3 years:
Swollen lymph glands all over the body
Fungal infections of the mouth, fingernails, toes
Repeated vaginal infections (yeast and trichomonas)
Development of lots of warts
Exacerbations of prior conditions, such as eczema, psoriasis, herpes infection
Shingles
Night sweats
Weight loss
Chronic diarrhea
Once HIV has progressed to AIDS, the immune system has become quite weakened. Opportunistic infections are infections that people with a normal immune system don't usually get. These infections occur in patients with AIDS because the immune system isn't able to fight them off. Examples of opportunistic infections and other complications of AIDS include:
Thrush (an overgrowth of yeast)
Pneumonia (particularly Pneumocystis carinii pneumonia)
Invasive fungal infections (resulting in brain and/or lung infections)
Toxoplasmosis infection
Tuberculosis
Viral brain infection
Kaposi's sarcoma
Lymphoma
Cervical cancer
Eye disease due to cytomegalovirus infection
Intestinal infections, especially due to Shigella, Salmonella, and Campylobacter
Severe weight loss (wasting syndrome)
Severe skin rashes
Reactions to medications
Psychiatric problems, including depression and dementia
Diagnosis
The doctor will ask about your symptoms, medical history, and risk factors, and perform a physical exam.
A blood test called an ELISA test is used to detect HIV infection. If an ELISA test is positive, the Western blot blood test is usually done to confirm the diagnosis. The ELISA test may be negative if you were infected with HIV recently. Many people (95%) will have a positive test within three months. Most people (99%) will have a positive test within six months. If an ELISA test is negative, but you think you may have HIV, you should be tested again in 1–3 months.
Treatment
With medication, the development of AIDS can be prevented, delayed, or controlled in many people infected with HIV.
Drugs That Fight HIV
These drugs are often given in combination, referred to popularly as "AIDS cocktails." They include:
Nucleoside reverse transcriptase inhibitors:
AZT (zidovudine or ZDV)
ddC (zalcitabine)
ddI (dideoxyinosine)
d4T (stavudine)
3TC (lamivudine)
Non-nucleoside reverse transriptase inhibitors:
Delvaridine (Rescriptor)
Nevirapine (Viramune)
Efravirenz (Sustiva)
Protease inhibitors:
Ritonavir (norvir)
Saquinivir (invirase)
Indinavir (crixivan)
Amprenivir (Agenerase)
Nelfinavir (Viracept)
Lopinavir (Kaletra)
Drugs That Fight AIDS-related Infections and Cancers
People who have developed AIDS are treated with numerous drugs that help prevent:
Pneumonia
Thrush
Repeated herpes infections
Toxoplasmic brain infections
Prevention
To prevent becoming infected with HIV:
Abstain from sex or use a male latex condom. This includes intercourse and any other sexual acts that result in the exchange of bodily fluids.
Do not share needles for drug injection.
Limit your number of sexual partners.
Avoid sexual partners who are HIV-infected or injection drug users.
Avoid receiving transfusion of unscreened blood products.
If you are a health care worker:
Wear latex gloves and facial masks during all procedures.
Carefully handle and properly dispose of needles.
Carefully follow universal precautions (a detailed list of how to handle such things as needles and other biohazard materials).
If you live in a household with an HIV-infected person:
Wear latex gloves if handling HIV-infected bodily fluids.
Cover all cuts and sores (yours and the HIV-infected person's) with bandages.
Do not share any personal hygiene items (razors, toothbrushes, etc.).
Carefully handle and properly dispose of needles used for medication.
To prevent spreading HIV to others if you are HIV infected:
Abstain from sex or use a male latex condom. This includes intercourse and any other sexual acts that result in the exchange of bodily fluids.
Inform former or potential sexual partners.
Do not donate blood or organs.
Try not to get pregnant. If you are sexually active, ask for professional advice about contraception.
If you have a baby, do not breastfeed.
RESOURCES:
AIDS Action
http://www.aidsaction.org
American Foundation for AIDS Research
http://www.amfar.org
References:
Centers for Disease Control and Prevention
The Merck Manual of Medical Information. Simon and Schuster, Inc.; 2000.
National Center for HIV, STD, and Tuberculosis Prevention
How to floss
by Karen Schroeder, MS, RD
Dental floss removes plaque from between teeth and at the gumline. Plaque is a sticky material containing germs that accumulates on teeth and can lead to gum disease (periodontal disease). The best way to get rid of plaque is to brush and floss your teeth daily. The toothbrush cleans the tops and sides of your teeth. Dental floss cleans in between them. The Academy of General Dentistry recommends flossing at least once a day, for 2-3 minutes.
Flossing also:
Polishes tooth surfaces
Controls bad breath
Increases the chances of keeping your teeth for a lifetime
Steps:
Break off about 18 inches of floss, and wind most of it around one of your middle fingers. Wind the rest around the middle finger of your other hand.
Pinch floss between the thumb and index finger of each hand, leaving about one inch of floss between your two hands.
Pull the floss taut and use a gentle sawing motion to insert it between two teeth.
When the floss reaches the tip of the triangular gum flap, curve the floss into a C shape against one of the teeth. Then slide the floss gently into the space between the tooth and the gum until you feel resistance.
Holding the floss tightly against the tooth, scrape up and down five or six times along the side of the tooth and under the gumline.
Without removing the floss, curve it around the adjacent tooth and scrape that one too.
Floss each tooth thoroughly with a clean section of floss. A turn of each middle finger brings out a fresh section of floss.
After flossing, rinse well with water.
Flossing aids
A pre-threaded flosser or floss holder may be helpful for some people, including:
People just learning to floss
People with limited dexterity
Caretakers who are flossing someone else's teeth
Sources:
The American Dental Hygienists’ Association
http://www.adha.org/
Academy of General Dentistry
http://www.agd.org/
by Karen Schroeder, MS, RD
Dental floss removes plaque from between teeth and at the gumline. Plaque is a sticky material containing germs that accumulates on teeth and can lead to gum disease (periodontal disease). The best way to get rid of plaque is to brush and floss your teeth daily. The toothbrush cleans the tops and sides of your teeth. Dental floss cleans in between them. The Academy of General Dentistry recommends flossing at least once a day, for 2-3 minutes.
Flossing also:
Polishes tooth surfaces
Controls bad breath
Increases the chances of keeping your teeth for a lifetime
Steps:
Break off about 18 inches of floss, and wind most of it around one of your middle fingers. Wind the rest around the middle finger of your other hand.
Pinch floss between the thumb and index finger of each hand, leaving about one inch of floss between your two hands.
Pull the floss taut and use a gentle sawing motion to insert it between two teeth.
When the floss reaches the tip of the triangular gum flap, curve the floss into a C shape against one of the teeth. Then slide the floss gently into the space between the tooth and the gum until you feel resistance.
Holding the floss tightly against the tooth, scrape up and down five or six times along the side of the tooth and under the gumline.
Without removing the floss, curve it around the adjacent tooth and scrape that one too.
Floss each tooth thoroughly with a clean section of floss. A turn of each middle finger brings out a fresh section of floss.
After flossing, rinse well with water.
Flossing aids
A pre-threaded flosser or floss holder may be helpful for some people, including:
People just learning to floss
People with limited dexterity
Caretakers who are flossing someone else's teeth
Sources:
The American Dental Hygienists’ Association
http://www.adha.org/
Academy of General Dentistry
http://www.agd.org/
Osteoporosis
Definition
Osteoporosis is a disease in which bones become weak and brittle. If left unchecked, osteoporosis can progress painlessly until a bone breaks (fracture). Any bone can be affected, but of special concern are fractures of the hip, spine, and wrist.
Causes
Throughout life, old bone is removed and new bone is added to the skeleton. During childhood and adolescence, new bone is added faster than old bone is removed. As a result, bones become heavier, larger and denser. Peak bone mass is reached around age 30. From that point on, more bone is lost than is replaced. If not treated, bone losses may lead to osteoporosis. Osteoporosis is more likely to occur if optimal bone mass was not achieved during the bone-building years.
Bone density also plays a role in bone health. Bone density is determined in part by the amount of calcium, phosphorus and other minerals contained within the framework of the bone. As the mineral content of a bone (especially calcium) decreases, the bone becomes weaker. Getting enough calcium and vitamin D and exercising regularly can help ensure that bones stay strong throughout life.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Sex: female
Age: risk increases with age
Body size: small, underweight women
Race: Caucasian and Asian women
Family members with osteoporosis
Post-menopausal status
Abnormal cessation of menstrual periods (amenorrhea) due to anorexia nervosa, rigorous exercise, or an endocrinological problem
Low-calcium diet
Medications:
Immunosuppressants, such as prednisone and other steroids, methotrexate, cyclosporine
Thyroid drugs
Anticonvulsants
Aluminum-containing antacids
Cholesterol-lowering drugs
Long-term heparin therapy
Low estrogen levels in women
Low testosterone levels in men
Inactive lifestyle
Too little sunlight
Depression
Anorexia
Cigarette smoking
Excessive use of alcohol, coffee and tea
Diseases including:
Liver disease, including cirrhosis
Hyperthyroidism
Scurvy
Alcoholism
Marfan's and Ehler-Danlos syndromes
Cushing's syndrome
Hyperparathyroidism
Cancer, including lymphoma
Gastrointestinal disorders
Symptoms
Osteoporosis does not usually cause symptoms. Pain is the only symptom, and generally occurs when the bones have broken or collapsed.
Symptoms include:
Severe back pain with fracture of the vertebrae, wrists, hips, or other bones
Loss of height, with stooped posture (kyphosis)
Kyphosis
Copyright © 2005 Nucleus Communications, Inc. All rights reserved. www.nucleusinc.com
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Early signs of osteoporosis can be detected with bone density testing.
Bone density testing techniques include:
Dual-energy x-ray absorptiometry - measures bone density in the entire body
Single-energy x-ray absorptiometry - measures bone density in the arm or heel
Dental x-rays of bone
Ultrasound bone density measurement - measures bone density in fingers, heels, leg bones
Other tests may include:
Blood and urine tests - to test for calcium levels or substances created when bone is broken down
Treatment
Treatment includes:
Nutrition
Eat a balanced diet rich in calcium and vitamin D. Consider decreasing your intake of caffeinated beverages and alcohol. Calcium is abundant in:
Dairy products
Green leafy vegetables
Canned fish with bones
Calcium-fortified products
Smoking
Do not smoke. If you smoke, quit.
Exercise
Exercise improves bone health and increases muscle strength, coordination, and balance. Maximum benefits are gained from doing weight-bearing exercises, including strength-training exercises. Balance training may help prevent falls and fractures.
Dietary Supplements
People who cannot consume enough calcium from food might want to consider calcium supplements. Other vitamins and minerals may be recommended, including vitamin D, magnesium, vitamin K, and potassium. Talk to your doctor or dietitian before you begin taking dietary supplements.
Medications
These include medications to prevent bone loss, increase bone density, and reduce the risk of spine and hip fractures.
Raloxifene (Evista) - one of a class of drugs known as selective estrogen receptor modulators (SERMS) that appears to prevent bone loss of the hip, spine, and total body. It is approved for both prevention and treatment of osteoporosis.
Bisphosphonates (alendronate [Fosamax]; risedronate [Actonel]) - reduce bone loss, increase bone density, and reduce the risk of spine and hip fractures
Calcitonin - slows bone loss, increases spinal bone density, and may relieve pain from bone fractures
Fluoride – low doses of monofluorophosphate to decrease pain and fractures in the spine
Hormone Replacement Therapy (HRT) – Although HRT (including estrogen replacement therapy, or ERT) may cut the risk of osteoporosis in half, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.
HRT therapy may include:
Estrogen alone (also referred to as Estrogen Replacement Therapy or ERT)
Estrogen and Progestin - estrogen combined with progestin (frequently preferred for women with an intact uterus because ERT slightly increases the risk of uterine cancer)
Foods containing soy - may improve bone mass because they contain plant estrogens
HRT can:
Reduce bone loss
Increase bone density
Reduce the risk of hip and spinal fractures in postmenopausal women
Safety Measures
Because falls can increase the likelihood of fracture in someone with osteoporosis, the following measures are recommended:
Use a cane or walker for added stability.
Wear rubber soled shoes for traction.
Use plastic or carpet runners when possible.
Keep rooms free of clutter.
Install grab bars in bathrooms.
Prevention
Building strong bones throughout the early years is the best defense against osteoporosis. There are four steps to prevent osteoporosis, none of which is likely to be effective by itself.
A balanced diet rich in calcium and vitamin D
Weight-bearing exercise
Healthful lifestyle (no smoking and moderate alcohol)
Bone density testing and medications where appropriate:
Fosamax
Actonel
Evista
RESOURCES:
National Osteoporosis Foundation
http://www.nof.org/
National Resource Center for Osteoporosis and Bone-Related Health
http://www.osteo.org/
Sources:
National Osteoporosis Foundation.
Nelson M. Strong Women, Strong Bones: Everything You Need to Prevent, Treat, and Beat Osteoporosis. Putnam;2000.
Definition
Osteoporosis is a disease in which bones become weak and brittle. If left unchecked, osteoporosis can progress painlessly until a bone breaks (fracture). Any bone can be affected, but of special concern are fractures of the hip, spine, and wrist.
Causes
Throughout life, old bone is removed and new bone is added to the skeleton. During childhood and adolescence, new bone is added faster than old bone is removed. As a result, bones become heavier, larger and denser. Peak bone mass is reached around age 30. From that point on, more bone is lost than is replaced. If not treated, bone losses may lead to osteoporosis. Osteoporosis is more likely to occur if optimal bone mass was not achieved during the bone-building years.
Bone density also plays a role in bone health. Bone density is determined in part by the amount of calcium, phosphorus and other minerals contained within the framework of the bone. As the mineral content of a bone (especially calcium) decreases, the bone becomes weaker. Getting enough calcium and vitamin D and exercising regularly can help ensure that bones stay strong throughout life.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Sex: female
Age: risk increases with age
Body size: small, underweight women
Race: Caucasian and Asian women
Family members with osteoporosis
Post-menopausal status
Abnormal cessation of menstrual periods (amenorrhea) due to anorexia nervosa, rigorous exercise, or an endocrinological problem
Low-calcium diet
Medications:
Immunosuppressants, such as prednisone and other steroids, methotrexate, cyclosporine
Thyroid drugs
Anticonvulsants
Aluminum-containing antacids
Cholesterol-lowering drugs
Long-term heparin therapy
Low estrogen levels in women
Low testosterone levels in men
Inactive lifestyle
Too little sunlight
Depression
Anorexia
Cigarette smoking
Excessive use of alcohol, coffee and tea
Diseases including:
Liver disease, including cirrhosis
Hyperthyroidism
Scurvy
Alcoholism
Marfan's and Ehler-Danlos syndromes
Cushing's syndrome
Hyperparathyroidism
Cancer, including lymphoma
Gastrointestinal disorders
Symptoms
Osteoporosis does not usually cause symptoms. Pain is the only symptom, and generally occurs when the bones have broken or collapsed.
Symptoms include:
Severe back pain with fracture of the vertebrae, wrists, hips, or other bones
Loss of height, with stooped posture (kyphosis)
Kyphosis
Copyright © 2005 Nucleus Communications, Inc. All rights reserved. www.nucleusinc.com
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Early signs of osteoporosis can be detected with bone density testing.
Bone density testing techniques include:
Dual-energy x-ray absorptiometry - measures bone density in the entire body
Single-energy x-ray absorptiometry - measures bone density in the arm or heel
Dental x-rays of bone
Ultrasound bone density measurement - measures bone density in fingers, heels, leg bones
Other tests may include:
Blood and urine tests - to test for calcium levels or substances created when bone is broken down
Treatment
Treatment includes:
Nutrition
Eat a balanced diet rich in calcium and vitamin D. Consider decreasing your intake of caffeinated beverages and alcohol. Calcium is abundant in:
Dairy products
Green leafy vegetables
Canned fish with bones
Calcium-fortified products
Smoking
Do not smoke. If you smoke, quit.
Exercise
Exercise improves bone health and increases muscle strength, coordination, and balance. Maximum benefits are gained from doing weight-bearing exercises, including strength-training exercises. Balance training may help prevent falls and fractures.
Dietary Supplements
People who cannot consume enough calcium from food might want to consider calcium supplements. Other vitamins and minerals may be recommended, including vitamin D, magnesium, vitamin K, and potassium. Talk to your doctor or dietitian before you begin taking dietary supplements.
Medications
These include medications to prevent bone loss, increase bone density, and reduce the risk of spine and hip fractures.
Raloxifene (Evista) - one of a class of drugs known as selective estrogen receptor modulators (SERMS) that appears to prevent bone loss of the hip, spine, and total body. It is approved for both prevention and treatment of osteoporosis.
Bisphosphonates (alendronate [Fosamax]; risedronate [Actonel]) - reduce bone loss, increase bone density, and reduce the risk of spine and hip fractures
Calcitonin - slows bone loss, increases spinal bone density, and may relieve pain from bone fractures
Fluoride – low doses of monofluorophosphate to decrease pain and fractures in the spine
Hormone Replacement Therapy (HRT) – Although HRT (including estrogen replacement therapy, or ERT) may cut the risk of osteoporosis in half, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.
HRT therapy may include:
Estrogen alone (also referred to as Estrogen Replacement Therapy or ERT)
Estrogen and Progestin - estrogen combined with progestin (frequently preferred for women with an intact uterus because ERT slightly increases the risk of uterine cancer)
Foods containing soy - may improve bone mass because they contain plant estrogens
HRT can:
Reduce bone loss
Increase bone density
Reduce the risk of hip and spinal fractures in postmenopausal women
Safety Measures
Because falls can increase the likelihood of fracture in someone with osteoporosis, the following measures are recommended:
Use a cane or walker for added stability.
Wear rubber soled shoes for traction.
Use plastic or carpet runners when possible.
Keep rooms free of clutter.
Install grab bars in bathrooms.
Prevention
Building strong bones throughout the early years is the best defense against osteoporosis. There are four steps to prevent osteoporosis, none of which is likely to be effective by itself.
A balanced diet rich in calcium and vitamin D
Weight-bearing exercise
Healthful lifestyle (no smoking and moderate alcohol)
Bone density testing and medications where appropriate:
Fosamax
Actonel
Evista
RESOURCES:
National Osteoporosis Foundation
http://www.nof.org/
National Resource Center for Osteoporosis and Bone-Related Health
http://www.osteo.org/
Sources:
National Osteoporosis Foundation.
Nelson M. Strong Women, Strong Bones: Everything You Need to Prevent, Treat, and Beat Osteoporosis. Putnam;2000.
Steroids: Bigger Is Not Better
by Rick Alan
Anabolic steroids are synthetically-produced derivatives of testosterone, a natural hormone that, among other things, promotes muscle growth. There are a number of different types of manufactured steroids. The official name for this type of steroid is androgenic anabolic steroid, or in English, "a drug that promotes protein synthesis (anabolic) and leads to masculine secondary sexual characteristics (androgenic)."
To understand how anabolic steroids work, it helps to know how testosterone works. Testosterone is a male sex hormone (although women also produce it) that serves two basic purposes. During the first stage of puberty, young men produce an increased amount of testosterone for a number of months. During this stage, the bulk of the male physical maturation process occurs including bone growth, deepening of voice, and development of facial and body hair. Testosterone also maintains the male reproductive system and helps to produce larger body size and muscle mass.
Androgenic steroids are prescribed by physicians for therapeutic treatment of conditions where testosterone (or its effects) need to be added or replaced. Anabolic steroids are designed to copy the muscle-building effects of testosterone but with fewer of the accompanying "masculinization" effects.
Users of anabolic steroids can be divided into two groups:
Those who use them for medical purposes
Those who use them to enhance their strength and athletic ability, and/or enhance their physical appearance by adding muscle mass
Medical Uses
Anabolic steroids are prescribed for a small number of legitimate medical purposes. These include the treatment of:
Males who are unable to produce sufficient amounts of testosterone due to pituitary malfunctions or loss of their testes. (However, these men are most commonly treated with testosterone.)
Persons with a rare genetic condition known as hereditary angioneurotic edema. Both makes and females with this condition are given anabolic steroids.
Persons with decreased muscle mass due to HIV, cancer and/or surgery.
Athletes and Body Enhancers
As far back as the 1950s, athletes have been using anabolic steroids. The reason is simple: the use of these drugs in conjunction with intense physical training increases the body's overall muscle mass, lowers the body's percentage of fat, and thus, enhances body strength. These effects occur in both men and women.
Though many people equate anabolic steroid use with a limited number of athletes such as weight lifters and football players, the fact is that anabolic steroid use can be found among all types of athletes. Since their use was banned in Olympic athletes, testing has detected at least one instance of anabolic steroid use among athletes in every Olympic sport except figure skating and women's field hockey.
Moreover, many people now use anabolic steroids to help enhance their physical appearance. In recent years, this use has become more pronounced among young people. This is especially troubling because the potentially dangerous side effects of using anabolic steroids are heightened in adolescents.
Dangerous Side Effects
The potentially dangerous side effects of anabolic steroid use are numerous. Men run the risk of testicular shrinkage, reduced sperm count, impotence, baldness, and enlarged prostate. Women can suffer from masculinization effects such as deepened voice or the growth of facial hair, cessation of menstruation, enlargement of genitals, and reduction of breast size. And both sexes run the risk of serious medical problems, including high blood pressure and liver damage.
Finally, there is the belief held by some that both men and women may be susceptible to so-called "'roid rage"—sudden pronounced outbursts of anger due to their anabolic steroid use. Furthermore, depression after quitting steroid use.
As mentioned, adolescents are at even greater risk from anabolic steroid use. In addition to the above dangers, adolescents who use steroids run the risk of suffering irreversible stunting of their growth. Indeed, this danger is so significant that steroids are rarely medically prescribed for children and young adults, and then only in extreme cases.
As if the dangers inherent in using anabolic steroids were not enough, the manner in which abusers of these drugs acquire and administer them only serves to increase the dangers. Due to the difficulty in acquiring non-medically prescribed anabolic steroids, a black market for the drugs has developed. And as a result, tainted drugs and/or drugs of uncertain potency are sometimes sold to users. In addition to being taken orally, anabolic steroids can also be injected. Since some users reuse or share needles, this creates a danger of transferring blood-borne diseases such as HIV/AIDS and hepatitis.
The way that some users manage their intake of anabolic steroids is particularly unsafe. Some users "cycle" their intake, taking anabolic steroids on and off for one- to six-month periods. Some who compete in regulated sports do this in the hopes of avoiding detection. Hoping to increase the effect of the drug, many users "megadose," sometimes taking hundreds of milligrams of the drug per day when the medically prescribed dose would be much lower. Others partake in "stacking"--taking many different types of anabolic steroids at the same time, sometimes in combination with other drugs such as stimulants, painkillers and/or other hormones--which, Dr. Grinspoon notes, may further increase the risks associated with using anabolic steroids.
Some signs of anabolic steroid use include:
Puffy face
Severe acne (on face, chest, upper back, and thighs)
Increased weight gain over a short period of time
Yellowing of skin and/or eyes
Spotted, dark skin
Profuse sweating
Hair loss (in men)
The non-medically authorized use of anabolic steroids poses grave danger. It is also illegal. Possession and distribution of anabolic steroids for non-medical purposes is illegal under federal law, because steroids are classified as a Schedule III drug under the Controlled Substances Act.
So, the intelligent conclusion is simple: unless anabolic steroids have been medically prescribed for you, don't take them. This is one case where bigger is not better. Especially since consistent hard work with resistance training will provide most of the muscle mass that steroids do.
RESOURCES:
National Institute on Drug Abuse
http://www.nida.nih.gov/
Partnership for a Drug-Free America
http://www.drugfreeamerica.org/
by Rick Alan
Anabolic steroids are synthetically-produced derivatives of testosterone, a natural hormone that, among other things, promotes muscle growth. There are a number of different types of manufactured steroids. The official name for this type of steroid is androgenic anabolic steroid, or in English, "a drug that promotes protein synthesis (anabolic) and leads to masculine secondary sexual characteristics (androgenic)."
To understand how anabolic steroids work, it helps to know how testosterone works. Testosterone is a male sex hormone (although women also produce it) that serves two basic purposes. During the first stage of puberty, young men produce an increased amount of testosterone for a number of months. During this stage, the bulk of the male physical maturation process occurs including bone growth, deepening of voice, and development of facial and body hair. Testosterone also maintains the male reproductive system and helps to produce larger body size and muscle mass.
Androgenic steroids are prescribed by physicians for therapeutic treatment of conditions where testosterone (or its effects) need to be added or replaced. Anabolic steroids are designed to copy the muscle-building effects of testosterone but with fewer of the accompanying "masculinization" effects.
Users of anabolic steroids can be divided into two groups:
Those who use them for medical purposes
Those who use them to enhance their strength and athletic ability, and/or enhance their physical appearance by adding muscle mass
Medical Uses
Anabolic steroids are prescribed for a small number of legitimate medical purposes. These include the treatment of:
Males who are unable to produce sufficient amounts of testosterone due to pituitary malfunctions or loss of their testes. (However, these men are most commonly treated with testosterone.)
Persons with a rare genetic condition known as hereditary angioneurotic edema. Both makes and females with this condition are given anabolic steroids.
Persons with decreased muscle mass due to HIV, cancer and/or surgery.
Athletes and Body Enhancers
As far back as the 1950s, athletes have been using anabolic steroids. The reason is simple: the use of these drugs in conjunction with intense physical training increases the body's overall muscle mass, lowers the body's percentage of fat, and thus, enhances body strength. These effects occur in both men and women.
Though many people equate anabolic steroid use with a limited number of athletes such as weight lifters and football players, the fact is that anabolic steroid use can be found among all types of athletes. Since their use was banned in Olympic athletes, testing has detected at least one instance of anabolic steroid use among athletes in every Olympic sport except figure skating and women's field hockey.
Moreover, many people now use anabolic steroids to help enhance their physical appearance. In recent years, this use has become more pronounced among young people. This is especially troubling because the potentially dangerous side effects of using anabolic steroids are heightened in adolescents.
Dangerous Side Effects
The potentially dangerous side effects of anabolic steroid use are numerous. Men run the risk of testicular shrinkage, reduced sperm count, impotence, baldness, and enlarged prostate. Women can suffer from masculinization effects such as deepened voice or the growth of facial hair, cessation of menstruation, enlargement of genitals, and reduction of breast size. And both sexes run the risk of serious medical problems, including high blood pressure and liver damage.
Finally, there is the belief held by some that both men and women may be susceptible to so-called "'roid rage"—sudden pronounced outbursts of anger due to their anabolic steroid use. Furthermore, depression after quitting steroid use.
As mentioned, adolescents are at even greater risk from anabolic steroid use. In addition to the above dangers, adolescents who use steroids run the risk of suffering irreversible stunting of their growth. Indeed, this danger is so significant that steroids are rarely medically prescribed for children and young adults, and then only in extreme cases.
As if the dangers inherent in using anabolic steroids were not enough, the manner in which abusers of these drugs acquire and administer them only serves to increase the dangers. Due to the difficulty in acquiring non-medically prescribed anabolic steroids, a black market for the drugs has developed. And as a result, tainted drugs and/or drugs of uncertain potency are sometimes sold to users. In addition to being taken orally, anabolic steroids can also be injected. Since some users reuse or share needles, this creates a danger of transferring blood-borne diseases such as HIV/AIDS and hepatitis.
The way that some users manage their intake of anabolic steroids is particularly unsafe. Some users "cycle" their intake, taking anabolic steroids on and off for one- to six-month periods. Some who compete in regulated sports do this in the hopes of avoiding detection. Hoping to increase the effect of the drug, many users "megadose," sometimes taking hundreds of milligrams of the drug per day when the medically prescribed dose would be much lower. Others partake in "stacking"--taking many different types of anabolic steroids at the same time, sometimes in combination with other drugs such as stimulants, painkillers and/or other hormones--which, Dr. Grinspoon notes, may further increase the risks associated with using anabolic steroids.
Some signs of anabolic steroid use include:
Puffy face
Severe acne (on face, chest, upper back, and thighs)
Increased weight gain over a short period of time
Yellowing of skin and/or eyes
Spotted, dark skin
Profuse sweating
Hair loss (in men)
The non-medically authorized use of anabolic steroids poses grave danger. It is also illegal. Possession and distribution of anabolic steroids for non-medical purposes is illegal under federal law, because steroids are classified as a Schedule III drug under the Controlled Substances Act.
So, the intelligent conclusion is simple: unless anabolic steroids have been medically prescribed for you, don't take them. This is one case where bigger is not better. Especially since consistent hard work with resistance training will provide most of the muscle mass that steroids do.
RESOURCES:
National Institute on Drug Abuse
http://www.nida.nih.gov/
Partnership for a Drug-Free America
http://www.drugfreeamerica.org/
Stroke
by Debra Wood, RN
Definition
Stroke is a brain injury that occurs when the brain's blood supply is interrupted. Without oxygen and nutrients from blood, brain tissue starts to die rapidly, resulting in a sudden loss of function.
(Also called brain attack or cerebrovascular accident)
Causes
A stroke most often occurs when blood flow to the brain becomes blocked (called ischemic stroke). One of the following problems may cause this blockage:
A build-up of fatty substances (atherosclerotic plaque) along an artery's inner lining causes it to narrow, reduces its elasticity, and decreases its blood flow.
A clot forms in an artery supplying the brain.
A clot forms somewhere in the body (often the heart) and breaks free, traveling to and becoming lodged in an artery supplying the brain.
A stroke may also occur if a blood vessel breaks and bleeds into or around the brain, this is called hemorrhagic stroke.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Modifiable risk factors:
High blood pressure
Narrowing of arteries supplying the brain due to atherosclerosis
High cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol
Smoking
Obesity
Lack of exercise
Drinking excessive amounts of alcohol
Diabetes mellitus
Atrial fibrillation (abnormality of heart rhythm)
Non-modifiable risk factors:
A prior stroke or pre-existing cardiovascular disease other than stroke
A prior transient ischemic attack (a temporary interrupting of the brain's blood supply, often called a mini-stroke)
Age: 60 or older
Family members who have had a stroke
Race: Black
Some patients experience a "warning stroke" or transient ischemic attack (TIA). These are symptoms of a stroke that resolve completely, usually within minutes. Such patients are at a significantly increased risk of having a full-blown stroke sometime in the near future.
Symptoms
Symptoms occur suddenly and differ depending on the part of the brain affected. Multiple symptoms generally arise simultaneously. Do not delay calling for emergency medical help. Brain tissue dies quickly when deprived of oxygen.
Symptoms include:
Weakness or numbness on one side of the body
Blurry, dimming, or no vision
Difficulty swallowing, talking, or comprehending others
Dizziness, falling, or loss of balance
Severe or unusual headache
Diagnosis
Having a stroke is an emergency situation. Diagnosis includes:
Neurological exams
Blood tests
Imaging scans
Other tests to quickly determine the cause, location, and amount of damage
Tests may include:
CT Scan - a type of x-ray that uses a computer to make pictures of the brain
MRI Scan - a test that uses magnetic waves to make pictures of the brain
Arteriography (Angiography) - shows arteries in the brain
Magnetic Resonance Angiography (MRA) - shows brain blood vessels by mapping blood flow
Functional MRI - shows brain activity by picking up signals from oxygenated blood
Doppler Ultrasound - shows narrowing of the arteries supplying the brain
Treatment
Immediate treatment is needed to:
Dissolve a clot causing an ischemic stroke
Stop the bleeding during a hemorrhagic stroke
Other stroke care aims to:
Reduce the chance of subsequent strokes
Improve functioning
Overcome disabilities
Medications
Medications include:
Clot-dissolving drugs - given within three hours of the onset of symptoms. (Note: only in carefully selected patients.) Tissue plasminogen activator (tPA) is given through a vein after the doctor has confirmed the stroke's cause and there is no evidence of bleeding.
Nerve-protecting drugs - help prevent additional nerve-cell damage caused by the chemicals released from dying brain cells. These drugs are promising but not yet routinely used.
Other drugs are used to:
Control blood pressure
Reduce chance of additional clot formation (aspirin or similar medications)
Reduce brain swelling
Correct irregular heart rhythm
Other interventions during an acute stroke include:
Providing adequate oxygen
Taking precautions to prevent choking
Frequent neurological examinations
Surgery
Surgery may be performed following a stroke or TIA to prevent a recurrence. Surgical techniques include:
Carotid endarterectomy - fatty deposits are removed from a carotid artery (major arteries in the neck that lead to the brain)
Extracranial/intracranial bypass - reroutes the blood supply around a blocked artery using a healthy scalp artery
Rehabilitation
Rehabilitation may include:
Physical therapy
Occupational therapy
Speech therapy
Prevention
The following may help prevent a stroke:
Exercise regularly.
Increase intake of fruits and vegetables and limit dietary salt and fat.
Stop smoking.
Drink alcohol only in moderation (1–2 drinks per day).
Maintain a healthy weight.
Frequently check blood pressure and follow physician recommendations for keeping it in a safe range.
Consider taking a low dose of aspirin (75 milligrams per day) if your physician determines it is safe.
Keep chronic medical conditions under control (such as high cholesterol and diabetes).
Seek medical care if you have symptoms of a stroke, even if symptoms stop.
RESOURCES:
American Heart Association
http://www.americanheart.org/
National Stroke Association
http://www.stroke.org/
SOURCES:
American Heart Association.
National Institute of Neurological Disorders and Stroke.
by Debra Wood, RN
Definition
Stroke is a brain injury that occurs when the brain's blood supply is interrupted. Without oxygen and nutrients from blood, brain tissue starts to die rapidly, resulting in a sudden loss of function.
(Also called brain attack or cerebrovascular accident)
Causes
A stroke most often occurs when blood flow to the brain becomes blocked (called ischemic stroke). One of the following problems may cause this blockage:
A build-up of fatty substances (atherosclerotic plaque) along an artery's inner lining causes it to narrow, reduces its elasticity, and decreases its blood flow.
A clot forms in an artery supplying the brain.
A clot forms somewhere in the body (often the heart) and breaks free, traveling to and becoming lodged in an artery supplying the brain.
A stroke may also occur if a blood vessel breaks and bleeds into or around the brain, this is called hemorrhagic stroke.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Modifiable risk factors:
High blood pressure
Narrowing of arteries supplying the brain due to atherosclerosis
High cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol
Smoking
Obesity
Lack of exercise
Drinking excessive amounts of alcohol
Diabetes mellitus
Atrial fibrillation (abnormality of heart rhythm)
Non-modifiable risk factors:
A prior stroke or pre-existing cardiovascular disease other than stroke
A prior transient ischemic attack (a temporary interrupting of the brain's blood supply, often called a mini-stroke)
Age: 60 or older
Family members who have had a stroke
Race: Black
Some patients experience a "warning stroke" or transient ischemic attack (TIA). These are symptoms of a stroke that resolve completely, usually within minutes. Such patients are at a significantly increased risk of having a full-blown stroke sometime in the near future.
Symptoms
Symptoms occur suddenly and differ depending on the part of the brain affected. Multiple symptoms generally arise simultaneously. Do not delay calling for emergency medical help. Brain tissue dies quickly when deprived of oxygen.
Symptoms include:
Weakness or numbness on one side of the body
Blurry, dimming, or no vision
Difficulty swallowing, talking, or comprehending others
Dizziness, falling, or loss of balance
Severe or unusual headache
Diagnosis
Having a stroke is an emergency situation. Diagnosis includes:
Neurological exams
Blood tests
Imaging scans
Other tests to quickly determine the cause, location, and amount of damage
Tests may include:
CT Scan - a type of x-ray that uses a computer to make pictures of the brain
MRI Scan - a test that uses magnetic waves to make pictures of the brain
Arteriography (Angiography) - shows arteries in the brain
Magnetic Resonance Angiography (MRA) - shows brain blood vessels by mapping blood flow
Functional MRI - shows brain activity by picking up signals from oxygenated blood
Doppler Ultrasound - shows narrowing of the arteries supplying the brain
Treatment
Immediate treatment is needed to:
Dissolve a clot causing an ischemic stroke
Stop the bleeding during a hemorrhagic stroke
Other stroke care aims to:
Reduce the chance of subsequent strokes
Improve functioning
Overcome disabilities
Medications
Medications include:
Clot-dissolving drugs - given within three hours of the onset of symptoms. (Note: only in carefully selected patients.) Tissue plasminogen activator (tPA) is given through a vein after the doctor has confirmed the stroke's cause and there is no evidence of bleeding.
Nerve-protecting drugs - help prevent additional nerve-cell damage caused by the chemicals released from dying brain cells. These drugs are promising but not yet routinely used.
Other drugs are used to:
Control blood pressure
Reduce chance of additional clot formation (aspirin or similar medications)
Reduce brain swelling
Correct irregular heart rhythm
Other interventions during an acute stroke include:
Providing adequate oxygen
Taking precautions to prevent choking
Frequent neurological examinations
Surgery
Surgery may be performed following a stroke or TIA to prevent a recurrence. Surgical techniques include:
Carotid endarterectomy - fatty deposits are removed from a carotid artery (major arteries in the neck that lead to the brain)
Extracranial/intracranial bypass - reroutes the blood supply around a blocked artery using a healthy scalp artery
Rehabilitation
Rehabilitation may include:
Physical therapy
Occupational therapy
Speech therapy
Prevention
The following may help prevent a stroke:
Exercise regularly.
Increase intake of fruits and vegetables and limit dietary salt and fat.
Stop smoking.
Drink alcohol only in moderation (1–2 drinks per day).
Maintain a healthy weight.
Frequently check blood pressure and follow physician recommendations for keeping it in a safe range.
Consider taking a low dose of aspirin (75 milligrams per day) if your physician determines it is safe.
Keep chronic medical conditions under control (such as high cholesterol and diabetes).
Seek medical care if you have symptoms of a stroke, even if symptoms stop.
RESOURCES:
American Heart Association
http://www.americanheart.org/
National Stroke Association
http://www.stroke.org/
SOURCES:
American Heart Association.
National Institute of Neurological Disorders and Stroke.
THYROID DISEASE
Causes of Thyroid Disease
by Skye Schulte, MS, MPH
About 13 million Americans have been diagnosed with a thyroid disease and a research study published in February 2000, estimated that another 13 million may have a thyroid condition of which they are unaware. Approximately one in eight women will develop a thyroid disorder in her life and women are five to eight times more likely than men to have hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).
People with thyroid conditions may suffer debilitating side effects such as depression, weight gain or loss, fatigue, nervousness, muscle weakness or cramps, hair loss, poor memory, and difficulty concentrating. These statistics show that many people may be at risk of developing thyroid disease. How can you tell if you are at increased risk? Are there ways you can prevent thyroid disorders?
The most common risk factors for thyroid disease are:
Diet low in iodide (iodine)
History of radiation to the head, neck, or chest, especially in infancy or childhood
Family history of thyroid disease
History of other autoimmune diseases
Being a woman (5–8 times more common in women than in men)
Being between the ages of 20 and 40 (for hyperthyroidism)
Pregnancy, which may lead to postpartum thyroiditis (first hyperthyroid followed by hypothyroid)
Viral infection (possibly)
Some of these risk factors may be involved in the development of thyroid disease, though scientists are still uncertain of the exact causes.
Your Diet
There are a number of dietary factors that may influence your thyroid health. This may include:
Too little iodide
If you don’t have enough iodide your body can’t make enough of the thyroid hormones that regulate your body's energy use. This lack of iodide can cause a goiter, or enlarged thyroid gland. A chronic deficiency of this mineral can result in destruction of the thyroid gland. Because we have iodized salt in the United States, iodide deficiency and goiter are rarely seen. The recommended dietary allowance is 120 micrograms per day (mcg/d) for adults and 220 mcg/d for pregnant women.
Too much iodide
The thyroid can also become enlarged if you have too much iodide in your diet, though this is rare in the United States. This “toxic goiter” is caused by elevated concentrations of thyroid stimulating hormone (TSH), and is often seen in people who eat a lot of seaweed, which can add a significant amount of iodide to the diet. Iodide levels up to one milligram (more than six times the Recommended Dietary Allowance) appear to be safe.
Foods that can cause problems
Some foods have chemicals that can cause goiters and inhibit thyroid gland functions if eaten in raw and in large quantities. These chemicals, called goitrogens, are destroyed when these foods are cooked. Examples of “goitrogenic” foods include: Brussels sprouts, broccoli, turnips, rutabagas, kohlrabi, radishes, cauliflower, African cassava, millet, and kale.
There is also some evidence that soy has potential negative effects on the thyroid gland, though the evidence is conflicting. For instance, some studies have found that soy reduces the absorption of thyroid medications and may even directly inhibit the function of the thyroid gland. While others have found that soy has either no effect on thyroid hormone levels, or actually increases levels. Because of soy’s complex effects regarding the thyroid, it is recommended that people with impaired thyroid function not consume large amounts of soy products.
Radioactive Iodine
Radioactive iodine is often used to treat thyroid cancer or hyperthyroidism (overactive thyroid)—but there are also some risks. For instance, high doses of radioactive iodine (used to treat hyperthyroidism) can often cause hypothyroidism (underactive thyroid) because the iodine will concentrate in the thyroid gland during treatment.
Considerable attention has been paid to design radioactive iodine treatment that will bring the thyroid function back to normal, however, at this time the majority of people who undergo this procedure will develop hypothyroidism and be required to take synthetic thyroid hormone.
Medications
It is thought that medications such as lithium and the heart drug Cordarone may cause hypothyroidism. Lithium acts on the central nervous system and is used to treat the manic stage of bipolar disorder (manic-depressive illness). Lithium is not recommended for use during pregnancy, especially during the first three months since studies have shown that it (rarely) may cause thyroid problems and heart or blood vessel defects in the baby. Elderly people taking lithium can also develop goiter or symptoms of underactive thyroid because of their increased sensitivity to the effects of lithium. The elderly are also more likely to have thyroid problems with Cordarone (a drug used to correct irregular heartbeats). This drug increases the risk of overactive or underactive thyroid.
Practical Prevention --Thyroid Disease
by Elizabeth Smoots, MD
Thyroid Trouble: More Common Than You Might Think
Over the years I've met many people with thyroid disease. It's probably the most frequent hormone problem I deal with as a family physician. It's also one of the most under-diagnosed and under-treated diseases in America today.
The reasons for this are simple: Thyroid disease can sneak up on you slowly and subtly. And the symptoms it causes are vague, easily confused with other health problems, or not present at all. As a result, more than 13 million Americans with a thyroid condition are not aware of the problem.
Women More at Risk
By some estimates, thyroid disorders occur about five times more often in women than men. And the incidence increases with age. In a recent study of 25,000 healthy people attending the Colorado State Health Fair, 4% of women ages 18-24 had evidence of thyroid disease. The numbers climbed gradually, reaching a whopping 21% of women over age 75. And these were "healthy" people who were not aware they had any health problems.
What Is the Thyroid?
Your thyroid is a butterfly-shaped gland just below the Adam's apple at the base of your neck. It secretes a hormone called thyroxin that regulates your metabolism—the rate at which every part of your body works. As a result, this hormone can affect your energy level as well as your health from head to toe.
Thyroid Disorders
The two most common thyroid disorders are:
Hypothyroidism (underactive thyroid)
This condition occurs when your thyroid doesn't produce enough thyroxin hormone, causing your metabolism to slow down.
Symptoms of an underactive thyroid include:
Fatigue
Depression
Unexplained weight gain
Dry skin
Hair loss
Intolerance to cold
In addition, hypothyroidism can contribute to:
High cholesterol
Memory problems
Irregular periods
Swelling of the face or extremities
Hyperthyroidism (overactive thyroid)
This condition occurs when your thyroid makes too much thyroxin hormone, causing your metabolism to speed up.
Symptoms of an overactive thyroid include:
Nervousness
Mood swings
Insomnia
Unexplained weight loss
Weakness
Tremors
Heat intolerance
Excessive sweating
Palpitations
Shortness of breath
Preventing Complications of Thyroid Disease
Without treatment, thyroid disorders can lead to serious health problems. A high cholesterol level, commonly associated with even mild hypothyroidism, can contribute to heart attacks and hardening of the arteries.
Hyperthyroidism, or too much thyroid hormone, may result in:
Osteoporosis
Premature births or miscarriages among pregnant women
Irregular heart beat
Heart failure
Stroke
These problems can be minimized when you catch a thyroid problem early. A simple blood test diagnoses most common thyroid diseases. The thyroid-stimulating hormone (TSH) test is safe, accurate, widely available, and relatively inexpensive. The American Thyroid Association (ATA) says TSH testing is as cost-effective as screening tests for high blood pressure, cholesterol and breast cancer. And, in older women, it's even more so.
Who Should Be Tested?
If you're over age 34—especially if you're a woman—I advise asking your health care provider about thyroid disease. Currently, there is controversy about when and how often to conduct screening. The ATA recommends that all adults receive a TSH test every five years starting at age 35.
You may need to be tested more frequently, says the ATA, if you have symptoms or risk factors for thyroid disease. These include:
Previous thyroid problems or goiter (an enlarged thyroid)
Surgery or radiation therapy affecting the thyroid gland
Diabetes
Vitiligo (white skin patches)
Pernicious anemia (from vitamin B12 deficiency)
Prematurely gray hair
Use of certain medicines (thyroid medication, lithium, iodine-containing compounds)
High cholesterol or calcium
Low sodium
Anemia
Elevated liver enzymes
Family history of diabetes, pernicious anemia, adrenal problems or thyroid disease
Consider getting your thyroid checked. If you do have a thyroid disorder, there are medications to correct the problem.
RESOURCES:
American Thyroid Association
http://www.thyroid.org
The Endocrine Society
http://www.endo-society.org
Thyroid Foundation of America
http://www.tsh.org
Causes of Thyroid Disease
by Skye Schulte, MS, MPH
About 13 million Americans have been diagnosed with a thyroid disease and a research study published in February 2000, estimated that another 13 million may have a thyroid condition of which they are unaware. Approximately one in eight women will develop a thyroid disorder in her life and women are five to eight times more likely than men to have hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).
People with thyroid conditions may suffer debilitating side effects such as depression, weight gain or loss, fatigue, nervousness, muscle weakness or cramps, hair loss, poor memory, and difficulty concentrating. These statistics show that many people may be at risk of developing thyroid disease. How can you tell if you are at increased risk? Are there ways you can prevent thyroid disorders?
The most common risk factors for thyroid disease are:
Diet low in iodide (iodine)
History of radiation to the head, neck, or chest, especially in infancy or childhood
Family history of thyroid disease
History of other autoimmune diseases
Being a woman (5–8 times more common in women than in men)
Being between the ages of 20 and 40 (for hyperthyroidism)
Pregnancy, which may lead to postpartum thyroiditis (first hyperthyroid followed by hypothyroid)
Viral infection (possibly)
Some of these risk factors may be involved in the development of thyroid disease, though scientists are still uncertain of the exact causes.
Your Diet
There are a number of dietary factors that may influence your thyroid health. This may include:
Too little iodide
If you don’t have enough iodide your body can’t make enough of the thyroid hormones that regulate your body's energy use. This lack of iodide can cause a goiter, or enlarged thyroid gland. A chronic deficiency of this mineral can result in destruction of the thyroid gland. Because we have iodized salt in the United States, iodide deficiency and goiter are rarely seen. The recommended dietary allowance is 120 micrograms per day (mcg/d) for adults and 220 mcg/d for pregnant women.
Too much iodide
The thyroid can also become enlarged if you have too much iodide in your diet, though this is rare in the United States. This “toxic goiter” is caused by elevated concentrations of thyroid stimulating hormone (TSH), and is often seen in people who eat a lot of seaweed, which can add a significant amount of iodide to the diet. Iodide levels up to one milligram (more than six times the Recommended Dietary Allowance) appear to be safe.
Foods that can cause problems
Some foods have chemicals that can cause goiters and inhibit thyroid gland functions if eaten in raw and in large quantities. These chemicals, called goitrogens, are destroyed when these foods are cooked. Examples of “goitrogenic” foods include: Brussels sprouts, broccoli, turnips, rutabagas, kohlrabi, radishes, cauliflower, African cassava, millet, and kale.
There is also some evidence that soy has potential negative effects on the thyroid gland, though the evidence is conflicting. For instance, some studies have found that soy reduces the absorption of thyroid medications and may even directly inhibit the function of the thyroid gland. While others have found that soy has either no effect on thyroid hormone levels, or actually increases levels. Because of soy’s complex effects regarding the thyroid, it is recommended that people with impaired thyroid function not consume large amounts of soy products.
Radioactive Iodine
Radioactive iodine is often used to treat thyroid cancer or hyperthyroidism (overactive thyroid)—but there are also some risks. For instance, high doses of radioactive iodine (used to treat hyperthyroidism) can often cause hypothyroidism (underactive thyroid) because the iodine will concentrate in the thyroid gland during treatment.
Considerable attention has been paid to design radioactive iodine treatment that will bring the thyroid function back to normal, however, at this time the majority of people who undergo this procedure will develop hypothyroidism and be required to take synthetic thyroid hormone.
Medications
It is thought that medications such as lithium and the heart drug Cordarone may cause hypothyroidism. Lithium acts on the central nervous system and is used to treat the manic stage of bipolar disorder (manic-depressive illness). Lithium is not recommended for use during pregnancy, especially during the first three months since studies have shown that it (rarely) may cause thyroid problems and heart or blood vessel defects in the baby. Elderly people taking lithium can also develop goiter or symptoms of underactive thyroid because of their increased sensitivity to the effects of lithium. The elderly are also more likely to have thyroid problems with Cordarone (a drug used to correct irregular heartbeats). This drug increases the risk of overactive or underactive thyroid.
Practical Prevention --Thyroid Disease
by Elizabeth Smoots, MD
Thyroid Trouble: More Common Than You Might Think
Over the years I've met many people with thyroid disease. It's probably the most frequent hormone problem I deal with as a family physician. It's also one of the most under-diagnosed and under-treated diseases in America today.
The reasons for this are simple: Thyroid disease can sneak up on you slowly and subtly. And the symptoms it causes are vague, easily confused with other health problems, or not present at all. As a result, more than 13 million Americans with a thyroid condition are not aware of the problem.
Women More at Risk
By some estimates, thyroid disorders occur about five times more often in women than men. And the incidence increases with age. In a recent study of 25,000 healthy people attending the Colorado State Health Fair, 4% of women ages 18-24 had evidence of thyroid disease. The numbers climbed gradually, reaching a whopping 21% of women over age 75. And these were "healthy" people who were not aware they had any health problems.
What Is the Thyroid?
Your thyroid is a butterfly-shaped gland just below the Adam's apple at the base of your neck. It secretes a hormone called thyroxin that regulates your metabolism—the rate at which every part of your body works. As a result, this hormone can affect your energy level as well as your health from head to toe.
Thyroid Disorders
The two most common thyroid disorders are:
Hypothyroidism (underactive thyroid)
This condition occurs when your thyroid doesn't produce enough thyroxin hormone, causing your metabolism to slow down.
Symptoms of an underactive thyroid include:
Fatigue
Depression
Unexplained weight gain
Dry skin
Hair loss
Intolerance to cold
In addition, hypothyroidism can contribute to:
High cholesterol
Memory problems
Irregular periods
Swelling of the face or extremities
Hyperthyroidism (overactive thyroid)
This condition occurs when your thyroid makes too much thyroxin hormone, causing your metabolism to speed up.
Symptoms of an overactive thyroid include:
Nervousness
Mood swings
Insomnia
Unexplained weight loss
Weakness
Tremors
Heat intolerance
Excessive sweating
Palpitations
Shortness of breath
Preventing Complications of Thyroid Disease
Without treatment, thyroid disorders can lead to serious health problems. A high cholesterol level, commonly associated with even mild hypothyroidism, can contribute to heart attacks and hardening of the arteries.
Hyperthyroidism, or too much thyroid hormone, may result in:
Osteoporosis
Premature births or miscarriages among pregnant women
Irregular heart beat
Heart failure
Stroke
These problems can be minimized when you catch a thyroid problem early. A simple blood test diagnoses most common thyroid diseases. The thyroid-stimulating hormone (TSH) test is safe, accurate, widely available, and relatively inexpensive. The American Thyroid Association (ATA) says TSH testing is as cost-effective as screening tests for high blood pressure, cholesterol and breast cancer. And, in older women, it's even more so.
Who Should Be Tested?
If you're over age 34—especially if you're a woman—I advise asking your health care provider about thyroid disease. Currently, there is controversy about when and how often to conduct screening. The ATA recommends that all adults receive a TSH test every five years starting at age 35.
You may need to be tested more frequently, says the ATA, if you have symptoms or risk factors for thyroid disease. These include:
Previous thyroid problems or goiter (an enlarged thyroid)
Surgery or radiation therapy affecting the thyroid gland
Diabetes
Vitiligo (white skin patches)
Pernicious anemia (from vitamin B12 deficiency)
Prematurely gray hair
Use of certain medicines (thyroid medication, lithium, iodine-containing compounds)
High cholesterol or calcium
Low sodium
Anemia
Elevated liver enzymes
Family history of diabetes, pernicious anemia, adrenal problems or thyroid disease
Consider getting your thyroid checked. If you do have a thyroid disorder, there are medications to correct the problem.
RESOURCES:
American Thyroid Association
http://www.thyroid.org
The Endocrine Society
http://www.endo-society.org
Thyroid Foundation of America
http://www.tsh.org
Subject: Dr. Devi-Indian Heart Specialist
You might find interesting to read this transcript of a chat with Dr. Devi
Shetty, Heart Specialist in India
Q. : What are the five thumb rules for a layman to take care of his heart?
Dr Devi Shetty:
1. Diet - Less of carbohydrate, more of protein, less oil
2. Exercise - Half an hour's walk, at least five days a week; avoid lifts
and avoid sitting for a long-time
3. Quit smoking
4. Control weight
5. Control blood pressure and sugar
==========
Q.: It's still a grave shock to hear that some apparently healthy person
gets a cardiac arrest. How do we understand it in perspective?
Dr Devi Shetty: This is called silent attack; that is why we recommend
everyone past the age of 30 to undergo routine health checkups.
=============
Q.: Are heart diseases hereditary?
Dr Devi Shetty: Yes
=============
Q.: What are the ways in which the heart is stressed? What practices do you
suggest to de-stress?
Dr Devi Shetty: Change your attitude towards life. Do not look for
perfection in everything in life.
=============
Q.: Is walking better than jogging or is more intensive exercise required
to keep a healthy heart?
Dr Devi Shetty: Walking is better than jogging since jogging leads to early
fatigue and injury to joints
=============
Q.: Can people with low blood pressure suffer heart diseases?
Dr Devi Shetty: Extremely rare
=============
Q.: Does cholesterol accumulates right from an early age (I'm currently
only 22) or do you have to worry about it only after you are above 30 years of
age?
Dr Devi Shetty: Cholesterol accumulates from childhood.
=================
Q.: How do irregular eating habits affect the heart?
Dr Devi Shetty: You tend to eat junk food when the habits are irregular and
your body's enzyme release for digestion gets confused.
==================
Q.: Can a healthy person without a medical history have a heart attack due
to stress?
Dr Devi Shetty: Extremely rare
==================
Q.: How can I control cholesterol content without using medicines?
Dr Devi Shetty: Control diet, walk and eat walnut.
===================
Q.: Can yoga prevent heart ailments?
Dr Devi Shetty: Yoga helps.
===================
Q.: Which is the best and worst food for the heart?
Dr Devi Shetty: Best food is fruits worst are oil.
==================
Q.:If a person has undergone angioplasty, what are the chances of the stent
getting displaced?
Dr Devi Shetty: The Stent doesn't get displaced it can get blocked. You
could prevent it by controlling sugar, cholesterol and taking medication to
prevent clots
==============
Q.: Do negative emotions like depression or anger always cause heart
disease?
Dr Devi Shetty: Not always. On the other hand, positive emotions help
recovery of the heart.
==============
Q.: Which oil is better - gingili, groundnut, sunflower, saffola, olive?
Dr Devi Shetty: All oils are bad; the so-called best oil company has the
largest marketing budget.
============
Q.: What is the routine checkup one should go through? Is there any
specific test?
Dr Devi Shetty: Routine blood test to ensure sugar, cholesterol is ok.Check
BP, Treadmill test after an echo.
=============
Q.: What are the first aid steps to be taken on a heart attack?
Dr Devi Shetty: Help the person into a sleeping position, put an aspirin
tablet under the tongue with a sorbitrate tablet if available, and rush him to
a coronary care unit since the maximum casualty takes place within the first
hour.
===============
Q.: How do you differentiate between pain caused by a heart attack and that
caused due to gastric trouble?
Dr Devi Shetty: Extremely difficult without ECG.
=================
Q.: Can drinking less water lead to heart problems?
Dr Devi Shetty: No. However, drinking plenty of water in normal people
helps preserve good health.
================
Q.: Is it true that diabetic women seem to have 3 to 7 times greater risk
of developing heart diseases than non-diabetic women? Is it the same with
high BP patients as well?
Dr Devi Shetty:Women are protected by the hormones till the age of 45;
after that their risk increases like men and in general, the result of treatment
on heart patients who are women is slightly poorer than men.
================
Q.: What is the main cause of a steep increase in heart problems amongst
youngsters? I see people of about 30-40 yrs of age having heart attacks and
serious heart problems.
Dr Devi Shetty: Increased awareness has increased incidents. Also,
sedentary lifestyles, smoking, junk food, lack of exercise in a country where people
are genetically three times more vulnerable for heart attacks than Europeans
and Americans.
==============
Q.: What is the right time to check the BP in any person?
Dr Devi Shetty: Past the age of 30 and earlier, if you have symptoms.
===============
Q.: Is it possible for a person to have BP outside the normal range of
120/80 and yet be perfectly healthy?
Dr Devi Shetty: Yes.
===============
Q.: Are there any symptoms for heart problems, which we need to be aware of?
Dr Devi Shetty: Shortness of breath on exertion, and chest pain.
=============
Q.: If a person has had a heart attack, how frequently is regular heart
check up recommended?
Dr Devi Shetty: Once in 6 months
=============
Q.: Marriages within close relatives can lead to heart problems for the
child.Is it true?
Dr Devi Shetty: Yes, co-sanguinity leads to congenital abnormalities and
you may not have a software engineer as a child
============
Q.: Many of us have an irregular daily routine and many a times we have to
stay late nights in office. Does this affect our heart? What precautions
would you recommend?
Dr Devi Shetty: When you are young, nature protects you against all these
irregularities. However, as you grow older, respect the biological clock.
============
Q.: How can we find out about blockage of arteries, beforehand?
Dr Devi Shetty: Routine cardiac evaluation by blood tests, ECGs, TMTs,
Stress thallium scan, cardiac CTscan for calcium score.
================
Q.: Does a recurring pain in the left arm signify any heart related ailment?
Dr Devi Shetty: Not always. However, heart pain can radiate to the left arm.
======================
Q.: Can we foresee the occurrence of a heart attack? Are there any
indications that the body feels before getting a heart attack?
Dr Devi Shetty: Usually, you get chest discomfort or shortness of
breath,months or years before the heart attack. So, when in doubt, go for a heart
checkup, which shouldn't take more than a couple of hours.
================================
Q.: Will taking anti-hypertensive drugs cause some other complications
(short / long term)?
Dr Devi Shetty: Yes, most drugs have some side effects. However, modern
anti-hypertensive drugs are extremely safe.
========================
Q.: Will consuming more coffee/tea lead to heart attacks?
Dr Devi Shetty: No.
======================
Q.: What are the chances of lean people developing heart complications?
Are they at less risk?
Dr Devi Shetty: Obese people are at a higher risk. Lean people also develop
heart attacks, but primarily because of genetic pre-disposition.
==============================
Q.: Is it true that after open-heart surgery, patients lose memory recall
to some extent?
Dr Devi Shetty: No. Especially after bypass grafting on a beating heart,
incidence of neurological problems have come down significantly.
=================================
Q.: Are asthma patients more prone to heart disease?
Dr Devi Shetty: No.
===============================
Q.: How would you define junk food?
Dr Devi Shetty: Fried food like Kentucky, McDonalds, samosas, and even
masala dosas.
========================
Q.: You mentioned that Indians are three times more vulnerable. What is the
reason for this, as Europeans and Americans also eat a lot of junk food?
Dr Devi Shetty: Every race is vulnerable to some disease and unfortunately,
Indians are vulnerable for the most expensive disease.
==================================
Q.: Is there any cure for chronic palpitations?
Dr Devi Shetty: The patient should be investigated and if there is a cause
for palpitation like anelectrical abnormality of the heart, this can be
rectified by a procedure called radio frequency ablation.
=====================
Q.: If there is a small hole in the heart, what are the possible ways of
curing it? Is operation the only solution?
Dr Devi Shetty: Small holes in children less than 6 months of age usually
closes but the decision not to operate should be taken by the specialists who
are experts in treating children with heart problems.
=====================
Q.: Are emotions really controlled by the heart?
Dr Devi Shetty: No. The heart is just a slave of the brain and it is the
brain, which controls the emotions.
============================
Q.: If a person does not do any physical exercise, he is bound to have
shortness of breath on exertion; say climbing stairs. Is this an indication of
heart disease?
Dr Devi Shetty: No. But if one has difficulty in breathing on mild
exertion, it is a good idea to go for a heart checkup.
===========================
Q.: Can a person help himself during a heart attack (Because we see a lot of
forwarded emails on this)?
Dr Devi Shetty: Yes. Lie down comfortably and put an aspirin tablet of any
description under the tongue and ask someone to take you to the nearest
coronary care unit without any delay and do not wait for the ambulance since most
of the time, the ambulance does not turn up.
===========================
Q.: Do, in any way, low white blood cells and low hemoglobin count lead to
heart problems?
Dr Devi Shetty: No. But it is ideal to have normal hemoglobin level to
increase your exercise capacity.
========================
Q.: Sometimes, due to the hectic schedule we are not able to exercise. So,
does walking while doing daily chores at home or climbing the stairs in the
house, work as a substitute for exercise?
Dr Devi Shetty: Certainly. Avoid sitting continuously for more than half an
hour and even the act of getting out of the chair and going to another chair
and sitting helps a lot.
=========================
Q. : Is there a relation between heart problems and blood sugar?
Dr Devi Shetty: Yes. A strong relationship since diabetics are more
vulnerable to heart attacks than non-diabetics.
=============================
Q.: Do bypass surgeries reduce the risk of future heart attacks?
Dr Devi Shetty: It significantly reduces the risk of heart attack.
============================
Q.: What are the things one needs to take care of after a heart operation?
Dr Devi Shetty: Diet, exercise, drugs on time. Control cholesterol, BP,
weight.
================================
Q.: Are people working on night shifts more vulnerable to heart disease
when compared to day shift workers?
Dr Devi Shetty: No.
=================================
Q.: Can you brief us about angina attack and how major it is?
Dr Devi Shetty: Angina is the pain, which comes on exertion and goes away
with rest and medication. One has to be investigated in detail to plan
treatment.
=============================-
Q.: What are the modern anti-hypertensive drugs?
Dr Devi Shetty: There are hundreds of drugs and your doctor will chose the
right combination for your problem, but my suggestion is to avoid the drugs
and go for natural ways of controlling blood pressure by walk, diet to reduce
weight and changing attitudes towards lifestyles.
================
Q.: If there is about 85 percent blockage in the arteries, can the person
be treated without surgery? If not, what other remedies are there?
Dr Devi Shetty: It depends on collateral or natural bypass, the quality of
other arteries and the power of your heart muscles. It's impossible to give
an opinion without seeing the angiography film.
===================================
Q.: There is a feeling that bypass is unnecessarily being performed in some
cases. When is bypass really needed?
Dr Devi Shetty: When you have blockages affecting major arteries, bypass is
the best option. I am sure conscientious doctors will not perform an
operation when it is not required.
================================
Q.: Is it true that mechanical valves can fail any moment?
Dr Devi Shetty: No. If you take medication to prevent clot formation and
maintain the INR at accepted levels, the valve cannot get blocked. However,
like any mechanical gadget, it can fail and fortunately, such incidences are
extremely low.
=======================
Q.: Can you brief me on pulmonary stenosis problems? What are the
complications involved and what care needs to be taken?
Dr Devi Shetty: In this condition, the pulmonary valve is narrower at birth
and putting a balloon across the valve and dilating it can easily correct
it.
===================
Q.; Why is the rate of heart attacks more in men than in women?
Dr Devi Shetty: Nature protects women till the age of 45.
========================
Q.: How can one keep the heart in a good condition?
Dr Devi Shetty: Eat a healthy diet, avoid junk food, exercise everyday, do
not smoke and, go for a health checkup if you are past the age of 30 for at
least once in two yrs. And work very hard...
====================
You might find interesting to read this transcript of a chat with Dr. Devi
Shetty, Heart Specialist in India
Q. : What are the five thumb rules for a layman to take care of his heart?
Dr Devi Shetty:
1. Diet - Less of carbohydrate, more of protein, less oil
2. Exercise - Half an hour's walk, at least five days a week; avoid lifts
and avoid sitting for a long-time
3. Quit smoking
4. Control weight
5. Control blood pressure and sugar
==========
Q.: It's still a grave shock to hear that some apparently healthy person
gets a cardiac arrest. How do we understand it in perspective?
Dr Devi Shetty: This is called silent attack; that is why we recommend
everyone past the age of 30 to undergo routine health checkups.
=============
Q.: Are heart diseases hereditary?
Dr Devi Shetty: Yes
=============
Q.: What are the ways in which the heart is stressed? What practices do you
suggest to de-stress?
Dr Devi Shetty: Change your attitude towards life. Do not look for
perfection in everything in life.
=============
Q.: Is walking better than jogging or is more intensive exercise required
to keep a healthy heart?
Dr Devi Shetty: Walking is better than jogging since jogging leads to early
fatigue and injury to joints
=============
Q.: Can people with low blood pressure suffer heart diseases?
Dr Devi Shetty: Extremely rare
=============
Q.: Does cholesterol accumulates right from an early age (I'm currently
only 22) or do you have to worry about it only after you are above 30 years of
age?
Dr Devi Shetty: Cholesterol accumulates from childhood.
=================
Q.: How do irregular eating habits affect the heart?
Dr Devi Shetty: You tend to eat junk food when the habits are irregular and
your body's enzyme release for digestion gets confused.
==================
Q.: Can a healthy person without a medical history have a heart attack due
to stress?
Dr Devi Shetty: Extremely rare
==================
Q.: How can I control cholesterol content without using medicines?
Dr Devi Shetty: Control diet, walk and eat walnut.
===================
Q.: Can yoga prevent heart ailments?
Dr Devi Shetty: Yoga helps.
===================
Q.: Which is the best and worst food for the heart?
Dr Devi Shetty: Best food is fruits worst are oil.
==================
Q.:If a person has undergone angioplasty, what are the chances of the stent
getting displaced?
Dr Devi Shetty: The Stent doesn't get displaced it can get blocked. You
could prevent it by controlling sugar, cholesterol and taking medication to
prevent clots
==============
Q.: Do negative emotions like depression or anger always cause heart
disease?
Dr Devi Shetty: Not always. On the other hand, positive emotions help
recovery of the heart.
==============
Q.: Which oil is better - gingili, groundnut, sunflower, saffola, olive?
Dr Devi Shetty: All oils are bad; the so-called best oil company has the
largest marketing budget.
============
Q.: What is the routine checkup one should go through? Is there any
specific test?
Dr Devi Shetty: Routine blood test to ensure sugar, cholesterol is ok.Check
BP, Treadmill test after an echo.
=============
Q.: What are the first aid steps to be taken on a heart attack?
Dr Devi Shetty: Help the person into a sleeping position, put an aspirin
tablet under the tongue with a sorbitrate tablet if available, and rush him to
a coronary care unit since the maximum casualty takes place within the first
hour.
===============
Q.: How do you differentiate between pain caused by a heart attack and that
caused due to gastric trouble?
Dr Devi Shetty: Extremely difficult without ECG.
=================
Q.: Can drinking less water lead to heart problems?
Dr Devi Shetty: No. However, drinking plenty of water in normal people
helps preserve good health.
================
Q.: Is it true that diabetic women seem to have 3 to 7 times greater risk
of developing heart diseases than non-diabetic women? Is it the same with
high BP patients as well?
Dr Devi Shetty:Women are protected by the hormones till the age of 45;
after that their risk increases like men and in general, the result of treatment
on heart patients who are women is slightly poorer than men.
================
Q.: What is the main cause of a steep increase in heart problems amongst
youngsters? I see people of about 30-40 yrs of age having heart attacks and
serious heart problems.
Dr Devi Shetty: Increased awareness has increased incidents. Also,
sedentary lifestyles, smoking, junk food, lack of exercise in a country where people
are genetically three times more vulnerable for heart attacks than Europeans
and Americans.
==============
Q.: What is the right time to check the BP in any person?
Dr Devi Shetty: Past the age of 30 and earlier, if you have symptoms.
===============
Q.: Is it possible for a person to have BP outside the normal range of
120/80 and yet be perfectly healthy?
Dr Devi Shetty: Yes.
===============
Q.: Are there any symptoms for heart problems, which we need to be aware of?
Dr Devi Shetty: Shortness of breath on exertion, and chest pain.
=============
Q.: If a person has had a heart attack, how frequently is regular heart
check up recommended?
Dr Devi Shetty: Once in 6 months
=============
Q.: Marriages within close relatives can lead to heart problems for the
child.Is it true?
Dr Devi Shetty: Yes, co-sanguinity leads to congenital abnormalities and
you may not have a software engineer as a child
============
Q.: Many of us have an irregular daily routine and many a times we have to
stay late nights in office. Does this affect our heart? What precautions
would you recommend?
Dr Devi Shetty: When you are young, nature protects you against all these
irregularities. However, as you grow older, respect the biological clock.
============
Q.: How can we find out about blockage of arteries, beforehand?
Dr Devi Shetty: Routine cardiac evaluation by blood tests, ECGs, TMTs,
Stress thallium scan, cardiac CTscan for calcium score.
================
Q.: Does a recurring pain in the left arm signify any heart related ailment?
Dr Devi Shetty: Not always. However, heart pain can radiate to the left arm.
======================
Q.: Can we foresee the occurrence of a heart attack? Are there any
indications that the body feels before getting a heart attack?
Dr Devi Shetty: Usually, you get chest discomfort or shortness of
breath,months or years before the heart attack. So, when in doubt, go for a heart
checkup, which shouldn't take more than a couple of hours.
================================
Q.: Will taking anti-hypertensive drugs cause some other complications
(short / long term)?
Dr Devi Shetty: Yes, most drugs have some side effects. However, modern
anti-hypertensive drugs are extremely safe.
========================
Q.: Will consuming more coffee/tea lead to heart attacks?
Dr Devi Shetty: No.
======================
Q.: What are the chances of lean people developing heart complications?
Are they at less risk?
Dr Devi Shetty: Obese people are at a higher risk. Lean people also develop
heart attacks, but primarily because of genetic pre-disposition.
==============================
Q.: Is it true that after open-heart surgery, patients lose memory recall
to some extent?
Dr Devi Shetty: No. Especially after bypass grafting on a beating heart,
incidence of neurological problems have come down significantly.
=================================
Q.: Are asthma patients more prone to heart disease?
Dr Devi Shetty: No.
===============================
Q.: How would you define junk food?
Dr Devi Shetty: Fried food like Kentucky, McDonalds, samosas, and even
masala dosas.
========================
Q.: You mentioned that Indians are three times more vulnerable. What is the
reason for this, as Europeans and Americans also eat a lot of junk food?
Dr Devi Shetty: Every race is vulnerable to some disease and unfortunately,
Indians are vulnerable for the most expensive disease.
==================================
Q.: Is there any cure for chronic palpitations?
Dr Devi Shetty: The patient should be investigated and if there is a cause
for palpitation like anelectrical abnormality of the heart, this can be
rectified by a procedure called radio frequency ablation.
=====================
Q.: If there is a small hole in the heart, what are the possible ways of
curing it? Is operation the only solution?
Dr Devi Shetty: Small holes in children less than 6 months of age usually
closes but the decision not to operate should be taken by the specialists who
are experts in treating children with heart problems.
=====================
Q.: Are emotions really controlled by the heart?
Dr Devi Shetty: No. The heart is just a slave of the brain and it is the
brain, which controls the emotions.
============================
Q.: If a person does not do any physical exercise, he is bound to have
shortness of breath on exertion; say climbing stairs. Is this an indication of
heart disease?
Dr Devi Shetty: No. But if one has difficulty in breathing on mild
exertion, it is a good idea to go for a heart checkup.
===========================
Q.: Can a person help himself during a heart attack (Because we see a lot of
forwarded emails on this)?
Dr Devi Shetty: Yes. Lie down comfortably and put an aspirin tablet of any
description under the tongue and ask someone to take you to the nearest
coronary care unit without any delay and do not wait for the ambulance since most
of the time, the ambulance does not turn up.
===========================
Q.: Do, in any way, low white blood cells and low hemoglobin count lead to
heart problems?
Dr Devi Shetty: No. But it is ideal to have normal hemoglobin level to
increase your exercise capacity.
========================
Q.: Sometimes, due to the hectic schedule we are not able to exercise. So,
does walking while doing daily chores at home or climbing the stairs in the
house, work as a substitute for exercise?
Dr Devi Shetty: Certainly. Avoid sitting continuously for more than half an
hour and even the act of getting out of the chair and going to another chair
and sitting helps a lot.
=========================
Q. : Is there a relation between heart problems and blood sugar?
Dr Devi Shetty: Yes. A strong relationship since diabetics are more
vulnerable to heart attacks than non-diabetics.
=============================
Q.: Do bypass surgeries reduce the risk of future heart attacks?
Dr Devi Shetty: It significantly reduces the risk of heart attack.
============================
Q.: What are the things one needs to take care of after a heart operation?
Dr Devi Shetty: Diet, exercise, drugs on time. Control cholesterol, BP,
weight.
================================
Q.: Are people working on night shifts more vulnerable to heart disease
when compared to day shift workers?
Dr Devi Shetty: No.
=================================
Q.: Can you brief us about angina attack and how major it is?
Dr Devi Shetty: Angina is the pain, which comes on exertion and goes away
with rest and medication. One has to be investigated in detail to plan
treatment.
=============================-
Q.: What are the modern anti-hypertensive drugs?
Dr Devi Shetty: There are hundreds of drugs and your doctor will chose the
right combination for your problem, but my suggestion is to avoid the drugs
and go for natural ways of controlling blood pressure by walk, diet to reduce
weight and changing attitudes towards lifestyles.
================
Q.: If there is about 85 percent blockage in the arteries, can the person
be treated without surgery? If not, what other remedies are there?
Dr Devi Shetty: It depends on collateral or natural bypass, the quality of
other arteries and the power of your heart muscles. It's impossible to give
an opinion without seeing the angiography film.
===================================
Q.: There is a feeling that bypass is unnecessarily being performed in some
cases. When is bypass really needed?
Dr Devi Shetty: When you have blockages affecting major arteries, bypass is
the best option. I am sure conscientious doctors will not perform an
operation when it is not required.
================================
Q.: Is it true that mechanical valves can fail any moment?
Dr Devi Shetty: No. If you take medication to prevent clot formation and
maintain the INR at accepted levels, the valve cannot get blocked. However,
like any mechanical gadget, it can fail and fortunately, such incidences are
extremely low.
=======================
Q.: Can you brief me on pulmonary stenosis problems? What are the
complications involved and what care needs to be taken?
Dr Devi Shetty: In this condition, the pulmonary valve is narrower at birth
and putting a balloon across the valve and dilating it can easily correct
it.
===================
Q.; Why is the rate of heart attacks more in men than in women?
Dr Devi Shetty: Nature protects women till the age of 45.
========================
Q.: How can one keep the heart in a good condition?
Dr Devi Shetty: Eat a healthy diet, avoid junk food, exercise everyday, do
not smoke and, go for a health checkup if you are past the age of 30 for at
least once in two yrs. And work very hard...
====================
Bulking Up on Fiber
by Mary Calvagna, MS
Fiber—you know you need to eat it. You are pretty sure it is good for you. And according to reports, you, like many other Americans, aren't getting anywhere as much fiber as you should. But what is fiber, really? And why is it good for you?
Fiber Facts
Fiber is found only in plants—it is from the plant cells, particularly the cell walls. The plant fiber that we eat is called dietary fiber. It is unique from other components of the plant because humans lack the enzymes necessary to digest it.
Dietary fiber is made up of two types of fiber: soluble and insoluble. Soluble means that when the fiber is mixed with a liquid, it forms a gel-like solution. Insoluble fiber does not mix with liquid and passes through the digestive tract largely intact. Both types of fiber help maintain bowel regularity.
Soluble fiber
Soluble fiber has been found to provide some additional health benefits. When eaten as part of a low-fat, low-cholesterol diet, soluble fiber can help lower blood cholesterol. Weaker and somewhat inconsistent evidence hints at a link between soluble fiber intake and a reduced risk of certain cancers, diabetes, digestive disorders, and heart disease. Foods high in soluble fiber include oat bran, oatmeal, beans, peas, rice bran, barley, citrus fruit (the whole fruit, not the juice), strawberries, apples, and psyllium.
Insoluble fiber
Although insoluble fiber has not been shown to lower blood cholesterol, it is important for normal digestive health. Insoluble fiber speeds up movement through the small intestine and helps alleviate constipation. Foods that are high in insoluble fiber include whole wheat breads, wheat bran, rye, rice, barley, and most other grains, as well as cabbage, carrots, and cauliflower.
How Much Fiber Do I Need?
Health experts recommend eating a minimum of 20 to 30 grams of fiber daily—this includes both soluble and insoluble fiber. Most Americans eat about 11 to 15 grams a day—about half of what is recommended. The following table lists some foods that are high in fiber.
Food Serving size Fiber
(grams)
Grains, Beans, and Nuts
Lentils ½ cup 7.8
Black beans ½ cup 7.7
Kidney beans ½ cup 7.3
Wheat germ ½ cup 7.3
Peanuts ½ cup 5.8
Kellogg's Bran Flakes 1 cup 5.5
Garbanzo beans (chickpeas) ½ cup 5.3
Oatmeal, cooked 1 cup 4.0
Bran muffin 1 medium 2.5
Bread, whole wheat 1 slice 1.5
Vegetables
Potato, baked with skin 1 medium 4.8
Peas, cooked ½ cup 4.4
Sweet potato, baked with skin 1 medium 3.4
Brussels sprouts, cooked ½ cup 3.4
Spinach, cooked ½ cup 2.8
Broccoli, cooked ½ cup 2.3
Potato, baked without skin 1 medium 2.3
Carrot 1 medium 2.2
Corn, cooked ½ cup 2.0
Cauliflower, cooked ½ cup 1.7
Fruits
Pear 1 medium 4.0
Apple, with skin 1 medium 3.7
Orange 1 medium 3.1
Banana 1 medium 2.7
Nectarine 1 medium 2.2
Cantaloupe ½ medium 2.1
Prunes, dried 10 pieces 1.8
Peach 1 medium 1.7
Strawberries ½ cup 1.7
Increasing Fiber in Your Diet
It is easy to increase the fiber in your diet—it just takes a little thought and some action. Here are a few ideas to help you get on track to 30 grams of fiber a day.
Try a whole grain cereal that contains at least 5 grams of fiber per serving. Slice a banana on top, or add some raisins or berries to increase the fiber even more.
Sprinkle a few teaspoons of wheat germ or ground psyllium on your meals before eating.
Try eating some vegetables raw. Cooking can break down some of the fiber content. If you do cook vegetables, steam them lightly, so they are tender but still firm.
Leave the skin on fruits and vegetables. Just make sure you rinse them well with warm water to remove any dirt or bacteria.
Eat the whole fruit or vegetable instead of drinking the juice made from it. Juice does not contain the skin or membrane of the fruit or vegetable, and therefore its fiber content is substantially reduced.
Try adding whole, unprocessed grain to your diet. Substitute brown rice, bulgar, kasha, or couscous for white rice. Or opt for whole wheat bread or pasta.
Add beans to your soups, salads, and stews. Throw some garbanzo beans on top of a salad or add lentils to soup while cooking.
Snack on fresh and dried fruit. Chomp some raisins or dried apricots in the afternoon, instead of a bag of potato chips or pretzels.
A Word of Caution...
When you begin to increase the fiber in your diet, take it slow. Increasing too quickly can upset your intestinal tract and you may experience gas, bloating, cramps, or even constipation or diarrhea. By increasing your fiber intake just a few grams a day, your intestinal tract will have time to adjust. Other tips to help minimize upset include:
Drink at least eight 8-ounce cups of water a day.
Use enzyme products, such as Beano, to help you digest fiber.
Don't cook dried beans in the same water in which you soaked them.
Click here for fabulous fiber recipes.
by Mary Calvagna, MS
Fiber—you know you need to eat it. You are pretty sure it is good for you. And according to reports, you, like many other Americans, aren't getting anywhere as much fiber as you should. But what is fiber, really? And why is it good for you?
Fiber Facts
Fiber is found only in plants—it is from the plant cells, particularly the cell walls. The plant fiber that we eat is called dietary fiber. It is unique from other components of the plant because humans lack the enzymes necessary to digest it.
Dietary fiber is made up of two types of fiber: soluble and insoluble. Soluble means that when the fiber is mixed with a liquid, it forms a gel-like solution. Insoluble fiber does not mix with liquid and passes through the digestive tract largely intact. Both types of fiber help maintain bowel regularity.
Soluble fiber
Soluble fiber has been found to provide some additional health benefits. When eaten as part of a low-fat, low-cholesterol diet, soluble fiber can help lower blood cholesterol. Weaker and somewhat inconsistent evidence hints at a link between soluble fiber intake and a reduced risk of certain cancers, diabetes, digestive disorders, and heart disease. Foods high in soluble fiber include oat bran, oatmeal, beans, peas, rice bran, barley, citrus fruit (the whole fruit, not the juice), strawberries, apples, and psyllium.
Insoluble fiber
Although insoluble fiber has not been shown to lower blood cholesterol, it is important for normal digestive health. Insoluble fiber speeds up movement through the small intestine and helps alleviate constipation. Foods that are high in insoluble fiber include whole wheat breads, wheat bran, rye, rice, barley, and most other grains, as well as cabbage, carrots, and cauliflower.
How Much Fiber Do I Need?
Health experts recommend eating a minimum of 20 to 30 grams of fiber daily—this includes both soluble and insoluble fiber. Most Americans eat about 11 to 15 grams a day—about half of what is recommended. The following table lists some foods that are high in fiber.
Food Serving size Fiber
(grams)
Grains, Beans, and Nuts
Lentils ½ cup 7.8
Black beans ½ cup 7.7
Kidney beans ½ cup 7.3
Wheat germ ½ cup 7.3
Peanuts ½ cup 5.8
Kellogg's Bran Flakes 1 cup 5.5
Garbanzo beans (chickpeas) ½ cup 5.3
Oatmeal, cooked 1 cup 4.0
Bran muffin 1 medium 2.5
Bread, whole wheat 1 slice 1.5
Vegetables
Potato, baked with skin 1 medium 4.8
Peas, cooked ½ cup 4.4
Sweet potato, baked with skin 1 medium 3.4
Brussels sprouts, cooked ½ cup 3.4
Spinach, cooked ½ cup 2.8
Broccoli, cooked ½ cup 2.3
Potato, baked without skin 1 medium 2.3
Carrot 1 medium 2.2
Corn, cooked ½ cup 2.0
Cauliflower, cooked ½ cup 1.7
Fruits
Pear 1 medium 4.0
Apple, with skin 1 medium 3.7
Orange 1 medium 3.1
Banana 1 medium 2.7
Nectarine 1 medium 2.2
Cantaloupe ½ medium 2.1
Prunes, dried 10 pieces 1.8
Peach 1 medium 1.7
Strawberries ½ cup 1.7
Increasing Fiber in Your Diet
It is easy to increase the fiber in your diet—it just takes a little thought and some action. Here are a few ideas to help you get on track to 30 grams of fiber a day.
Try a whole grain cereal that contains at least 5 grams of fiber per serving. Slice a banana on top, or add some raisins or berries to increase the fiber even more.
Sprinkle a few teaspoons of wheat germ or ground psyllium on your meals before eating.
Try eating some vegetables raw. Cooking can break down some of the fiber content. If you do cook vegetables, steam them lightly, so they are tender but still firm.
Leave the skin on fruits and vegetables. Just make sure you rinse them well with warm water to remove any dirt or bacteria.
Eat the whole fruit or vegetable instead of drinking the juice made from it. Juice does not contain the skin or membrane of the fruit or vegetable, and therefore its fiber content is substantially reduced.
Try adding whole, unprocessed grain to your diet. Substitute brown rice, bulgar, kasha, or couscous for white rice. Or opt for whole wheat bread or pasta.
Add beans to your soups, salads, and stews. Throw some garbanzo beans on top of a salad or add lentils to soup while cooking.
Snack on fresh and dried fruit. Chomp some raisins or dried apricots in the afternoon, instead of a bag of potato chips or pretzels.
A Word of Caution...
When you begin to increase the fiber in your diet, take it slow. Increasing too quickly can upset your intestinal tract and you may experience gas, bloating, cramps, or even constipation or diarrhea. By increasing your fiber intake just a few grams a day, your intestinal tract will have time to adjust. Other tips to help minimize upset include:
Drink at least eight 8-ounce cups of water a day.
Use enzyme products, such as Beano, to help you digest fiber.
Don't cook dried beans in the same water in which you soaked them.
Click here for fabulous fiber recipes.
"Why Am I Praying and Not Being Healed?"
Pain insists upon being attended to. God whispers to us in our pleasures, speaks in our consciences, but shouts in our pains. It is his megaphone to rouse a deaf world.
-C.S. Lewis
From "Towers of Hope: Stories to Help Us Heal," by Joy Carol:
Later that year my back was seriously re-injured in an automobile accident. Seven years earlier I had had extensive surgery on it. On July 29, an orthopedic surgeon informed me that there was nothing more that could be done for me because the risks were too great of my becoming paralyzed. I had been in bed for weeks and could barely walk. The pain was so excruciating that I was planning to start a pain management program to learn how to adapt to this way of living. I wondered what I would do with the rest of my life. . .
We were aware that Archbishop Tutu was very busy . . . but we asked if it would be possible to get an appointment with him.
At his office, the Archbishop asked: "Jenny, how is your back?" "Father, you don't want to know," I answered. "I feel depressed and have a lot of pain. Why am I praying and not being healed? I must have done something very wrong in my life, and God is punishing me. Perhaps I have sinned so much that He isn't able to heal me."
I'll never forget what he said. "Jenny, then Jesus must have been the greatest sinner of all, because no one suffered more than He did. What you need to do, my daughter, is give thanks for what God has given you. And you need to embrace this pain. There may be a reason for it. You need to give it to God and leave it with Him."
For a moment I just stared at him as I thought about those words. He went on: "One day you will look back on this experience and understand why you have this pain. You will be called to speak to people who are in pain, and you can tell them you've been there. Embrace that pain and then give it back to God. Until you can accept this and stop questioning why it is happening to you, you will not experience release and healing."
Pain insists upon being attended to. God whispers to us in our pleasures, speaks in our consciences, but shouts in our pains. It is his megaphone to rouse a deaf world.
-C.S. Lewis
From "Towers of Hope: Stories to Help Us Heal," by Joy Carol:
Later that year my back was seriously re-injured in an automobile accident. Seven years earlier I had had extensive surgery on it. On July 29, an orthopedic surgeon informed me that there was nothing more that could be done for me because the risks were too great of my becoming paralyzed. I had been in bed for weeks and could barely walk. The pain was so excruciating that I was planning to start a pain management program to learn how to adapt to this way of living. I wondered what I would do with the rest of my life. . .
We were aware that Archbishop Tutu was very busy . . . but we asked if it would be possible to get an appointment with him.
At his office, the Archbishop asked: "Jenny, how is your back?" "Father, you don't want to know," I answered. "I feel depressed and have a lot of pain. Why am I praying and not being healed? I must have done something very wrong in my life, and God is punishing me. Perhaps I have sinned so much that He isn't able to heal me."
I'll never forget what he said. "Jenny, then Jesus must have been the greatest sinner of all, because no one suffered more than He did. What you need to do, my daughter, is give thanks for what God has given you. And you need to embrace this pain. There may be a reason for it. You need to give it to God and leave it with Him."
For a moment I just stared at him as I thought about those words. He went on: "One day you will look back on this experience and understand why you have this pain. You will be called to speak to people who are in pain, and you can tell them you've been there. Embrace that pain and then give it back to God. Until you can accept this and stop questioning why it is happening to you, you will not experience release and healing."
Do Your Medications Actually Work?
by Deb Wood, RN
Pharmacogenomics or pharmacogenetics is the study of how peoples’ genes affect how they respond to medications. It is a relationship doctors have been investigating for almost 50 years, and only now are they growing closer to being able to tailor drugs and dosages to individual patients.
What Role Do Genes Play?
The medications you take rely on internal mechanisms to metabolize and transport them throughout your body. During this process, thousands of protein molecules interact with them and may alter how well they work. This means that your genes may affect how effectively (or ineffectively) you absorb and metabolize a particular drug, which in turn affects how well the drug works for you.
Therefore, your genetic make up could alter your response to drugs used to manage all types of conditions, including depression, pain, asthma, blood pressure, and more. It also explains why in some cases, you may need to try several different medications in order to find the one that works for you.
“A lot of people treated now do not respond to one drug,” Dr. Licinio says. “You have to stop, try something else and go on. If you could be right the first time around, you would save a lot of medical care.”
In some cases, these genetic-drug mismatches can prove fatal. Approximately 100,000 deaths occur each year due to adverse drug reactions, and while some adverse events are due to human error (giving the wrong dose or giving a drug to someone known to be allergic to it) some drug reactions may be caused by genetic-drug mismatches. Knowing a patient’s genetic code may therefore someday help doctors make drug treatments safer.
Cancer Drugs
Multiple studies have demonstrated the correlation between genes and drug response. The National Institute of General Medical Sciences, a part of the National Institutes of Health (NIH), has funded extensive research in this area. To date, the results have been promising. The basic link between genetics and drug efficacy is clear, however, much more research is needed to reach a practical understanding of how to apply knowledge to everyday care. Cancer drugs have been an area of particular interest. This is because in cancer care, the need to know whether a drug will or will not work is vitally important, both because these drugs often produce serious side effects and because the time it takes to prove a drug ineffective may allow cancer cells to grow or metastasize.
One example of the importance of genetics in cancer care is how the thiopurine methyltransferase (TPMT) gene affects the way some people metabolize a certain class of drug used to treat leukemia. Some children who are treated with this class of drug have an alteration in the TPMT gene that causes their bodies to metabolize the drug very slowly. When these children are given the standard dose of medications in this class, the medications can build up in their bodies, reaching potentially toxic levels. Other children, however, metabolize this class of drug much more rapidly. These children require larger doses in order to benefit from the drug. Fortunately, a simple blood test can determine how long it will take a child to process the drug, and the dose can be adjusted in advance.
What Does the Future Hold?
Within the next five to 15 years, your doctor may be able to tailor your treatment according to your genetic make-up. Some laboratories already offer blood tests to check for gene alterations that vary the effect of cancer drugs. These tests are designed to look for specific changes that may affect the drug about to be ordered. In the future, it may get even easier.
In the end, the experts offer patients three suggestions for learning more about these issues and technologies:
Ask if any information about genes and drugs exists for your condition.
Consider participating in a clinical trial.
Stay abreast of new developments.
“This is evolving every day,” Dr. Licinio says. “For what you have, a the test may not be available today but could be available tomorrow. Always be on the lookout for new things.”
RESOURCES:
American Medical Association
http://www.ama-assn.org
Human Genome Project Information
http://www.ornl.gov
National Institute of General Medical Sciences
http://www.nigms.nih.gov
Sources:
Anderson JL, Carlquist JF, Horne BD, Muhlestein JB. Cardiovascular pharmacogenomics: current status, future prospects. J Cardiovasc Pharmacol Ther. 2003;8(1):71-83.
Evans EE, McLeod HL. Pharmacogenomics—drug disposition, drug targets, and side effects. N Engl J Med. 2003;348:538-549.
Lennard L, Lilleyman JS, Van Loon J, Weinshilboum RM. Genetic variation in response to 6-mercaptopurine for childhood acute lymphoblastic leukaemia. Lancet. 1990;336 (8709):225-9.
Mancama D, Kerwin RW. Role of pharmacogenomics in individualising treatment with SSRIs. CNS Drugs. 2003;17(3):143-51.
Mancinelli L, Cronin M, Sadee W. Pharmacogenomics: The Promise of Personalized Medicine
AAPS PharmSci. 2000; 2(1):article 4.
Pharmacogenomics: Revolution in a Bottle? American Medical Association. Available at: http://www.ama-assn.org/ama/pub/category/7459.html. Accessed January 23, 2004.
Watters JW, McLeod HL. Cancer pharmacogenomics: current and future applications. Biochim Biophys Acta. 2003;1603(2):99-111.
What is Pharmacogenetics? National Institute of General Medical Sciences. Available at: http://www.nigms.nih.gov/news/facts/pha ... mmary.html. Accessed January 23, 2004.
What is pharmacogenomics? U.S. Department of Energy Office of Science, Office of Biological and Environmental Research, Human Genome Program. Available at: http://www.ornl.gov/sci/techresources/H ... arma.shtml. Accessed January 23, 2004.
by Deb Wood, RN
Pharmacogenomics or pharmacogenetics is the study of how peoples’ genes affect how they respond to medications. It is a relationship doctors have been investigating for almost 50 years, and only now are they growing closer to being able to tailor drugs and dosages to individual patients.
What Role Do Genes Play?
The medications you take rely on internal mechanisms to metabolize and transport them throughout your body. During this process, thousands of protein molecules interact with them and may alter how well they work. This means that your genes may affect how effectively (or ineffectively) you absorb and metabolize a particular drug, which in turn affects how well the drug works for you.
Therefore, your genetic make up could alter your response to drugs used to manage all types of conditions, including depression, pain, asthma, blood pressure, and more. It also explains why in some cases, you may need to try several different medications in order to find the one that works for you.
“A lot of people treated now do not respond to one drug,” Dr. Licinio says. “You have to stop, try something else and go on. If you could be right the first time around, you would save a lot of medical care.”
In some cases, these genetic-drug mismatches can prove fatal. Approximately 100,000 deaths occur each year due to adverse drug reactions, and while some adverse events are due to human error (giving the wrong dose or giving a drug to someone known to be allergic to it) some drug reactions may be caused by genetic-drug mismatches. Knowing a patient’s genetic code may therefore someday help doctors make drug treatments safer.
Cancer Drugs
Multiple studies have demonstrated the correlation between genes and drug response. The National Institute of General Medical Sciences, a part of the National Institutes of Health (NIH), has funded extensive research in this area. To date, the results have been promising. The basic link between genetics and drug efficacy is clear, however, much more research is needed to reach a practical understanding of how to apply knowledge to everyday care. Cancer drugs have been an area of particular interest. This is because in cancer care, the need to know whether a drug will or will not work is vitally important, both because these drugs often produce serious side effects and because the time it takes to prove a drug ineffective may allow cancer cells to grow or metastasize.
One example of the importance of genetics in cancer care is how the thiopurine methyltransferase (TPMT) gene affects the way some people metabolize a certain class of drug used to treat leukemia. Some children who are treated with this class of drug have an alteration in the TPMT gene that causes their bodies to metabolize the drug very slowly. When these children are given the standard dose of medications in this class, the medications can build up in their bodies, reaching potentially toxic levels. Other children, however, metabolize this class of drug much more rapidly. These children require larger doses in order to benefit from the drug. Fortunately, a simple blood test can determine how long it will take a child to process the drug, and the dose can be adjusted in advance.
What Does the Future Hold?
Within the next five to 15 years, your doctor may be able to tailor your treatment according to your genetic make-up. Some laboratories already offer blood tests to check for gene alterations that vary the effect of cancer drugs. These tests are designed to look for specific changes that may affect the drug about to be ordered. In the future, it may get even easier.
In the end, the experts offer patients three suggestions for learning more about these issues and technologies:
Ask if any information about genes and drugs exists for your condition.
Consider participating in a clinical trial.
Stay abreast of new developments.
“This is evolving every day,” Dr. Licinio says. “For what you have, a the test may not be available today but could be available tomorrow. Always be on the lookout for new things.”
RESOURCES:
American Medical Association
http://www.ama-assn.org
Human Genome Project Information
http://www.ornl.gov
National Institute of General Medical Sciences
http://www.nigms.nih.gov
Sources:
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What is Pharmacogenetics? National Institute of General Medical Sciences. Available at: http://www.nigms.nih.gov/news/facts/pha ... mmary.html. Accessed January 23, 2004.
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