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.
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.
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.
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.
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.
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.
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:
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:
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.
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
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.
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.
I feel about airplanes the way I feel about diets. It seems to me they are wonderful things for other people to go on.
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
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.
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.)
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
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
Extreme, unexplained fatigue
Swollen lymph nodes in armpits, neck, or groin
White spots on the tongue or in the mouth or throat
Discomfort from light
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
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)
Viral brain infection
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
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.
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)
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.
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.
Polishes tooth surfaces
Controls bad breath
Increases the chances of keeping your teeth for a lifetime
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.
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
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.
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.
A risk factor is something that increases your chance of getting a disease or condition.
Age: risk increases with age
Body size: small, underweight women
Race: Caucasian and Asian women
Family members with osteoporosis
Abnormal cessation of menstrual periods (amenorrhea) due to anorexia nervosa, rigorous exercise, or an endocrinological problem
Immunosuppressants, such as prednisone and other steroids, methotrexate, cyclosporine
Long-term heparin therapy
Low estrogen levels in women
Low testosterone levels in men
Too little sunlight
Excessive use of alcohol, coffee and tea
Liver disease, including cirrhosis
Marfan's and Ehler-Danlos syndromes
Cancer, including lymphoma
Osteoporosis does not usually cause symptoms. Pain is the only symptom, and generally occurs when the bones have broken or collapsed.
Severe back pain with fracture of the vertebrae, wrists, hips, or other bones
Loss of height, with stooped posture (kyphosis)
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
Eat a balanced diet rich in calcium and vitamin D. Consider decreasing your intake of caffeinated beverages and alcohol. Calcium is abundant in:
Green leafy vegetables
Canned fish with bones
Do not smoke. If you smoke, quit.
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.
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.
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
Reduce bone loss
Increase bone density
Reduce the risk of hip and spinal fractures in postmenopausal women
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.
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
Healthful lifestyle (no smoking and moderate alcohol)
Bone density testing and medications where appropriate:
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
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:
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
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.
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)
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.
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
Lack of exercise
Drinking excessive amounts of alcohol
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
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 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.
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
Having a stroke is an emergency situation. Diagnosis includes:
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
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
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:
The following may help prevent a stroke:
Increase intake of fruits and vegetables and limit dietary salt and fat.
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.
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.
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 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.
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.
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:
Unexplained weight gain
Intolerance to cold
In addition, hypothyroidism can contribute to:
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:
Unexplained weight loss
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:
Premature births or miscarriages among pregnant women
Irregular heart beat
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
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
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.
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
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
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
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
Q.: Do negative emotions like depression or anger always cause heart
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
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
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
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
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
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
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,
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
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
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
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...
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 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 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.
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
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
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
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.
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.
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.
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.”
Hostility, Anger, and Heart Disease
by Amy Scholten, MPH
“You will not be punished for your anger—you will be punished by your anger.” – Buddha
“Anger does more harm than the condition which aroused anger.” – David O. Mckay
“Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else—you are the one getting burned.” – Buddha
“Indulge not thyself in the passion of anger; it is whetting a sword to wound thine own breast, or murder thy friend.” – Akhenaton
“When anger arises, think of the consequences.” – Confucius
Sages through the ages have warned us about hostility and anger, and now research seems to confirm their admonitions. A number of studies suggest that high levels of hostility and anger are associated with coronary heart disease (CHD). In fact, a study published in the November 2002 issue of Health Psychology suggests that hostility may predict CHD more than other risk factors such as cholesterol and smoking.
Researchers Explore Hostility-Heart Disease Link in Men
Hostility is an attitudinal, emotional and behavioral construct that includes:
Negative beliefs about and attitudes toward others, including cynicism and mistrust
Anger, an unpleasant emotion ranging from irritation to rage
Actions or thoughts of harming others either verbally or physically
In an effort to determine whether hostility was an independent influence or contributing factor in the development of coronary heart disease, Raymond Niaura, PhD of Brown University, and his colleagues, looked at a sample of 774 predominately white men (average age 60) who participated in the Normative Aging Study (NAS).
The following factors were assessed over a three-year period, beginning in 1986:
Hostility levels, measured by the Cook-Medley Hostility Scale (Ho) of the Minnesota Multiphasic Personality Inventory (MMPI)
Blood lipids: total cholesterol, HDL and LDL cholesterol, and triglycerides
Body mass index (BMI), a measurement of height and weight to determine obesity
Waist-to-hip ratio (WHR)
Health behaviors, including
Total dietary calories
Incidence of coronary heart disease (CHD)
Results: Hostility May Independently Predict CHD
During the three-year NAS study, 45 of the men had an initial episode of CHD (defined as a heart attack, angina, or abnormal electrocardiogram). New episodes of CHD were more common in men with higher levels of hostility than those with other risk factors for CHD. Other risk factors for CHD, including high blood pressure, total cholesterol levels, fasting insulin, measurements of obesity and body fat distribution (BMI and WHR), and even smoking, did not predict a man’s risk of CHD during those three years.
Of the physiological measures, only levels of HDL or “good” cholesterol predicted a man’s risk of heart disease for the three years of the study. Specifically, HDL had a protective effect against CHD. However, hostility levels predicted incidences of CHD independent of the effect of HDL.
This study is consistent with other studies demonstrating that hostility is associated with and predicts the incidence CHD above and beyond the traditionally assessed risk factors. According to the researchers, the findings also demonstrated that hostility predicted incident CHD above and beyond factors related to the metabolic syndrome. Specifically, older men with the highest levels of hostility were at greatest risk for incident CHD, independent of the effects of fasting insulin, BMI, WRH, triglyceride levels, and blood pressure.
The researchers speculate that hostility may influence certain health behaviors that increase risk of CHD. Hostility may also be associated with sociodemographic characteristics (such as education level, income, job status, race) that are, in turn, associated with increased risk of CHD. Finally, hostility may be associated with changes in the body that could hasten atherosclerosis.
The researchers acknowledge that the study had a number of limitations, including:
It involved older, primarily white men of normal health status, and therefore limited the ability to generalize the results to younger adults, women, and other ethnic minority populations.
The ability to detect significant effects may have been low because of the relatively low incidence of CHD. A longer follow-up might have provided this opportunity.
It did not include measures of perceived stress, stress hormones, and other CHD risk factors.
The researchers recommend that future studies examining the relationship between hostility and CHD should focus on more diverse populations and other physiological, behavioral, and genetic factors.
Psychological Interventions for Hostility and Anger
According to Dr. Niaura, the study findings suggest that mental health professionals continue to look at the effectiveness of psychological interventions for people with high levels of hostility.
For help in managing anger, the American Psychological Association recommends finding books, courses, or therapists that can teach you:
How to change thinking that leads to anger
Healthy communication strategies
Problem solving techniques
How to use humor
How to be assertive
Strategies for managing or eliminating stressors
Counseling should be considered if you feel that your anger is out of control, or if it is having a negative effect on your relationships or other important parts of your life.
High cholesterol is excess levels of cholesterol in the blood. Cholesterol in the blood consists of three main components:
Low Density Lipoproteins (LDL) – involved in depositing cholesterol and other fats throughout the body. High levels of LDL put you at risk for hardening of the arteries and heart disease.
High Density Lipoproteins (HDL) – involved in eliminating cholesterol and other fats from the body. High levels of HDL are protective against heart disease.
Triglycerides – a common form of fat in the body
Causes of high cholesterol include:
Inherited tendency to have high cholesterol
Excess alcohol intake
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for high cholesterol include:
Age: Cholesterol levels tend to rise as you get older
Females after menopause
Family members with high cholesterol
High cholesterol rarely causes symptoms.
Eventually, symptoms may include:
Angina (chest pain)
In people with an inherited form of high cholesterol, cholesterol deposits:
In the tendons
Under the eyes
Around the cornea
The doctor will ask about your symptoms and medical history, and perform a physical exam. High cholesterol is diagnosed through tests that measure levels of the following factors in your blood:
Treatment may include:
Limit the amount of fat and cholesterol you eat.
Eat a diet high in fiber.
Begin a safe exercise program recommended by your doctor.
Increase physical activity in your daily life, as recommended by your doctor.
If you smoke, quit.
If you are overweight, lose weight.
Limit the amount of alcohol you drink. Moderate alcohol intake is no more than 2 drinks per day for men and 1 drink per day for women.
If diet and exercise don't lower your blood cholesterol in a reasonable period of time, you may need cholesterol-lowering medication. A partial list of medications includes:
To reduce your chance of having high cholesterol:
Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
Maintain a healthy weight.
Don't smoke. If you smoke, quit.
Drink alcohol in moderation. Moderate alcohol intake is no more than 2 drinks per day for men and 1 drink per day for women.
Posted: Fri Feb 17, 2006 9:01 am Post subject: In Her Own Words: Living With Infertility
In Her Own Words: Living With Infertility
As told to Debra Wood, RN
Cathy, 29, and her husband have been married 10 years and truly want to be parents. When the Kansas couple wasn't able to conceive naturally, they sought medical help.
What was your first sign that something was wrong? What symptoms did you experience?
Six years ago, we started trying to have a baby. Nothing happened. My OB-GYN reassured me and said for us to try on our own for a year. We took my temperature daily or used an ovulation predictor while waiting. My OB-GYN did some preliminary checks on my husband and myself. Everything was fine. He recommended we see a specialist. When we did, we got a little freaked out by what was involved and decided to hold off on treatment.
What was the diagnosis experience like?
About three years ago, we started going through testing again with our current reproductive endocrinologist. I had an hysterosalpingography (HSG) and a laparoscopy. He could not find any reason why we could not conceive.
What was your initial and then longer-term reaction to the diagnosis?
I've never been so scared, asking myself if my body would ever work like it's supposed to. I wanted a child. I'm very religious, so dealing with why God hadn't blessed us was difficult. I questioned and dealt with "Why is this happening to me?" and "What have we done not to be blessed?" But knowing there was an end—whether it would be a pregnancy through treatment or a miracle or adoption—helped. Also, I saw people who adopted and loved their child as much as my mother loved me. That helped me realize adoption would be OK. One way or the other, I knew we would be parents. I finally came to a place where I could rest in that fact.
How is infertility treated?
For three months after the laparoscopy, I had intrauterine inseminations (IUIs), sometimes called artificial inseminations. They were not successful. I knew the next step was in vitro fertilization (IVF). I took fertility drugs and underwent an egg retrieval procedure. My husband's sperm count was high, so we did traditional IVF, putting my 12 eggs and his sperm together to fertilize. The next day, the doctor called, saying none of my eggs had fertilized. It was a huge blow.
They tried a rescue intracytoplasmic sperm insertion (ICSI). In this procedure, single sperms are inserted into individual eggs. Seven fertilized. We had an embryo to transfer, but the pregnancy test was negative. That was hard. Not only couldn't we get pregnant naturally, it was like our bodies were fighting each other. But at least we had an answer about why conception wasn't happening naturally. We tried again, this time doing the ICSI immediately. There was good fertilization and transfer. Then I found out I was pregnant with twins. We're very excited and feel blessed.
Did you have to make any lifestyle or dietary changes in response to infertility?
I left a job I loved and people I loved working with for an employer with health insurance that pays for four tries of IVF. It was a huge decision. But I wasn't willing to go into major debt if I didn't have to. I also made all the recommended lifestyle changes. While trying to conceive, I rarely had a glass of wine. I don't smoke or drink caffeine. And I eat healthful foods.
Did you seek any type of emotional support?
I saw a counselor, because I started feeling angry at the world, myself, God, my family. I went to a monthly educational meeting at RESOLVE: The National Infertility Association and started to volunteer. The peer support group allowed me to talk to other people going through infertility, which helped enormously. I can't imagine going through this without the friends I've made through RESOLVE. It's great to have someone to call. They help you think through things, like what your friend with four kids just said.
Does infertility have any impact on your family?
My husband wanted children as much as I did. My angry stage was hard for him. But infertility has made our marriage stronger. We've had to come together and talk things over, make joint decisions, and set stopping points. We've made huge ethical decisions, like what to do with our embryos. We talk about things most married couples don't discuss. We've had bumpy times, but that has made us stronger.
Dealing with our families is harder. At every family reunion, we were asked when we were going to have children. We didn't want to get into an infertility discussion. That was our personal business. We made the choice not to go to family reunions, because we couldn't deal with it.
What advice would you give to anyone living with infertility?
If you want to be a parent, you will be, whether through treatment or adoption. Get plugged in with RESOLVE. And go to a reproductive endocrinologist, not just an OB-GYN.
Reducing Your Risk of Infertility in Women
by Alayne Ronnenberg, ScD
About 10% to 20% of couples in the U.S. experience infertility. Although little can be done to prevent physiologic and genetic causes of infertility, it is estimated that 50% to 75% of infertility cases can be prevented through changes in lifestyle.
Maintain Appropriate Body Weight
Women who are very thin as well as those who are substantially overweight may have fertility problems. Low body weight disrupts hormonal function and can cause anovulation (no ovulation) and amenorrhea (the absence of a menstrual period). Being overweight can also disrupt hormone levels and can lead to irregular menstrual cycles. Before attempting to change your weight, you should consult with your physician or a registered dietitian. These trained health professionals can help you determine what weight range is right for you and the best way to attain it. And if you do become pregnant, eating a healthful, balanced diet in the months before pregnancy can help to ensure that your baby is healthy, too.
Chronic, heavy drinking negatively affects ovarian function and can lead to irregular menstrual cycles, loss of ovulation, and cessation of menstruation. Even moderate drinking (five or fewer drinks per week) has been associated with reduced rates of conception and increased risk of miscarriage. It is well documented that drinking alcohol during pregnancy increases the risk of birth defects.
Limit Your Number of Sexual Partners and Practice Safe Sex
The more sexual partners you have, the greater your chances of contracting a sexually transmitted disease (STD). Many STDs produce few or no symptoms in women. They are often left untreated, which can lead to pelvic inflammatory disease and scarring of the fallopian tubes. Other STDs, such as human papillomavirus (HPV), can cause cells in the cervix to grow abnormally, necessitating treatments that can make the uterus less able to carry a fetus. Limiting your number of sexual partners and using a condom during intercourse can help to prevent the transmission of many STDs.
Manage Stress and Depression
Depression and high levels of stress hormones can affect ovarian function. Try to develop a system for managing stress and depression, either through regular exercise, yoga, or fulfilling leisure activities. To help reduce mental and emotional stress in your life, consider learning relaxation exercises, yoga or tai chi, or talking to a counselor about problems or stressful relationships in your life. Talk to your health care provider about which stress management options may be best for you, and request a referral to a stress management program.
Have Regular Physical Exams, Including Gynecologic Exams
Regular physical exams can identify hormonal abnormalities that could reduce your fertility. In addition, gynecological exams, including a pelvic exam and Pap smear, can help to identify any structural abnormalities that can influence fertility. These exams can also detect reproductive tract infections that, if left untreated, can lead to pelvic inflammatory disease and scarring of reproductive structures.
When to Contact Your Health Care Provider
Contact your heath care provider if you:
Are not sure if you need to gain or lose weight
Need help designing a healthy, balanced diet
Need help quitting smoking
Need help eliminating alcohol
Need help with depression or other mood disorders
Have pelvic pain or evidence of unusual discharge from your vagina
American Society for Reproductive Medicine
Reproductive Health Outlook (RHO)
Conditions InDepth: Infertility in Women
by Alayne Ronnenberg, ScD
Infertility in women is a disorder of the reproductive system that hinders the body’s ability to ovulate, conceive or carry an infant to term. A couple is considered infertile when they have not conceived after a full year of regular sexual intercourse without using contraception. Couple infertility may be due to male factors, female factors, or a combination.
A successful pregnancy involves many steps. First, a healthy egg must be released from a woman’s ovaries (ovulation) and travel to the fallopian tube, where it is fertilized by a man’s sperm. If fertilization (conception) occurs, the fertilized egg than moves to the uterus. The embryo secures itself to the uterine wall. This begins the 38-40 week journey from embryo to fetus to baby. Problems can occur at anytime during this process and may result in infertility
Female Reproductive Organs - A daigram not reproduceable, please refer to the link provided above.
Infertility affects an estimated 14% of married women ages 15-44 in the United States. Age related ability to have a successful pregnancy is well documented. Success rates begin to decline at age 35 and are severely reduced by age 40 in women.
Common causes of infertility in women include:
Menstrual cycle dysfunction - The most common cause of infertility in women
Problems with ovulation- Something affects the release of an egg by the ovary
Fallopian tube blockage - Present from birth or may result from surgery, trauma or infection in the pelvic area
Endometriosis –Results when tissue from the uterine lining is found outside the uterus
What are the risk factors for infertility in women?
What are the symptoms of infertility in women?
How is infertility in women diagnosed?
What are the treatments for infertility in women?
Are there screening tests for infertility in women?
How can I reduce my risk of infertility?
What questions should I ask my health care provider?
What is it like to live with infertility?
Where can I get more information about infertility in women?
American College of Obstetricians and Gynecologists
American Medical Association
American Society for Reproductive Medicine
International Council on Infertility Information Dissemination
The healthy human body is the temple in which the flame of the Holy Spirit burns, and thus it deserves the respect of scrupulous cleanliness and personal hygiene. Prayer is a daily necessity, a direct communication of the spark with the Universal flame. .
Homeopathy: What's It All About?
by Elissa Sonnenberg
People who practice homeopathy say it taps into the body's innate ability to heal itself. The term has its roots in the Greek words "homos" (similar) and "pathos" (suffering).
The Law of Similars
Rather than simply suppressing symptoms of a disease, homeopathic remedies are believed to help the body's own healing mechanisms work. This is accomplished by giving patients small amounts of a substance that causes an illness to stimulate the body's natural capacity to heal from it. Known as the "law of similars," this approach was introduced by German physician and chemist Samuel Hahnemann in the late 1700s.
Today, homeopathic practitioners choose from a wide variety of treatments that include minute amounts of ingredients that create symptoms similar to what each patient is experiencing. Because the active ingredients are significantly diluted, patients rarely feel worse. On the contrary, their symptoms should go away.
Too Little Medicine to Do Any Good?
Skeptics of homeopathy say that these dilutions, some with concentrations of substances as small as one in 100 (to the 200th power), are useless. After being diluted to this degree, they say, the solution does not contain a single molecule of the medicinal substance.
"[Hahnemann] invented something that would be a foolproof way of not doing harm to people, which meant diluting substances so that they have no effect," says Wallace Sampson, MD, editor-in-chief of The Scientific Review of Alternative Medicine.
Letting Your Body Do the Work
Homeopathic practitioners, many of whom are also medical doctors, disagree. They point to 200 years of anecdotal evidence and the popularity of homeopathy abroad as proof that their methods work.
"Homeopathy is a very important component in natural holistic medicine," maintains Raphael Kellman, MD, founder and head of the Raphael Kellman Center for Progressive Medicine in New York City. Dr. Kellman sees homeopathy as a way to tap into the body's powerful "software" that conventional medicine too often ignores.
"Ultimately, it's the body that does the healing," says Dr. Kellman, who uses homeopathy to complement traditional medical therapies.
Conventional physicians respond that anecdotes are highly unreliable, and the apparent healing seen could be no more than the placebo effect.
Homeopathic practitioners say that their approach allows them to treat illnesses for which traditional medicine has no good answers.
"I have had many cases of long-term cures of chronic asthma, chronic migraine headaches, rheumatoid arthritis and chronic depression," says Todd Rowe, MD, CCH, DHt, president-elect of the National Center for Homeopathy.
However, medical researchers reply that since high rates of apparent improvement occur among people in the placebo group of medical trials, even when chronic diseases are involved, these testimonials do not indicate a real treatment effect.
The Individual and the Whole
Dr. Rowe stresses that homeopathy focuses on the whole patient in an attempt to heal both surface and underlying issues not to suppress symptoms.
"The goal," he says, "is to find one remedy that covers all the individual's problems."
Searching for Evidence
Advocates say that the individualized nature of homeopathy makes finding scientific proof of its effectiveness an unnecessary challenge.
"You can't apply the same methods of proof in natural medicine," maintains Dr. Kellman. But most physicians and clinical researchers strongly disagree with this point of view.
An analysis of 110 studies on homeopathy published in 2005 in the British journal Lancet concluded that in the best designed studies homeopathy most often proved to be no more effective than placebo. Based on these findings, medical researchers have suggested that use of homeopathy should be regarded as just as ineffective as the absence of material ingredients in homeopathic remedies would indicate.
Finding a Practitioner
There are various types of doctors practicing homeopathy in the United States, and their certification depends on their qualifications and level of training. For example, one certifying board licenses medical doctors who are also homeopaths (DHt), one certifies naturopaths for homeopathy (DHANP), one certifies professional homeopaths only (RSHOM), and one certifies any of the above (CCH).
"Some professional homeopaths choose to work in conjunction with a conventional physician, thereby helping their patients to receive the best of both worlds," Dr. Rowe explains.
Not a Replacement for Traditional Medicine
Dr. Rowe says that homeopathy is not the answer to every medical problem.
"Some conditions require immediate conventional intervention," he says. For example, a car accident requires a trip to the emergency room, not a homeopath, he says.
Still, Dr. Rowe believes that in cases where homeopathy is not the complete answer, it can still play an important role. For example, he has seen patients with insulin-dependent diabetes reduce the amount of insulin they need by using homeopathic treatments. However, there are no clinical studies to support this observation.
"It is not an either or," he says. "Some conditions are best treated by conventional methods, some conditions are best treated by combined treatment and other conditions are best treated by homeopathy."
Medical researchers, however, believe that at most homeopathy is an inexpensive placebo.
Jacobs J, et al. Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. J Infect Dis. 2001 Feb;20(2):177-83.
Shang A, Huwiler-Muntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005;366:726-32.
Sollars D. The Complete Idiot's Guide to Homeopathy. Alpha Books; 2001.
Ten grams of dark chocolate a day, or about one-third of a chocolate bar, may reduce the risk of dying from heart disease and stroke by half, new research suggests.
Dutch men who regularly consumed cocoa, from Mars and Milky Way bars to full-fat chocolate milk, had significantly lower blood pressure.
And men with the highest cocoa consumption (4.2 grams per day, or equal to 10 grams of chocolate) were half as likely as the others to die from cardiovascular disease.
It's the latest study to tout the benefits of cocoa, however this time scientists saw an effect with relatively small amounts of chocolate -- one-tenth of what other researchers have said would have to be eaten to see a benefit, at least in terms of lowering blood pressure.
Lactose intolerance is the inability to digest significant quantities of lactose. Lactose is a sugar found in milk and other dairy products.
Lactose intolerance is caused by an inadequate amount of the digestive enzyme lactase. Lactase breaks down the sugar lactose into sugars the blood stream can more easily absorb. Without enough lactase to digest the lactose eaten, lactose ferments in the colon (large intestine) and causes symptoms.
Some people are born with the inability to make the enzyme lactase. Others develop the intolerance over time.
Causes of lactose intolerance include:
Aging (lactase decreases as people age)
Gastroenteritis (or infection in the intestinal tract)
Nontropical and tropical sprue
A risk factor is something that increases your chance of getting a disease or condition.
Race: Black, Asian, or Native American
Ethnicity: Mediterranean or Jewish
Symptoms of lactose intolerance generally begin within two hours of consuming milk or other dairy products. The severity of symptoms depends on how much lactase your body produces and how much lactose you eat.
Abdominal rumbling sounds
The doctor will ask about your symptoms and medical history and perform a physical exam. Often the doctor will recommend a two-week trial period of eating no milk or milk products. If symptoms subside, you will be asked to consume milk products again. If milk causes symptoms to recur, you will be diagnosed with lactose intolerance.
Your doctor may also order some tests, which may include:
Lactose Tolerance Test – measures the amount of glucose (simple sugar that is created from lactose) absorbed two hours after drinking a high-lactose liquid. This tells how well the body is digesting lactose.
Hydrogen Breath Test – measures how much hydrogen is exhaled after drinking a high-lactose liquid
Stool Acidity Test (for infants and small children) – measures lactic acid in the stool
Biopsy of the Small Intestine – removing and testing a sample of tissue to confirm lactase deficiency (only performed in rare cases)
Currently there is no way to increase the body’s production of lactase, so treatment focuses on managing symptoms.
Dietary changes include:
Keep a food diary of what you eat and what the reaction is. Discuss the findings with your doctor or a dietitian.
Make gradual changes to your diet and record the results.
Try eating a smaller portion before giving up on a dairy product. Dairy products made from milk include:
Aged cheese and yogurt may be easier to tolerate than other dairy products.
Try milk that is modified so it contains less lactose.
Ask a dietitian for help choosing substitutes for dairy products or recommending supplements to ensure that you eat enough calcium.
Non-dairy foods rich in calcium include:
Read product labels because other foods containing lactose include:
Instant potatoes and soups
Other words that indicate lactose are:
Dry milk solids
Nonfat dry milk
Be aware that some medications may contain small amounts of lactose.
The doctor may recommend lactase enzymes if you can tolerate only small quantities of lactose. The enzyme supplements come in liquid and chewable form. A few drops of the liquid added to milk allowed to sit overnight can decrease the amount of lactose in the milk by 70-90%. Tablets are chewed or swallowed prior to eating foods that contain lactose.
There are no guidelines for preventing lactose intolerance.
Wendy Mesley had a rough idea what the results would be when her blood was tested for cancer-causing toxins, but that didn't lessen her dismay when she read the list.
She was tested for 57 carcinogens, 45 were found. But this, she says, is the point: The cocktail of cancer-causing poisons in her body is about the North American average. "Cancer is multiple exposures to multiple risk factors over a period of time," says Mesley. "I'm contaminated and I'm sure everyone else who grew up in North America is, too. I was probably born with a fairly clean slate in the late 1950s, but our own kids are starting out contaminated. That's the really depressing thing."
Mesley had the blood test as part of Chasing the Cancer Answer, her 30-minute documentary that broadcasts this Sunday evening on the CBC-TV consumer series Marketplace. She reads the blood results for the first time on camera. Despite an apparent effort to keep her emotions in check as she quotes from the lab report, she isn't quite able to do so.
There is no shortage of shocking detail in Chasing the Cancer Answer, but essentially Mesley's message is this: Through a combination of ignorance, benign neglect, misplaced trust and corporate cynicism, we are allowing ourselves to be poisoned into cancer by commonly used, legal carcinogens and, worse, condemning an alarming number of children and young adults to the same fate.
Doctors diagnosed Mesley with breast cancer in 2004. She had two growths removed and underwent chemotherapy and radiation. Her outlook is now good, but she is in the throes of a year-long treatment with the new drug Herceptin.
The greatest cause of rising cancer rates is not genetic but environmental, says Mae Burrows, a Canadian environmentalist pushing for legislation that will force companies to declare all carcinogens on consumer product labels.
The documentary features an interview with Dr. Sam Epstein, a cancer expert at the University of Chicago. Epstein says Canada is in a cancer epidemic and the real reasons are being trivialized or ignored by governments and such groups as the Canadian Cancer Society.
When we develop reverence for food and the miracle of transformation inherent in it, just the simple act of eating creates a ritual of celebration.
From "If the Buddha Came to Dinner: How to Nourish Your Body and Awaken Your Spirit" by Halé Sofia Schatz with Shira Shaiman:
We eat every day, all day long. But we are eating on the run, grabbing a doughnut and a cup of coffee on our way to work, heating up TV dinners, or making meals from instant foods. According to Fast Food Nation, Eric Schlosser’s thorough investigation of our nation’s fast-food preoccupation, about 90 percent of the money Americans spend on food goes toward purchasing processed food. In the incredible pace of our lives and with the availability of every prepackaged imaginable, we have lost the connection between what we eat, why we feed ourselves, and how we feel. For the most part, people eat without a great deal of thought beyond the taste. But the simple, daily act of eating has the potential to become a profound catalyst for spiritual growth, from experiencing a renewed sense of vitality and purpose in life to discovering our true vocations and making deeper connections in all of our relationships.
How to we regularly nourish our spirit so that it continually bears fruit? How do we literally feed this part of ourselves? Imagine for a moment that the Buddha is coming to dinner. What would you prepare? Most likely you wouldn’t run out for fast-food burgers and onion rings. Instead, you’d spend time shopping and preparing the freshest, most tasty, wholesome meal you could produce with your own hands, in your very own kitchen.
Now let’s imagine that you are a spiritual being—which you are!—what would you feed yourself?
The above article alludes to the benefit of preparing Mehmani for MHI when cooking. It can transform the whole process of preparation until consumption into something revitilising for the soul and body, i.e. brings Barakah in the family.- KM.
Food Expiration Dates: What Do They Really Mean?
by Robin Brett Parnes, MS, MPH
According to the Centers for Disease Control and Prevention (CDC), foodborne diseases cause an estimated 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Unfortunately, foodborne illness (food poisoning) often presents with flu-like symptoms such as nausea, vomiting, and diarrhea, and is dismissed as such. So, while it’s true that almost any food can become contaminated if handled improperly, foods that are purchased or used after their expiration dates may be more likely to contain spoilage bacteria or other pathogens that can cause a foodborne illness.
To Toss or Not to Toss
The expiration dates on foods reflect when to buy or use a product at its best quality. So, while you won’t necessarily get sick from eating expired food, its freshness and nutrient value may be diminished. Therefore, the trick is to know how long a product is safe to eat after its expiration date. The following tips may help:
Pantry, or shelf stable (non-perishable) foods, like cereal, baking mixes, and peanut butter may display “best if used by (or before)” dates. These indicate the shelf-life of a product—they tell you when a product is no longer at peak flavor, texture, and appearance. You can safely eat most of these types of foods past their listed date if they’ve been stored properly, but they may not taste their best or be as nutritious. There are two major categories of pantry foods, unprocessed and processed:
Unprocessed Pantry Foods: These include pastas, cereal, baking mixes, dry beans, grains, and nuts. If they have been stored unopened, these shelf stable foods should be good to eat indefinitely unless the packaging has been damaged. After opening, store these products in airtight containers to keep out insects, humidity, and other odors, and to keep in flavor.
Processed Pantry Foods: These are considered shelf stable because they have either been heat treated (canned foods), are a dry formulation (cake mixes), or have reduced water content (dried foods, crackers). The quality of these products should also be fine until opened. But watch out for cans that develop cracks at the seams, bulge, or spurt liquid when opened. These changes may indicate the presence of a bacterium called Clostridium botulinum, the toxin that causes botulism, and the cans should be discarded. Note also that certain processed pantry foods must be refrigerated once you’ve opened them.
To keep these foods at their best quality, store them in clean, dry, cool (below 85° Fahrenheit) cabinets away from the stove or the refrigerator's exhaust.
“Sell-By (or Pull)” dates on refrigerated foods like milk and chicken tell stores how long to display the product for sale and take into account additional storage time at home. If possible, it’s best to buy a product before this date.
“Use-By” dates indicate the last day recommended for use of a perishable product while at peak quality. Try to avoid buying foods that are already past this date, even though most are generally still safe to eat. Simply check the item first for an off odor, a strange appearance, or an unpleasant flavor.
Here’s how to store your perishable foods:
Meat, Fish, and Poultry: Store meat, fish, and poultry in the coldest part of the refrigerator (generally in the “meat keeper” drawer or toward the back of the bottom shelf), wrapped in foil, leak-proof plastic bags, or airtight containers. Fresh poultry, seafood, and ground or chopped meat can be refrigerated for one to two days before cooking. Fresh red meat, cooked poultry, and meat leftovers can be refrigerated for three to five days, and processed meat products (lunch meats) for three to seven days. Freeze any meat if you won’t be using it within these time frames.
Eggs: If you’ve purchased a carton of eggs before the date expires, you should be able to use them safely for three to five weeks after expiration. Eggs should be stored in their original carton on a shelf, not in the door (where it’s not as cold).
Dairy products: Milk, cheese, yogurt, and butter tend to spoil quickly once their dates have passed. Like eggs, these products should be stored on a shelf, not in the door.
Fruits and Veggies: Raw fruits and vegetables may last anywhere from a couple days to a few weeks before spoiling. For best quality, store ripe fruit in the refrigerator or you can prepare it and then freeze it. Some dense raw vegetables such as potatoes, onions, and tomatoes can be stored in cabinets at cool room temperatures. Other types of raw vegetable should be refrigerated. After cooking, all vegetables must be refrigerated or frozen within two hours.
Always keep your refrigerator at or just below 40° Fahrenheit. And don't overload the fridge—this prevents air from circulating freely and cooling foods evenly.
According to the Food and Drug Administration (FDA), frozen foods are safe indefinitely, so their expiration dates apply only to quality and nutritional value. But, make sure the items are frozen solid without signs of thawing. Otherwise:
If you plan to freeze your food, don’t wait to do so. Freezing it right away will help keep the product at its peak quality.
Freeze food in either its original packaging or packed in freezer bags or heavy-duty foil for maximum freshness.
“Freezer-burned” foods are generally still safe to eat. Cut freezer-burned portions away either before or after cooking the food.
Bakery items (which should have a “sell-by” date) that contain custards, meat, vegetables, or frostings made of cream cheese, whipped cream, or eggs should be kept refrigerated. Any bread product not containing these ingredients, or those that contain eggs but have been baked (like muffins), can safely be kept at room temperature. These foods should be good for about a week. However, if you begin to see signs of mold, they should be tossed.
What to Do If You Suspect a Foodborne Illness
Contaminated foods can cause illness within a few minutes or up to a few days after consumption. Look for symptoms such as fever, headache, chills, vomiting, nausea, irregular heartbeat, or difficulty breathing. While most foodborne illnesses are short-lived and require no medical treatment, others can be serious or even life threatening. If you suspect food poisoning, you should talk to a doctor immediately. This is especially important for pregnant women, young children, the elderly, and immunocompromised people, who are more likely than others to experience severe illness or complications. In addition, any incidence of suspected food poisoning should be reported to your local health department immediately.
The Bottom Line
Regardless of the date on any product always be on the lookout for spoilage. If a food smells funny to you or has something growing on it that you think shouldn’t be there, throw it out immediately.
Most foods are not only safe to eat, but are also acceptable in terms of taste, aroma, and appearance beyond the expiration date printed on the label. By following these guidelines, you should be able to determine how long foods are good to eat.
Varicose Veins: The Tangled Web They Weave
by Anne Martinez
One in ten Americans, predominantly women, will develop varicose veins. Although a very common and usually benign condition, many women seek out plastic surgery and newer laser removal techniques for cosmetic reasons.
What Is a Varicose Vein?
Your heart pumps blood throughout your body in long, muscular pipes called blood vessels. The pipes that transport the fresh, oxygen-rich blood (and the nutrients it carries) to your vital organs and tissues are called arteries. The tubes that return the blood back to your heart are called veins. In medium-sized veins, a series of valves keeps the blood flowing in the right direction.
Sometimes the valves fail or the muscle walls weaken, and instead of flowing forward, tiny amounts of blood pool inside the veins. When this happens, the vein bulges and twists, eventually emerging as a varicose vein. If the varicose vein is near the surface of your skin, it will appear enlarged, lumpy, and dark blue.
Another, less extreme type of varicose vein is a "spider vein." These thin red or purplish networks of very fine veins near the surface of the skin take their name from the pattern they form, often resembling a tangle of spiders. No one knows what causes them. "They run in families and often follow pregnancy, as do all varicose veins," says Dr. Harold Sussman, director of the Marina Laser Center of the Plastic Surgery Associates in Marina del Rey, California.
Although they can appear anywhere, varicose veins appear most often on the legs, especially behind the knees. Spider veins may also develop on the face.
Are They Harmful to My Health?
Spider veins are strictly a cosmetic issue and don't affect your physical health. Varicose veins, on the other hand, sometimes have medical consequences if left untreated, says Sussman. They may ache or burn after long periods of standing, and can eventually lead to thrombosis (clotting) or phlebitis, an inflammation of the wall of the vein. "In some people, when the pooling of the blood causes severe varicose veins, you can develop ulcers. That's the end stage, with destruction of the skin," says Sussman.
How Can I Prevent Them?
If you inherited a tendency toward varicose veins, there isn't much you can do to prevent them, says Susman. But it's still a good idea to avoid clothing that restricts blood flow. Try to also avoid long periods of sitting or standing in one position. Regular exercise also helps.
Can I Get Rid of Them?
Once you have varicose veins, they're not likely to go away on their own. Custom-fitted elastic stockings, which put pressure on the legs, may alleviate symptoms and keep varicose veins from becoming worse. If your doctor prescribes these stockings, be sure to put them on first thing in the morning, before you even get out of bed. Take the stockings off at night just before you go to bed.
Periodically during the day, and especially at the end of the day, rest with your feet elevated at least 12 inches above your heart to reduce swelling. You might make it an end-of-day habit to lie back on the couch and prop your feet up on a couple of pillows while you catch up on reading.
If you and your physician decide that the veins are to be removed, there are several options from which to choose. Laser therapy is very effective for spider veins on the face. "With certain types of lasers there's no bruising and basically no down time for spiders on the face," says Sussman. Laser treatment of spider veins on the extremities are another matter. "You can only treat the small veins, and even then you get redness along where the vein was, and then a cat scratch type crusting which lasts two to three weeks," reports Sussman. Laser treatment is also less successful on the extremities.
Because it is considered cosmetic surgery, laser treatment of spider veins usually isn't covered by health insurance.
Although laser therapy can't successfully be used on veins more than one millimeter in diameter, larger varicose veins can be treated by other means. In a procedure called sclerotherapy, a chemical irritant, called a sclerosing solution, is injected into the vein that basically flushes out the blood and causes the vein to swell shut. Hypertonic saline solution, a very heavy salt solution, is the only substance currently approved for this use. According to Sussman, other safer, less painful solutions are expected to receive FDA approval later this year. A vein may require more than one treatment before it disappears.
Potential side effects of sclerotherapy include a stinging sensation after the injection, and in one out of three people, a brownish staining around the treated area that lasts for several weeks or longer. Occasionally a reddish blush of tiny new blood vessels, called a matte, will form adjacent to the treated vein. "It's as if the injury to one [vein] releases a substance that wants to form new ones," explains Sussman. This matting can be treated with lasers.
Something else to keep in mind: even in the best of hands, this treatment is not 100% effective, especially on the legs. "If sclerotherapy is 60%–70% effective, you've done very well," says Sussman. Sclerotherapy cannot correct the problem of reverse blood flow patterns, and for this reason its results are often temporary.
Larger varicose veins can be physically removed through a procedure called ambulatory phlebectomy. A series of tiny incisions is made along the course of the vein, under local anesthesia. A little hook is inserted through the openings and used to grasp the vein, so it can be removed a portion at a time. "It gets rid of them completely," says Sussman.
Although the ambulatory phlebectomies have been performed in Europe for many years, the procedure began to gain acceptance in the United States around 1990, specifically as a replacement for a more invasive procedure called vein stripping. Ambulatory phlebectomy is an outpatient procedure with few side effects. One side effect seen if phlebectomy is performed on leg veins, is swelling of the legs after the procedure.
In 1999, the FDA approved a new treatment for varicose veins called the closure technique, which is similar in concept to scelortherapy. This procedure involves the insertion of a catheter that delivers radiofrequency energy into the vein to shrink and seal it shut. The closure technique can be performed in a doctor's office.
Before undergoing any treatment for varicose veins, ask your physician how many of them he or she has performed, and what the results were. Successful treatment largely depends upon the skill of the physician. And remember, in most cases you don't HAVE to do anything about varicose veins; medical treatment is necessary only if the vascular symptoms become life threatening. Alternative treatments such as acupuncture are also being used.
For two years, a 26-year-old woman suffered burning and swelling in and near her vagina for 15 minutes after making love.
But she and her husband were puzzled because the symptoms went away if they used a condom. She finally went to her doctor, and what she learned there was startling. Most family physicians and gynecologists are unaware of her mysterious condition.
She is allergic to sex.
How Can This Be?
Medical researchers have found that some women are allergic to their partner's seminal fluid, the thick liquid that carries sperm. Doctors know the disorder as "human seminal plasma hypersensitivity." In rare cases, the allergic response can cause death.
But there is good news. The malady can usually be treated by allergists although it takes some effort by concerned, caring male partners. But more about the mens' role later.
Who Discovered Sex Allergies?
In addition, doctors have learned that the condition first described in 1958 is much more widespread than they first thought. It came to light when M.D.-brothers Jonathan A., David I. and I. Leonard Bernstein, allergists and assistant professors at the University of Cincinnati College of Medicine, surveyed almost 1,100 women who had reported at least some symptoms consistent with the sex allergy.
Their findings? Writing in the January 1997 issue of Annals of Allergy, Asthma, & Immunology, the researchers found that 12% of patients examined met the diagnostic criteria for an allergy to seminal fluid.
"We don't know yet if the women who have this hypersensitivity are allergic to all seminal fluid or just their partner's," says David Bernstein.
What Are the Symptoms?
For many women, a sexual allergy is as serious as a heart attack. Most sufferers complain of symptoms that include wheezing, itching and hives all over, chest tightness, vomiting, or diarrhea. Severe reactions include loss of consciousness or complete circulatory collapse. Other women seek medical help complaining of localized reactions such as vaginal burning or swelling. Some women even report blisters in and near their genitalia.
Left untreated, the malady is a sure marriage and relationship wrecker. It's also a source of complete frustration for the couple who wants to have children but must always use a condom.
"A primary candidate for a diagnosis of sexual allergy is a woman who has burning, itching, or swelling in or near her vagina after sexual intimacy has started, and also has some food allergies," says David Bernstein. "The dead-bang give away to seminal fluid hypersensitivity is when she has zero symptoms after sex with a condom."
In some cases, afflicted women report the start of pesky post-coital symptoms after their very first sexual experience.
So far, there are no actual deaths on record from this condition. However, an afflicted women could conceivably die if anaphylactic shock caused her air pathways to swell up and block completely.
"The condition is so new that it's very possible a family practitioner or even a gynecologist would not be familiar with it," says David Bernstein. "It's also very likely the conditioned is under-reported by both patients and physicians."
In another case, a 30-year-old women went to her doctor because she was having painful burning and tingling in and around her vagina immediately after intercourse. The symptoms then lasted for about six hours. Moreover, several love-making sessions caused her face to swell. But, again, the woman told her doctor there were no symptoms at all when her husband used a condom.
Both that patient and the 26-year-old woman saw an allergist. Through a skin reactivity test, they discovered that were indeed allergic to their husband's seminal fluid. Researchers haven't yet identified the troublesome culprit, but they think that certain proteins in the seminal fluid cause the reaction.
How Is a Sex Allergy Treated?
Once the hypersensitivity is diagnosed, partners are called on to do more than just use a condom. Treatment involves injecting the women regularly with their partner's purified seminal proteins. The Bernsteins report a 100% success rate among their patients.
For the initial diagnostic screening, only a single sample of the male's ejaculate is needed. But then the allergist needs 5–7 days worth of ejaculate in order to have the volume to formulate enough vaccine for regular injections.
One of the couples went through all the trouble of having the puzzling, painful symtoms diagnosed as sexual allergy. They then worked out a treatment plan, only to discover yet another dimension of human seminal plasma hypersensitivity.
Says Jonathan Bernstein: "When we start giving the woman injections, and she and her partner stop having sex, she can lose her tolerance to his seminal plasma." In other words, couples must continue to have regular intercourse or the bothersome symptoms will return.
This created some logistic difficulties for the 26-year old woman. Because her husband was an airline pilot who was out of town frequently, she was at a loss as to how they would continue their "treatments".
Dr. Bernstein to the rescue. "We tell our patients that if they must be apart for some weeks, the male can leave several samples of ejaculate and the woman can then inject a small amount into the vagina. That will keeps the woman's tolerance up."
Published: Wednesday, March 15, 2006
Capsaicin, the pungent ingredient that gives hot peppers their kick, causes prostate cancer cells to self-destruct, a finding that opens the possibility of a new treatment for the most common cancer in Canadian men.
Reporting today in the journal Cancer Research, scientists from the Cedars-Sinai Medical Center at the University of California at Los Angeles found that the pepper extract enhances apoptosis, a kind of cellular suicide, in prostate tumours.
The team injected prostate cancer cells into mice and treated one group with a dose of capsaicin that was the equivalent of giving 400 milligrams of capsaicin three times a week to a 170-pound man -- or about eight fresh habanera peppers, the hottest on the market.
After one to two months of followup, the tumours in the treated mice were about one-fifth the size of the tumours in the non-treated rodents.
"The tumours shrank, while, in the non-treated, they just grow and grow," said Dr. Soren Lehmann, a visiting scientist at Cedars-Sinai Medical Center and the UCLA School of Medicine.
The pepper component "had a strong, anti-proliferate effect on the prostate cancer cells in the mice."
It also kept human prostate cancer cells from reproducing in lab dishes.
"These results suggest that capsaicin may have a role for the management of prostate cancer patients," even for men who don't respond to hormone therapy, the researchers report.
An estimated 20,500 men in Canada will be diagnosed with prostate cancer this year, and 4,300 will die of it.
The active ingredient in pepper spray, capsaicin has been used in food additives and drugs for years.
Scientists discovered the compound's pain-numbing effect in the 1980s; capsaicin-containing creams and skin patches are used to treat arthritis and post-shingles pain. The extract also helps vasomotor rhinitis -- nasal congestion.
It also churns out endorphins, which is why humans are thought to like hot foods -- a moment of pain, followed by endorphin bliss.
Recently, capsaicin was shown to inhibit the growth of adult leukemia cells and gastric cancer.
"We screened a number of cancer cell lines, and it seemed that the prostate cancer cells were the most sensitive to capsaicin," Lehmann said.
Capsaicin appears to work in several ways: It kept the cells from being "immortal," according to a background article by the American Association for Cancer Research, by inducing cell suicide. It shut down two pathways that send signals to prostate cancer cells to grow. And it reduced the production of PSA, or prostate specific antigen.
Men who have prostate cancer can have a higher level of PSA in their blood. "That probably has some impact on the growth of the cancer cells, too," Lehmann said.
Lehmann's team has not proven that men can prevent prostate cancer by eating a lot of habaneras. And while there were no side effects in the mice, it's not known if the dose tested would be tolerable to humans.
Wounds Heal Slower in Couples Who Fight
by Urmila R. Parlikar, MS
Occasional arguments are par for the course in any healthy marriage. But true marital discord can be both psychologically and physically damaging. Fighting with one’s spouse is stressful, and stress has been shown to affect immunity. For example, stress affects the production of cytokines, an immune cell chemical that plays a role in wound healing and many other functions of the immune system.
In an article published in the December 2005 Archives of General Psychiatry, researchers sought to determine whether the stress associated with marital conflict affected the ability of wounds to heal. They found that local cytokine production was lower and wounds healed more slowly after couples had been fighting, compared to when they’d interacted supportively. In addition, wounds healed 40% more slowly in couples that were deemed to be more hostile towards one another compared to couples characterized as less hostile.
About the Study
The researchers recruited 42 couples who’d been married an average of 12 years, and brought them into a research center for two 24-hour visits. During each visit, the researchers created eight blisters on the arms of the husbands and wives. The researchers sampled fluid from the wound sites and drew blood samples several times during the visit, and for 12 days after each visit. During the first session, researchers asked the couples to have a supportive, positive discussion. During the second session, the couples were asked to discuss an emotional subject about which they disagreed. The discussions were videotaped and analyzed to determine the level of hostility between the couples.
The researchers found that cytokine levels were lower, and that wounds took one day longer to heal, after arguments than after supportive discussions. Couples who were deemed to be more hostile overall healed 40% slower than couples determined to be less hostile. In addition, the more hostile couples had higher levels of cytokines in their blood than the less hostile couples. (Local production of cytokines can help heal wounds, but certain cytokines circulating in the bloodstream have been linked to inflammation associated with certain chronic diseases.)
How Does This Affect You
This study demonstrated that arguments slowed wound healing in all couples and that couples who were more hostile towards each other took longer to heal than couples who were less hostile. The more hostile couples also had higher circulating levels of cytokines. The point of the study is not that physical wounds inflicted during an argument will take longer to heal (although they probably will). Rather, the results imply that marital strife might be making husband and wife more susceptible to a variety of chronic illnesses.
While these results are certainly provocative, what this type of study could not show is whether long-term, persistent marital stress actually leads to an increased risk of heart disease, arthritis, and other diseases associated with inflammation. Nevertheless, many years of stressful relations at home is likely to take a toll, not only emotionally, but physically. It stands to reason that ending or mending this kind of relationship would be beneficial to everyone’s health.
Kiecolt-Glaser JK et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Arch Gen Psychiatry. 2005;62: 1377-1384.
Balance Your Inner and Outer Healing
From "Thank You for Being Such a Pain, Spiritual Guidance for Dealing with Difficult People" by Mark I. Rosen:
Inner work, as the foundation for healing relationship difficulties, is all too often neglected.
Still, too much attention to inner work can make one preoccupied and self-absorbed. Outside activity is necessary as a balance. Here are some simple observations about activities that can also help you in the healing process:·
Find activities that bring you joy; you've experienced enough pain. Think of things you can do alone or with others that bring you delight and warm your heart.
Get silly and have fun. Relationship difficulties can become much too serious.
Let your friends know that you are having a hard time, and ask for their support.
Spend time doing things that help you to think about something or someone other than yourself. Help a friend or do volunteer work. Serving others is wonderfully therapeutic.
Consider attending lectures and taking classes that enhance your learning.
If your lifestyle IS sedentary, start doing something that requires physical activity.
Pay attention to what you eat; be sure you are getting adequate nutrition and are not using food for emotional nourishment.
Do something completely new and different that you've never done before.
Find ways to express your spiritual longings and deepen your spiritual experience.
Just as pre-cancer may be detected and removed before turning into cancer, discovery of diabetes in its earliest stages can help prevent the development of full-blown diabetes. That, in a nutshell, is the idea behind the new term “pre-diabetes.”
Blood glucose levels that are higher than normal but not high enough to be called diabetes are now classified as pre-diabetes. This name replaces older terminology such as impaired glucose tolerance and impaired fasting glucose—a change I applaud. I think the concept of pre-diabetes will make it easier for those at risk to thwart progression to frank diabetes.
Exciting evidence indicates that people with pre-diabetes can use simple, readily available means to return their blood glucose levels to the normal range. This can help prevent or delay complications that research has linked to both diabetes and the pre-diabetic state. Here, I've summarized the prominent features of pre-diabetes I think you need to know.
How Serious a Problem?
Research shows that people with pre-diabetes are at risk for the same complications that are seen with diabetes. These include impaired vision or blindness, heart disease, stroke, kidney failure, nerve damage, and infections leading to leg amputations.
If you have pre-diabetes you may already be experiencing the adverse health effects of this serious condition. People with pre-diabetes have a 1.5-times increased risk of cardiovascular disease—including heart attack, stroke and arterial disease—compared to people with normal blood glucose. In contrast, people with diabetes have a 2- to 4- times increased risk of cardiovascular disease. Both diabetics and pre-diabetics are more likely to develop additional cardiac risk factors such as elevated cholesterol, high blood pressure, and obesity.
An Epidemic of Diabetes
Lack of exercise and super-sized portions are fueling twin epidemics of obesity and diabetes in this country. In the past 10 years the incidence of obesity has increased 61 percent and new cases of diabetes have gone up 49 percent. The majority of Americans are now overweight and at risk for developing pre-diabetes and type 2 diabetes.
Both of these conditions make your body cells less sensitive to the effects of insulin, a hormone that regulates blood glucose levels. This allows blood sugar levels to rise over time and can result in long-term damage to your body.
Detection of Pre-Diabetes
Millions of Americans are currently considered candidates for pre-diabetes and diabetes screening. Both conditions can be diagnosed with a simple blood test. During a routine office visit your doctor can order one of two tests:
Fasting plasma glucose test – you will fast overnight and have your blood glucose measured in the morning before eating. Your results may be read as follows:
Normal: below 100
Diabetes: 126 or above
Oral glucose tolerance test – you will fast overnight and have your blood glucose measured after the fast. Then you'll drink a sugary drink and have your blood glucose measured two hours later. Results two hours after the drink are usually read as follows:
Normal: below 140
Diabetes: 200 or above
Who Should Get Screened?
Experts from the American Diabetes Association and the National Institutes of Health recently developed screening guidelines for pre-diabetes. They recommend glucose testing every three years for people aged 45 or older who are overweight (BMI above 24). If you’re over age 45 but not overweight ask your doctor if testing is appropriate.
For those under age 45 and overweight, testing may be advisable if you have another risk factor for pre-diabetes. Risk factors include:
High blood pressure
Low HDL (good) cholesterol level
High triglyceride level
Family history of diabetes
History of diabetes during pregnancy (gestational diabetes)
Giving birth to a baby weighing more than nine pounds
Belonging to an ethnic group other than Caucasian
Care of Pre-Diabetes
If your glucose test indicates pre-diabetes you should have it repeated for accuracy. People with a diagnosis of pre-diabetes also need retesting every one to two years. Without intervention, studies show that most people with pre-diabetes go on to develop type 2 diabetes within 10 years.
Fortunately, we know that people with pre-diabetes can delay or prevent the onset of diabetes with lifestyle changes. Experts recommend that people with pre-diabetes reduce their weight by 5-10% and engage in modest physical activity for 30 minutes most days of the week. A recent study in the New England Journal of Medicine followed a large group of pre-diabetics who made these changes. After an average follow-up of three years, they achieved nearly a 60% reduction in diabetes risk compared to only about a 30% reduction for those on medication.
I’d say it’s a powerful reason for anyone at risk for diabetes to control weight and exercise regularly—with your doctor’s okay of course.
Type 2 diabetes is primarily a disorder in which the cells in the body are not responding to the high levels of insulin (insulin resistance). In some type 2 diabetes, the beta cells are not producing enough insulin.
Insulin is a hormone normally produced by the pancreas. This hormone helps your body convert food into energy. Without insulin, glucose (sugar) from the food you eat cannot enter cells, and glucose builds up in the blood. Your body tissues become starved for energy.
Type 2 diabetes, which was formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. Of the nearly 16 million Americans with diabetes, 70-95% have type 2 diabetes. People usually develop type 2 diabetes after age 45, but it can occur at any age—even during childhood.
In recent years, there has been an increase in the number of cases of type 2 diabetes diagnosed in children and adolescents. This has been blamed, in part, on the increase in childhood overweight problems and obesity, resulting from poor eating habits and sedentary lifestyles.
Type 2 diabetes occurs because either one or both of the following conditions exist:
The beta cells in the pancreas does not make enough insulin relative to the demands of the body
The fat, muscle, or liver cells do not respond to the high levels of insulin (called insulin resistance)
Being overweight is the primary cause of insulin resistance and increases the chance of developing type 2 diabetes.
The key to controlling diabetes is keeping your blood sugar level within a healthful range. When your blood sugar level is not within the ideal range, you can experience the following problems:
In the short-term:
High blood sugar, called hyperglycemia
Low blood sugar, called hypoglycemia
In the long-term:
Nerve disease, which can cause numbness, pain, or altered sensation such as a burning feeling in the legs and feet
Loss of limbs, when amputations are needed because of infection, poor circulation, or nerve disease
What are the risk factors for type 2 diabetes?
What are the symptoms of type 2 diabetes?
How is type 2 diabetes diagnosed?
What are the treatments for type 2 diabetes?
Are there screening tests for type 2 diabetes?
What are the complications of type 2 diabetes?
How can I reduce my risk of type 2 diabetes?
What questions should I ask my healthcare provider?
What is it like to live with type 2 diabetes?
Where can I get more information about type 2 diabetes?
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