Posted: Sat Nov 12, 2005 4:57 pm Post subject: Health and Healing
Chronic Pain and Depression: A Chicken or the Egg Story
By Rosalyn Carson-DeWitt, MD
A variety of recent medical studies have drawn a strong association between chronic pain and a diagnosis of major depression. The two conditions seem to go hand-in-hand in a large percentage of unfortunate patients, who suffer the debilitating effects of both chronically painful conditions and persistent mood problems.
Which Came First?
Do patients who are depressed perceive pain more acutely than people who aren’t depressed? Or does chronic pain have a debilitating effect on not just the body, but also the psyche, resulting in depression?
Researchers still don’t know whether there is a cause-and-effect relationship between chronic pain and depression, and if there is, which condition causes the other. Some research suggests that insufficiently treated, ongoing pain may cause changes in the chemical environment of the brain, thereby increasing the likelihood of depression. Similarly, other research suggests that insufficiently treated, ongoing depression causes changes in the chemical environment of the brain such that it increases an individual’s perception of painful sensations.
Who’s at Risk?
Some patients are at increased risk for both chronic pain and depression. For example, women and elderly patients are more likely to report both symptoms of chronic pain and symptoms of major depression. (Older adults, however, tend to report somatic or physical symptoms of depression rather than typical symptoms.) Researchers don’t fully understand why this is true.
Patients whose pain interferes with their independence, their mobility, or their ability to actively participate in their usual social activities are at a particularly high risk for depression.
Symptoms of Chronic Pain and Depression
Certain areas of the body are more likely to cause painful symptoms in patients with both chronic pain and depression. The types of chronic pain most commonly reported by depressed patients include:
Neck and back pain
Pain in the musculoskeletal system (muscles, bones)
The symptoms that lead to a diagnosis of depression include:
Low or sad mood
Inability to enjoy usual activities
Under- or over-eating
Difficulty sleeping or sleeping too much
Sense of guilt
Negative thought patterns
Complications of Chronic Pain and Depression
Both chronic pain and depression interfere with daily functioning at school, at work, and within relationships.
The most serious complication of depression is suicide. Patients who have both chronic pain and depression have a much higher risk of feeling suicidal, acting on those suicidal feelings, and successfully committing suicide. Treatments that both improve depression and relieve chronic pain may decrease the risk of suicide in patients.
Diagnosis of Chronic Pain and Depression
Unfortunately, depression can be a slippery diagnosis. When someone is already suffering from chronic pain, it may seem obvious that some degree of depression is likely. Depression may even worsen the physical symptoms of chronic pain. Similarly, untreated chronic pain may cause a cycle of distress and depression. Diagnosing the presence of both chronic pain and depression may be the first step toward breaking this cycle and improving both pain and depression.
And yet, depression is not an inevitable result of every chronic pain condition. Nor is chronic pain an inevitable result of depression. However, until researchers unravel the complex interactions between depression and chronic pain, it is important that both healthcare providers and patients be aware that these two conditions frequently co-exist. Diagnosing and treating only one of them could result in serious complications, debilitation, or decreased functioning.
A thorough evaluation by your healthcare provider should always include an inquiry into the presence of any chronic pain, as well as screening questions designed to uncover the presence of a mood disorder. A questionnaire called the SF-36 Health Status Survey is particularly helpful at uncovering the dimensions of chronic pain and the presence of depressive symptoms.
Treatment of Chronic Pain and Depression
The good news is that there are medications available that treat both depression and chronic pain. Certain medications traditionally used for depression also have a significant effect on decreasing chronic pain. This association has been tested in individuals who suffer from chronic pain without depression; when these patients are asked to fill out rating scales that describe the intensity of their chronic pain, those patients who are given antidepressants rate their pain as significantly decreased. But these medications are prescribed by your doctor and can have side effects. Consult with your doctor about what would be best for you.
The antidepressant medications that have been successfully used to decrease chronic pain include:
Selective serotonin reuptake inhibitors
***Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern - mostly SSRIs (Selective Serotonin Re-uptake Inhibitors) - are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.
What else can I do?
Psychotherapy, referred to commonly as therapy, in which a person with depression talks to a licensed and trained mental healthcare professional, can also be helpful for patients who are struggling with both chronic pain and depression.
In addition, a variety of other treatments are available that can improve pain and lessen depression, such as:
Finally, keeping a pain diary might also help you recognize which interventions help and which situations exacerbate your pain and/or depression. Or, you can try getting involved with a support group, which can put you into contact with other people who are meeting similar challenges. It may also give you an opportunity to learn from the experiences of others, and to share your own coping strategies with people who could use your support.
The secret to lasting youth may not lie in a pill or potion, but in produce! Carrots, spinach, and broccoli—among other vegetables—contain compounds known as antioxidants, which research suggests may be powerful weapons in the war against the effects of aging. "I think the evidence is very compelling, although not definitive, that as you increase your intake of certain antioxidants, you do increase the benefits," says Dr. Jeffrey Blumberg, chief of the Antioxidant Research Lab at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University.
Antioxidants and Free Radicals in the Body
As the body uses oxygen, byproducts called free radicals—oxygen molecules that are missing electrons—are formed. These free radicals steal electrons from healthy cells, causing damage to these cells. This cell damage is thought to be cumulative, and scientists theorize that this may lead to aging and disease. Everything from cancer and heart disease to wrinkles and cataracts may be attributed to the action of free radicals. Environmental factors such as exposure to radiation and tobacco smoke may also increase the number of free radicals in the body.
Antioxidants are compounds that work to deactivate free radicals, thus preventing cell damage. The three best-known antioxidants are vitamins E and C and beta carotene, but there are many others, including selenium, lutein, and lycopene.
Research Shows Mixed Results
A study involving 30,000 participants in China demonstrated that over the course of five years, those participants who received a daily supplement containing vitamin E, selenium, and beta carotene had a 13% lower rate of cancer than those study participants who received a placebo (or sugar pill). In the United States, a study of 1,795 nurses who had a history of heart problems showed that those nurses who consumed larger amounts of vitamins C and E and beta carotene showed the greatest cardiac improvement and reduced their chances of further heart damage.
A study reported in the May 20, 1993 issue of The New England Journal of Medicine reported a significant decrease in the incidence of coronary artery disease in men and women who consumed 100 international units (IU) of vitamin E daily. The current recommended intake for vitamin E is 15 mg per day (22.5 IUs).
Although it's tempting to take these kinds of results to heart, some critics have argued that studies like these have not ruled out other reasons for the study subjects' improvements, such as increased exercise or other dietary changes. In other words, maybe the effect is entirely unrelated to the supplement.
In January 2000, The New England Journal of Medicine reported the results of a 4 ½-year study of more than 9500 men and women aged 55 and older with risk factors for heart disease. Half of the participants were given 400 international units of vitamin E from natural sources, while other participants received a placebo, or sugar pill. Over the length of the study, there was no significant difference in the number of cardiac events or cardiac deaths in either group.
Why do these results contradict the results from other studies? The researchers themselves note that perhaps the study wasn't long enough to demonstrate any effect. They also suggest that perhaps the findings were influenced by the fact that they used vitamin E supplementation alone, without any other antioxidants. It may be that vitamin E requires other factors to have a beneficial effect.
Too much of a good thing?
Some studies have suggested that for certain people, over-consumption of antioxidants can be harmful. Studies of beta-carotene in humans were stopped in 1994, after results suggested that people at risk for cancer were at even greater risk after taking high doses of synthetic beta-carotene. A 2005 meta-analysis (an analysis of the results of multiple studies) suggests that taking more than 400 IU/day of vitamin E may also be harmful to health.
Benefits of Dietary Changes Are Clear
Dr. Blumberg cautions that research is ongoing. He cites new studies of the benefits of lesser-known antioxidants such as lycopene, which may reduce prostate cancer risk, and lutein, which is strongly associated with a decrease in age-related macular degeneration and prostate cancer. Studies of high-risk groups, such as the nurses with heart disease, suggest the greatest benefit from increased consumption of antioxidants is realized by those at the greatest risk of disease.
Though the jury is still out on the role of antioxidant supplements as disease and age fighters, consuming more antioxidant-rich fruits and vegetables has well-documented benefits in improving health, aside from their antioxidant contents.
Antioxidant Recommended Amount* Good Food Sources
Vitamin C Women: 75 mg
Men: 90 mg
Smokers: extra 35 mg Citrus fruits, cruciferous vegetables such as broccoli, cauliflower, and cabbage
Vitamin E 15 mg Fortified cereals, vegetable oils, nuts, spinach and kale, mangoes, and wheat germ
Selenium 55 micrograms (mcg) Onions, garlic, mushrooms, wheat germ, and rice bran
Vitamin A Women: 700 RAE**
Men: 900 REA As retinol:
Eggs, liver, vitamin A-fortified milk As beta-carotene:
Yellow-orange or dark-green leafy vegetables and fruits, such as kale, beet greens, spinach, carrots, sweet potatoes, pumpkin, papaya, apricots, parsley, and basil
*Recommended amounts are given as dietary reference intakes (DRIs), which replace recommended dietary allowances (RDAs); these are the government's recommendations for good health.
**REA = retinol equivalents; a measurement of vitamin A that includes the two major forms of vitamin A found in foods: retinol and beta-carotene. There is no separate DRI set for beta-carotene.
Are Supplements Necessary?
The problem for many people lies in consuming enough of these foods to receive any kind of benefit. "Few people meet the recommended intakes for all nutrients," Dr.Blumberg says. "And people eat less as they grow older. As their appetite decreases, they don't change how they eat, they just eat less." Instead of adding more fruits and vegetables to their diets, many older people eat smaller portions of the same kinds of foods they've eaten for years, which are often high in fats, starches, and sugars.
Smokers, heavy drinkers, people with impaired immune systems, and those on calorie-restricted diets may also have difficulty getting the nutrients they need from food alone. For these people in particular, supplements may be the only way for them to fulfill their nutrient needs. In addition, vitamin E is found in a limited number of foods, making it difficult to get enough of it in the average diet. While consuming more vegetables and fruits is still the best way to get essential nutrients, a good multivitamin can fill in any nutrient gaps.
The American Heart Association and the American Cancer Society do not endorse antioxidant supplements for the general population, but they do recommend a diet with plenty of antioxidant-rich fresh fruits, vegetables, and whole grains. Please also discuss any antioxidant use with yout doctor before you begin it.
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Miller ER 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005 Jan 4;142(1):37-46.
Stanner SA, Hughes J, Kelly CN, Buttriss J. A review of the epidemiological evidence for the 'antioxidant hypothesis'. Public Health Nutr. 2004 May;7(3):407-22.
Toxic tears: how crying keeps you healthy
by Charles Downey
Humans are the only animals who shed tears of emotion. Why do we cry? Are there any physical or health benefits from crying?
Years of tears
"Until the Industrial Revolution, crying in public was pretty normal, even for men," says Tom Lutz, Ph.D., an associate professor of English at the University of Iowa and author of Crying: The Natural and Cultural History of Tears. "Heroic epics from Greek times through the Middle Ages are soggy with weeping of all sorts," Dr. Lutz says. "Through most of history, tearlessness has not been the standard of manliness."
For instance, when Roland, the most famous warrior of medieval France died, 20,000 other knights wept so profusely they fainted and fell from their horses. Long before that, the Greek warrior Odysseus cries in almost every chapter of Homer's Iliad while St. Francis of Assisi was said to have been blinded by weeping. Later, in the 16th century, sobbing openly at a play, opera or symphony was considered appropriately sensitive for men and women alike.
The industrial age needed diligent, not emotional, workers. Crying was then delegated to privacy, behind closed doors. Children learned that weeping itself was the problem and not the result of a problem. People everywhere became more uncomfortable with public tears.
In 1972, public crying was still so unacceptable that candidate Edmund Muskie was driven out of the U.S. presidential race when he shed tears during a speech.
The purpose of crying
Throughout history and in every culture, people cry. "Weeping often occurs at precisely those times when we are least able to fully verbalize complex, overwhelming emotions and least able to fully articulate our feelings," Lutz writes.
Crying can also be an escape; it allows us to turn away from the cause of our anguish, and inward toward our own bodily sensations. Scientists feel that weeping is probably necessary because no human behavior has ever continuously evolved unless it somehow contributed to survival.
"Science has proven that stress is terrible for the health of your brain, heart and other organs," says William Frey II, Ph.D., biochemist and tear expert of the Ramsey Medical Center in Minneapolis, Minnesota. "It isn't proven yet, but weeping has most likely served humans throughout our evolutionary history by reducing stress."
Studying the waterworks
In one oft-quoted study, Frey studied five different groups of people. The people kept records of all emotional and irritant crying episodes for a period of 30 days. Information such as date, time, duration, reason for crying, thoughts, emotions and physical components, such as "lump in throat," watery eyes vs. flowing tears, etc.
Frey found that 94 percent of the females had an emotional crying episode in the 30-day recording period, as compared with only 55 percent of the males. Eighty-five percent of women and 73 percent of men reported feeling better and more relieved after a good cry. Dr. Frey's lab also chemically examined tears produced by onions and compared them with emotional tears. While chemical tears (caused by onions) were 98 percent water, emotional tears contained more toxins.
Though there was no difference between men and women in average duration of crying episodes, men and women cry differently. Men cry quietly and their eyes brim neatly with tears. Women, on the other hand, make lots of crying noises as the tears stream down their cheeks. "Our testing revealed that men weep an average of 1.4 times a month while women cry about 5.3 times monthly," says Dr. Frey.
Why do people produce tears?
Some people believe that the rapid breathing associated with sobbing would quickly dry out the sensitive mucous membranes if tears did not keep them moist and that mucosal dehydration in the absence of tears could increase the risk of infection. While this may be one of the functions of emotional tearing, the clinical experiences of Dr. Frey and others indicate that sobbing is not a component of all crying and tearing episodes. And humans don't excrete tears while running or engaging in other forms of rigorous exercise where rapid breathing is also increased.
Tears are secreted through a duct, a process much like urination or exhalation. Frey believes that like these other processes, tearing may be involved in removing waste products or toxic substances from the body. Perhaps that is why so many people report feeling better after crying. Not only is the venting of emotions liberating, but the actual chemical composition which is known to be different from tears produced from cutting onions may be involved in this increased feeling of well-being.
"Crying is natural, healthy and curative," according to Barry M. Bernfeld, Ph.D., director of the Primal Institute in Los Angeles. "[But] crying which should be the most natural, accepted way of coping with pain, stress, and sorrow is hardly mentioned in psychiatric literature. Now we seem finally to recognize that crying is good for people."
Are times changing?
"In just a few short decades, we've gone from the view that crying is just a loss of control and a sign of weakness to a common perception that there might be some value in open emotional crying," says Dr. Frey.
For instance, a weeping, unashamed New York Yankee Darryl Strawberry fell into the arms of manager Joe Torre on national television. Gwyneth Paltrow was so tearful on national television that she could barely speak when awarded her Oscar for best actress. President Clinton routinely sniffles openly, and presidential candidate Bob Dole choked up while recalling how people in his home state helped him with his war injuries.
"Today, it might even be a plus for politicians to cry," says Dr. Frey. "People now like the idea that our leaders can be open about their feelings."
One of the main obstacles to good mental health is that by stifling crying, a person must also hide or shut down valid feelings and emotions. When legitimate emotions are not fully recognized and expressed, insensitive acts from rudeness to school shootings can result.
For Better Health: Five Easy Pieces
by Lori P Marcotte, RD, CNSD
Although "an apple a day keeps the doctor away," and "eat your veggies" may sound like folklore, it turns out that these maxims may have scientific backing. The only catch is that just one apple or one vegetable serving a day isn't enough. In fact, to maximize your health, you need a combination of at least five a day.
The underlying causes of deaths from heart disease and cancer include behaviors that, unlike genetic factors, can be prevented or changed. For example, better dietary and exercise patterns can contribute significantly to a reduced risk for heart disease, stroke, diabetes, and cancer, and could prevent 300,000 deaths annually.
A recent scientific literature review ascertained that approximately 35% of all cancer deaths in the United States are related to poor dietary habits. Research also points to high intakes of fruits and vegetables as the most consistent factor associated with decreased cancer risk.
For years, epidemiologic studies have shown lower rates of chronic diseases in countries that have high per capita intakes of fruits and vegetables. Although this may sound compelling, the information is too isolated to prove a cause and effect relationship in and of itself.
However, recent studies have strengthened the argument for fruit and vegetable consumption. In these studies, people who ate large amounts of fruits and vegetables had lower rates of cancer compared to people who ate one or fewer servings a day. Five servings a day is the minimum number demonstrated to reap health benefits.
Despite such strong evidence, many Americans still don't realize the importance of fruits and vegetables in the diet. According to baseline data used to set the Healthy People 2000 National Health Promotion and Disease Prevention Objectives, average fruit and vegetable intake was approximately four servings per day. In fact, only 32% of US adults met the recommended five a day.
A 1991 survey revealed that only 8% of American adults knew how many fruits and vegetables to eat. In response to this lack of knowledge, the National Cancer Institute (NCI) in cooperation with the Produce for Better Health Foundation launched the 5 A Day—for Better Health program.
What Is The 5 A Day Program?
The 5 A Day program seeks to increase the number of fruits and vegetables consumed by Americans. The program's goal is to inform Americans that fruits and vegetables can easily become a part of the daily diet, improve health, and may reduce the risk of cancer and other chronic diseases.
Peter Greenwald, M.D., Dr.P.H., Director of NCI's Division of Cancer Prevention and Control, summed up the situation by saying, "In the last several years, consumers have been bombarded with food and nutrition messages—many of which have been confusing and sometimes frightening. The 5 A Day message is simple and positive: Eat more of something that tastes great and improves your overall health."
Fruits and vegetables readily fit the bill; they provide fiber, beneficial vitamins such as A and C, minerals, and other compounds that may help to fight cancer. While single-dose nutrients receive much press, it appears that the combination of nutrients in fruits and vegetables probably holds the key to disease prevention. A bonus for the weight conscious is that most fruits and vegetables (except avocados and olives) are naturally low in fat and calories, have no cholesterol, and taste delicious.
This simple, straightforward message—eat five a day—has successfully increased public awareness of the dietary guidelines. The actual number of people meeting the goal is unknown at this time, but awareness is a good predictor of consumption.
Where Do You And Your Family Fit In?
Children mimic the dietary habits of adults. Only 20% of American children consume the recommended five a day. Though children are not concerned with developing diseases such as cancer, they need healthful diets to promote growth and development. And dietary habits formed in childhood usually last a lifetime.Conversely, older Americans who have developed healthful eating patterns consume the most fruits and vegetables, while women manage to eat more fruits and vegetables than do men.
What Can Be Done?
To help motivate people to eat more fruits and vegetables, the NCI urges Americans to take the "5 A Day Challenge." The challenge encourages people to engage in a healthy competition that will prove easier than the Olympic games, and allows more people to feel like winners. Ultimately, fruits and vegetables can become part of a health routine that can make everyone feel good. (You can get more information on their website: http://www.5aday.gov.)
Start Your Own 5 A Day Challenge
To start your own 5 A Day Challenge, begin at home by striving to eat five servings of fruits and vegetables today. Continue your success each day, each week, and soon you will have a more healthful diet.
Take your challenge into the streets by organizing a friendly competition among neighbors. End the week with a potluck and ask everyone to bring his/her favorite fruit or vegetable dish.
Need some help getting started? For recipe ideas, try the recipes from the National Cancer Institute's 5 A Day web site.
Take the opportunity to beat the boss and suggest a 5 A Day Challenge at work. Teams can offer the best support as you share ideas in the lunch room. If your workplace has a cafeteria, invite the food service manager to help the challenge by offering daily specials on fruits and vegetable dishes.
Eating five a day is easier than most people think. A serving is:
a medium piece of fruit
1/2 cup cooked or raw fruit or vegetable
3/4 cup (6 ounces) juice
1 cup leafy greens
1/4 cup dried fruit
1/2 cup cooked beans or peas (such as lentils, pinto beans, kidney beans)
Eat five a day
At breakfast, enjoy a six ounce glass of 100% fruit juice and a medium piece of fruit. Two servings already!
At lunch, bring along some carrot or celery sticks; five sticks is a vegetable serving.
For dinner, try a salad with dark, leafy greens and tomato, and a medium baked potato with your meal for two more vegetable servings.
Voila! Not counting any fruit or vegetable snacks, you've already made your 5 A Day goal.
Buy five a day
In the grocery store, buy fresh fruits and vegetables that are in season. Locally grown produce is usually less expensive than produce that has been shipped, and it is fresher.
Softer fruits and vegetables, such as peaches and berries, or tomatoes and mushrooms, don't last as long as harder fruits and vegetables, such as apples and oranges, or carrots and potatoes.
Canned and frozen fruits and vegetables are good to have on hand so that you never run out.
Find five a day on the road
Most fast food chains serve 100% fruit juice, and convenience stores stock both juice and fresh fruit.
Enjoy a breakfast waffle or pancake with strawberries instead of syrup, or have an omelet stuffed with tomatoes, mushrooms, peppers, and onions.
Bring along dried fruit or raisin packs for a transportable snack.
At the deli, take advantage of vegetable sandwich toppings and try a bowl of vegetable soup on the side.
For your evening meal, include the vegetable side choices, or try a vegetarian-based meal such as chili. Don't forget that a tomato pizza also counts towards your vegetable intake!
Don't stop at five a day!
While we would see real health benefits if all Americans increased their intake of fruits and vegetables to five a day, this target is only a first or baseline level. More recent recommendations suggest that women should aim for seven servings, and men for nine. Five is great, but more is better!
Krebs-Smith SM, et. al. US adult's fruit and vegetable intakes, 1989 to 1991: A revised baseline for the Healthy People 2000 Objective. Am J Public Health. 1995;85:1623-29.
Krebs-Smith SM, et. Al. Fruit and vegetable intakes of children and adolescents in the United States. Arch Pediatr Adolesc Med. 1996;150:81-86.
National Research Council, US Committee on Diet and Health. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: National Academy Press. 1989.
Steinmetz KA. Vegetables, fruit, and cancer, I: Epidemiology. Cancer Causes Control 1991;2:325-357.
US Department of Agriculture, US Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans, 4th edition. Washington, DC: US Government Printing Office; 1995. Home and Garden Bulletin 232.
US Department of Health and Human Services. Healthy People 20000: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Government Printing Office;1990.
The Connection Between Allergies and Asthma
by Rebecca A. Seguin, MS, CSCS
According to the Asthma and Allergy Foundation of America, 17 million Americans have asthma, and a staggering 40–50 million suffer from allergies. Additionally, asthma is the most common chronic childhood disease—affecting nearly nine million Americans under the age of 18. Because asthma and allergies are so common and frequently occur together, most parents will want to understand what is currently known about preventing or avoiding these conditions.
“Allergen” is the word that doctors use to describe a substance in the environment to which our bodies may react with an allergic or asthmatic reaction. Common allergens include pollen, mold, dust mites, latex, certain foods, bee stings, certain plants, and medications. We are all exposed to at least some allergens all the time, but many of us can encounter these troublemakers without experiencing any symptoms at all. For most people, their body simply doesn’t react to allergens. However, for millions of people, an excessive immune response to allergens triggers a cascade of unpleasant symptoms. Such symptoms are sometimes mild, but they can be severe, or rarely, even fatal. Allergic symptoms most commonly include: itching of the eyes, throat, or skin; sneezing; nasal congestion; coughing; wheezing; or rash.
Typically, allergic substances enter the body in one or more of the following ways:
Absorption through the skin (e.g., poison ivy)
Inhalation through the mouth or nose (e.g., pollen, dust mites)
Ingestion (e.g., foods, medications)
Injection (e.g., insect sting)
Asthma is a condition in which the lungs react to some kind of irritation by producing mucous and inflammation along your breathing pathway. This reaction may occur moments after exposure to an irritant or after several hours have passed. Allergy is a common cause of asthmatic reactions, but similar symptoms can be produced by non-allergen sources such as irritant chemicals, viral infections, or other lung irritants. Asthma is usually reversible with treatment. This means that in between “attacks,” or after treatment, the lungs return almost completely to normal. An asthma episode most commonly manifests as difficulty breathing, shortness of breath, cough, or other respiratory symptoms.
Exposure to tobacco smoke is a very common cause of asthma in children. This is often an irritant reaction rather than a true allergy. Other asthma triggers include exercise, cold air, viral infections, and allergens. The allergens that most commonly cause an asthma episode are dust mites, mold, pollen, and animal dander. Food allergies can also trigger an asthma episode in some individuals. Foods that are relatively common asthma triggers include shellfish and peanuts.
The Allergy-Asthma Connection
It is possible for you or your children to have allergies but not asthma, or to have asthma without allergies. However, the two conditions often occur together. Nearly all children and many adults who suffer from asthma have other allergies of one type or another. Eczema (allergic skin inflammation) and hay fever are the two most common allergies associated with asthma.
For the minority of individuals who suffer from allergies and asthma, the connection between them lies in the similar biologic responses they provoke to what are, for the most part, harmless environmental triggers. If you have allergies and/or asthma, your body, for not fully understood reasons, is attempting to protect itself from substances it wrongly perceives to be dangerous. Unfortunately, this intentionally protective reaction triggers the release of body chemicals that cause unpleasant results—those of either allergies (sneezing, nose congestion, itchy red eyes, skin rash) and/or asthma (wheezing, shortness of breath, cough). With allergic asthma, the allergic reaction is confined to the airways, whereas other forms of allergy may affect the skin, eyes, or ears.
Putting Knowledge Into Action
You can't change your child's genetics, but you can do a number of things to safeguard your home and family against allergies and asthma. While developing allergies and/or asthma may be inevitable for some, following these simple recommendations may lessen the severity and frequency of episodes.
Exposure to certain substances affect whether a child develops asthma. For instance, infants born to mothers who smoked during pregnancy are more likely to experience wheezing. Early exposure to secondhand smoke also increases a child’s risk for developing asthma. Other early interventions include:
Avoid Group Day Care
Avoiding group daycare for very young children will limit exposure to respiratory infections and may reduce wheezing during childhood. On the other hand, some studies suggest that children who have early daycare experiences may be less likely to have asthma later in life than children who avoid early respiratory infection. The relationship between early infection and asthma has been called “the hygiene hypothesis” and is still precisely that: a hypothesis. Some scientists and pediatricians think that early exposure to infections (and perhaps animals) is protective against later asthma. Parents may be interested in this hypothesis, but they should know that it remains controversial, and there is still much to be learned about the relationship between early childhood experience and later allergies and asthma.
If you or your child has asthma or allergies, talk to your doctor about controlling exposure to dust mites and other indoor allergens. Dust mites are microscopic creatures that are found in large quantities in your home. They tend to live in bedding but are far too small to be seen or otherwise detected. Some research shows that early exposure to dust mites in children with a genetic predisposition to allergies and asthma significantly increases their risk of developing one or both conditions. Reducing exposure to mites may make susceptible children (primarily those with allergic or asthmatic parents) less likely to develop asthma or allergies. Strategies to reduce exposure to mites include:
Wash all linens in hot water every seven days.
Place zippered, plastic covers on pillows and mattresses.
Vacuum carpeting and upholstered furniture frequently.
Keep indoor relative humidity below 50%.
Plan ahead to avoid environmental triggers. Bee stings, latex gloves, shellfish, and pollen are all potential triggers for allergies, asthma, or both. Some are easier to avoid than others, but awareness and planning can help. Simple strategies include:
For food allergies, prepare foods at home, always read ingredients panels on prepackaged items carefully, and ask servers for ingredient information before ordering food in restaurants.
For bee, wasp, and other insect sting allergies, become knowledgeable about the plant and environments they’re attracted to and avoid them. Also, carry appropriate medication (e.g., EpiPen®) at all times.
For pollen and related allergies, keep windows closed and use air conditioning, avoid being outdoors during peak pollen seasons, and be diligent in following allergy-related medication recommendations to avoid asthma episodes.
Knowing the underlying types, causes, and triggers of both asthma and allergies is the foundation of putting effective prevention and treatment strategies into action. It is essential that your health care provider direct medication-related strategies, but being knowledgeable and proactive will go a long way towards avoiding or reducing the negative effects of these conditions in yourself and your children.
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Questions and Answers About Arthritis Pain
Adapted from the National Institutes of Health
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What Is Arthritis?
The word arthritis literally means joint inflammation, but is often used to refer to a group of more than 100 rheumatic diseases that can cause pain, stiffness, and swelling in the joints. These diseases may affect not only the joints but also other parts of the body, including important supporting structures such as muscles, bones, tendons, and ligaments, as well as some internal organs. This fact sheet focuses on pain caused by two of the most common forms of arthritis-osteoarthritis and rheumatoid arthritis.
What Is Pain?
Pain is the body's warning system, alerting you that something is wrong. The International Association for the Study of Pain defines it as an unpleasant experience associated with actual or potential tissue damage to a person's body. Specialized nervous system cells (neurons) that transmit pain signals are found throughout the skin and other body tissues. These cells respond to things such as injury or tissue damage. For example, when a harmful agent such as a sharp knife comes in contact with your skin, chemical signals travel from neurons in the skin through nerves in the spinal cord to your brain, where they are interpreted as pain.
Most forms of arthritis are associated with pain that can be divided into two general categories: acute and chronic. Acute pain is temporary. It can last a few seconds or longer but wanes as healing occurs. Some examples of things that cause acute pain include burns, cuts, and fractures. Chronic pain, such as that seen in people with osteoarthritis and rheumatoid arthritis, ranges from mild to severe and can last a lifetime.
What Causes Arthritis Pain? Why Is It So Variable?
The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain.
The pain of arthritis varies greatly from person to person, for reasons that doctors do not yet understand completely. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint. In addition, activities affect pain differently so that some patients note pain in their joints after first getting out of bed in the morning whereas others develop pain after prolonged use of the joint. Each individual has a different threshold and tolerance for pain, often affected by both physical and emotional factors. These can include depression, anxiety, and even hypersensitivity at the affected sites due to inflammation and tissue injury. This increased sensitivity appears to affect the amount of pain perceived by the individual.
How Do Doctors Measure Arthritis Pain?
Pain is a private, unique experience that cannot be seen. The most common way to measure pain is for the doctor to ask you, the patient, about your problems. For example, the doctor may ask you to describe the level of pain you feel on a scale of 1 to 10. You may use words like aching, burning, stinging, or throbbing. These words will give the doctor a clearer picture of the pain you are experiencing.
Since doctors rely on your description of pain to help guide treatment, you may want to keep a pain diary to record your pain sensations. On a daily basis, you can describe the situations that cause or alter the intensity of your pain, the sensations and severity of your pain, and your reactions to the pain. For example: "On Monday night, sharp pains in my knees produced by housework interfered with my sleep; on Tuesday morning, because of the pain, I had a hard time getting out bed. However, I coped with the pain by taking my medication and applying ice to my knees." The diary will give the doctor some insight into your pain and may play a critical role in the management of your disease.
What Will Happen When You First Visit a Doctor for Your Arthritis Pain?
The doctor will usually do the following:
Take your medical history and ask questions such as: How long have you had this problem? How intense is the pain? How often does it occur? What causes it to get worse? What causes it to get better?
Review the medications you are using
Conduct a physical examination
Take blood and/or urine samples and request necessary laboratory work
Ask you to get x-rays taken or undergo other imaging procedures such as a CAT scan (computerized axial tomography) or MRI (magnetic resonance imaging).
Once the doctor has done these things and reviewed the results of any tests or procedures, he or she will discuss the findings with you and design a comprehensive management approach for the pain caused by your osteoarthritis or rheumatoid arthritis.
Who Can Treat Arthritis Pain?
A number of different specialists may be involved in the care of an arthritis patient-often a team approach is used. The team may include doctors who treat people with arthritis (rheumatologists), surgeons (orthopaedists), and physical and occupational therapists. Their goal is to treat all aspects of arthritis pain and help you learn to manage your pain. The physician, other health care professionals, and you, the patient, all play an active role in the management of arthritis pain.
How Is Arthritis Pain Treated?
There is no single treatment that applies to all people with arthritis, but rather the doctor will develop a management plan designed to minimize your specific pain and improve the function of your joints. A number of treatments can provide short-term pain relief.
Medications-Because people with osteoarthritis have very little inflammation, pain relievers such as acetaminophen (Tylenol) may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti- inflammatory drugs (NSAIDs)such as ibuprofen (Motrin or Advil).
Heat and cold-The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.
Joint Protection-Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.
Transcutaneous electrical nerve stimulation (TENS)-A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception.
Massage -In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are very sensitive so the therapist must be very familiar with the problems of the disease.
Acupuncture -This procedure should only be done by a licensed acupuncture therapist. In acupuncture, thin needles are inserted at specific points in the body. Scientists think that this stimulates the release of natural, pain-relieving chemicals produced by the brain or the nervous system.
Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. Following are some sources of long-term pain relief.
Nonsteroidal anti-inflammatory drugs (NSAIDs)-These are a class of drugs including aspirin and ibuprofen that are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis.
Disease-modifying anti-rheumatic drugs (DMARDS)-These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include methotrexate, hydroxychloroquine, penicillamine, and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.
Corticosteroids-These are hormones that are very effective in treating arthritis. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. Because frequent injections may cause damage to the cartilage, they should only be done once or twice a year.
Weight reduction-Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.
Exercise -Swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit.
Surgery-In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one. Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.
What Alternative Therapies May Relieve Arthritis Pain?
Many people seek other ways of treating their disease, such as special diets or supplements. Although these methods may not be harmful in and of themselves, no research to date shows that they help. Nonetheless, some alternative or complementary approaches may help you to cope or reduce some of the stress of living with a chronic illness. If the doctor feels the approach has value and will not harm you, it can be incorporated into your treatment plan. However, it is important not to neglect your regular health care or treatment of serious symptoms.
How Can You Cope With Arthritis Pain?
The long-term goal of pain management is to help you cope with a chronic, often disabling disease. You may be caught in a cycle of pain, depression, and stress. To break out of this cycle, you need to be an active participant with the doctor and other health care professionals in managing your pain. This may include physical therapy, cognitive-behavioral therapy, occupational therapy, biofeedback, relaxation techniques (for example, deep breathing and meditation), and family counseling therapy.
Another technique is to substitute distraction for pain. Focus your attention on things that you enjoy. Imagine a peaceful setting and wonderful physical sensations. Thinking about something that is enjoyable can help you relax and become less stressed. Find something that will make you laugh—a cartoon, a funny movie, or even a new joke. Try to put some joy back into your life. Even a small change in your mental image may break the pain cycle and provide relief.
The Multipurpose Arthritis and Musculoskeletal Diseases Center at Stanford University, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), has developed an Arthritis Self-Help Course that teaches people with arthritis how to take a more active part in their arthritis care. The Arthritis Self-Help Course is taught by the Arthritis Foundation and consists of a 12- to 15-hour program that includes lectures on osteoarthritis and rheumatoid arthritis, exercise, pain management, nutrition, medication, doctor-patient relationships, and nontraditional treatment.
You may want to contact some of the organizations listed at the end of this fact sheet for additional information on the Arthritis Self-Help Course and on coping with pain, as well as for information on support groups in your area.
Things You Can Do To Manage Arthritis Pain
Eat a healthy diet.
Get 8 to 10 hours of sleep at night.
Keep a daily diary of pain and mood changes to share with your physician.
Choose a caring physician.
Join a support group.
Stay informed about new research on managing arthritis pain.
Where Can You Find More Information on Arthritis Pain?
Prevention is key to living long and living well. Getting regular check-ups and preventive screening tests are among the most important things you can do for yourself. Take time to review these guidelines for screening tests. Use the chart below to remind yourself of when you need to see your health care provider based on your personal health profile. Make an appointment today!
Blood Pressure Measurement - Every one to two years
Breast Exams - Monthly self-exam; annual exam by a physician
Mammography - Every one to two years after age 40; see your doctor for your personal risk needs assessment
Cholesterol Levels - Every five years after age 18
Pelvic Exams/Pap Smears - Every one to three years after age 18, or when sexually active
Rectal Exams - Annually after age 50; earlier if you have inflammatory bowel disease or a first-degree relative with colon cancer
Blood Sugar Levels - Varies depending on family history and risk factors for diabetes
Skin Exams - Annual mole checks; check yourself for suspicious growths or changes.
Dental Exams - Twice a year for checkup and cleaning
HIV Test - If you had a blood transfusion between 1978 and 1985; have injected illegal drugs, had multiple sex partners, or had sex with a man who had sex with a man.
Tests for Sexually Transmitted Disease - If you have had multiple sexual partners or any sexually transmitted disease; recommended for all pregnant women at their first prenatal visit
Eye Exams - Every one to two years; yearly if you have diabetes or a family history of eye diseases
What to Expect With Preventive Screenings
Your provider will wrap a rubber cuff around your upper arm and inflate it. He or she will slowly release the air from the cuff, listening to the pulse beats in your arm with a stethoscope to measure your "systolic" and "diastolic" blood pressure levels. These levels correspond to the pressure when your heart contracts and when it relaxes.
Clinical breast exam
Your provider will look at your breasts for dimples, inverted nipples, or lumps. Then, he or she will manually examine your breasts using a circular motion, checking for lumps. Remember: You should also check your own breasts monthly.
The day of the exam you should not wear powder, cream, or deodorant on your upper body. If you experience breast tenderness before your period, you may want to schedule the test at a point in your menstrual cycle when your breasts are less sensitive. You will undress from the waist up. Your breasts will be pressed between plates and x-rays will be taken.
Since your blood travels throughout the body, blood samples can offer a wide range of information about your health. Usually blood is drawn from your arm with a needle connected to a tube. Less often, a finger prick test will collect drops of blood. Common blood tests are used to measure the levels of cholesterol, triglycerides (a form of fat), blood sugar, thyroid hormones, or other chemicals in your body. A test of your complete blood count (CBC) can indicate if you have anemia (low red blood cells), have an infection (high white blood cells), or a serious illness like leukemia. Some diseases, like hepatitis, syphilis, and AIDS, can also be detected through specifically ordered blood tests.
Pelvic exam and Pap test
During the pelvic exam, you lie on your back with knees bent and feet in stirrups. The doctor or nurse will feel your pelvic organs and use an instrument called a speculum to look inside your vagina at your cervix. He or she will also scrape a few cells from the cervix that will be sent to a lab to check for signs of cancer, disease, or infection.
These important exams screen for colorectal cancers—the third leading cancer killer of American women—and other possible problems in your digestive tract such as an ulcer or infection. Usually recommended after age 50, the most common are: fecal occult blood (looks for blood in a stool sample), flexible sigmoidoscopy, and colonoscopy (both inspect the colon with a light on the end of a flexible tube inserted through your rectum as you lie on your side, lightly sedated).
Urinalysis (urine test)
An analysis of a urine sample can indicate possible problems such as diabetes, kidney problems, liver problems, or bacterial infection. You will be asked to urinate in a special container.
Your dermatologist will examine your whole body, looking for suspicious moles that have uneven borders, more than one color, are asymmetrical shape, or are a size larger than a pencil eraser. Remember: You should do a self-check of your skin monthly.
Tests will depend on your age, medical history, and date of your last exam. You may need to read letters on a chart in the distance or at reading distance. You may get eye drops to numb your eye or dilate your pupil, to test for glaucoma and check your retina. Your ophthalmologist may test how your eye moves and responds to light.
Have you ever forgotten where you left your car keys, misplaced your eyeglasses, or forgotten a dental appointment? Of course you have, it's only human.
Are such lapses signs of an inferior memory? Definitely not. In fact, many people mistakenly believe that their memory is "bad" or on its way to becoming lost. It's usually not. And if you think about the millions of things each day that you do remember, you'll realize that your memory is really quite astounding.
For example, consider the routine act of meeting a friend for dinner. At minimum, you have to remember:
Your friend's name and face
The history of your relationship
The concept of time
The actual time of your dinner date
Which restaurant you'll be eating at
Directions for getting there
How to drive your car (or walk or flag a taxi)
How to read the menu
What the different food items taste like and whether you like them
To bring along money or a credit card, and a bevy of other details
It's All In Your Head
All of this information, along with the capacity to store, recall, and analyze it, is a mere fraction of what's stored in the roughly three pounds of tissue that make up your brain.
The basic building block of the brain is the nerve cell, or neuron. Your brain contains approximately 10 billion neurons. They connect with each other via electronic impulses sent and received through contact points called synapses. Each sound, image, feeling, or event we perceive activates a unique subset of these synapses. Each time the memory is recalled, that same pattern is reactivated, making the connections stronger and more indelible. Thus, the memories you recall most often become the most ingrained. To make something easier to recall, you can practice remembering it—a study technique used by many students.
Temporary Or Permanent?
Scientists talk about two different kinds of memory: working (short-term) memory and long-term memory. Information in short-term memory lasts twenty seconds or less and then is gone, unless that information is moved to long-term memory. A good example of working memory is looking up a phone number and remembering it just long enough to dial it, and then it's gone.
The decision to move something into long-term memory is handled by a structure deep in the brain called the hippocampus. The hippocampus acts like a filter, letting certain bits of information through and discarding others. Information that has emotional significance to you, such as your child's birth date, is likely to be passed on to long-term memory. Details that are related to information already stored in your memory such as a sign announcing an early bird special at your favorite restaurant usually make the cut as well. That's because the brain seems to store and retrieve things by their associations.
What would happen if your hippocampus stopped functioning for some reason? You'd still be able to carry on a perfectly intelligent conversation with a new acquaintance. But if the person you were chatting with left the room and came back five minutes later, you wouldn't remember ever having met her, let alone having spoken with her just minutes before.
You may wonder if your memory will inevitably weaken as you age. Although some eighty-year-olds have sharper memories than their children, experts agree that the ability to form and recall memories does change somewhat with age. The good news is that barring Alzheimer's disease or some other condition that affects brain function, the change in your memory abilities is likely to be small. As we age, we continue to form new memories, but the memories tend to include less detail. For example, you might remember that you saw a friend one morning, but perhaps not recall what he was wearing.
You can improve your ability to recall information by doing one, simple thing: pay attention. Often we're thinking about other things when other people are speaking. Or we're so distracted by everyday life that we're not able to focus on the details. By forcing yourself to pay attention to something, you'll be much more likely to remember it.
What about supplements? You've probably seen them advertised in magazines or heard about them from friends: pills that claim to improve memory. The most widely available of these are ginkgo biloba (an herb), vitamin E (an antioxidant), and DHEA (a hormone). Although all of the evidence isn't in yet, there is no consensus that these supplements boost memory function in healthy adults.
As much as scientists have learned about memory, there's much more to be discovered. "Space is not the last frontier," says Epstein, "It's the space between our ears that's the last frontier." Meanwhile, rest assured that when you misplace your keys, it's not a sign that your memory is failing. You were probably just distracted and didn't pay attention when you put them down.
Ginkgo Biloba: Brain Power in a Bottle?
by Jennifer Pitzi Hellwig
Is ginkgo biloba a mental health miracle or just another yet-to-be-proven-effective dietary supplement? The answer lies somewhere in between.
Chances are you've heard of ginkgo biloba–the dietary supplement with the strange-sounding name–even if you don't know exactly what it is or what it does. Advertisements call the herb "the thinking person's supplement," and claim that it improves memory and concentration and enhances mental focus.
An extract made from the leaves of the ginkgo biloba tree, ginkgo has been used medicinally by Chinese herbalists since as early as 3000 B.C. The tree itself is so primitive that it doesn't produce flowers, and so hardy that one tree actually survived atomic destruction at Hiroshima. The key to ginkgo's efficacy seems to be a substance that scientists have dubbed EGb 761.
Ginkgo is the most popular botanical extract in Europe, and there are more than 400 scientific studies attesting to its ability to increase blood flow and protect the nervous system. In Germany the extract has been the subject of hundreds of scientific studies. These studies show that among other things, EGb 761 helps keep platelets in the blood from clumping together. That's why ginkgo extract is prescribed in low doses (40 mg a day) in Europe for patients with circulatory problems. Much higher doses (240 mg a day) are used to treat cognitive deficits, such as memory loss.
Ginkgo and Alzheimer's
Public interest in the medicinal powers of ginkgo was fueled in the United States in the fall of 1997 when a study published in the prestigious Journal of the American Medical Association (JAMA) reported that ginkgo had a positive effect on the mental status of people with dementia, including those with Alzheimer's disease.
The researchers studied men and women with mild to moderate dementia that resulted either from stroke or Alzheimer's disease. The subjects were given either daily ginkgo supplements or a placebo. Results indicated that approximately 26% of the patients taking ginkgo showed an improvement in mental status (roughly equivalent to a delay of six months' progression of the disease), compared with 15% taking placebo. And 37% of those taking ginkgo exhibited improved social functioning, compared with 23% in the placebo group. The effect was most pronounced in the subjects who were the least impaired, suggesting that if Alzheimer's is treated early enough, dementia might be postponed.
This study, although seemingly favorable, should be considered with caution. When it was published, critics questioned the methods used to assess improvement, and even the researchers warned that ginkgo will not cure dementia or prevent Alzheimer's disease. The unanimous consensus is that although the results appear promising, it is premature to consider ginkgo a treatment for Alzheimer's disease; more research will be necessary to determine its effects.
Improvement for Forgetfulness?
Meanwhile, millions of generally healthy Americans are losing their keys and forgetting phone numbers daily. Will ginkgo work for them, as the advertisements seem to imply? The answer is an unequivocal maybe.
"Ginkgo is not a smart pill," according to Varro E. Tyler, Ph.D., dean emeritus of the Purdue University School of Pharmacy and a leading U.S. expert on herbal remedies. However, in Germany, where ginkgo is a top-selling herb, studies have shown it to be effective in some people for improving short-term memory loss and concentration.
Short-term memory loss and decreased concentration, which we've all experienced to some degree, can have several different causes. One factor is decreased blood flow to the brain. This is where ginkgo may help, because it acts as a blood thinner, thereby improving blood flow and oxygen transport to the brain.
But how do you know if blood flow is your problem? Unless you've received a diagnosis from a physician, you don't. But since studies on ginkgo show it to be safe, it might be worth giving it a try. The recommended dose is 40 mg three times a day, but if after a month you see no improvement in memory with this dosage, you likely won't see any improvement at all.
In August, 2002, a study published in JAMA found that ginkgo did not improve memory or concentration in healthy older adults with no mental function decline. In this study, subjects took 40 mg of ginkgo (Ginkoba brand) or a matching placebo three times daily for six weeks. The results showed no difference in memory or concentration changes between the two groups. These findings suggest that people with normal mental function probably won’t benefit from taking ginkgo.
What to Look for When Buying Ginkgo
Be aware that not all ginkgo products are the same. Many do not contain all the active ingredients. Avoid bargain prices. If it's the real thing, the label should read at least 24% "flavonoids" or "ginkgo flavone glycosides" and six percent "ginkgolides" or "terpene lactones." There are no known side effects beyond stomach upset, but again, Dr. Tyler advises against the use of any herb by pregnant or nursing women. Those taking blood thinners–aspirin, garlic, vitamin E, ginger, or Coumadin (among others)–should use ginkgo only under a doctor's supervision.
Symptoms of Sinusitis
by Rosalyn Carson-DeWitt, MD
Symptoms of sinus infection are very similar to those of the common cold, however when due to a cold virus, such symptoms typically improve after a few days. If you continue to have nasal symptoms ten days after having a cold, then you may have developed a sinus infection.
Nasal discharge that may be
Headache (in acute sinusitis)
Toothache (dental pain)
Facial pain and pressure that increases when you lie down or lean over
Facial fullness or congestion
Nagging cough that may get worse when lying down
Decreased energy or fatigue
Unpleasant taste in your mouth
Decreased sense of smell
Most experts believe that sinus infection does not cause chronic headaches. However alteration in sinus pressure associated with weather changes might provoke migraine headaches in susceptible people.
American Academy of Otolaryngology – Head and Neck Surgery
Conn’s Current Therapy, 54th ed. W.B. Saunders Company;2002.
National Institute of Allergy and Infectious Diseases
Medicine today has the power to prolong life in two different ways. Many of us will live longer and fuller life spans because of medical advances, lifesaving interventions, and new prevention knowledge. Others of us will find our last days and months prolonged—sometimes in an unwelcome way—by life support technology and practices that enhance neither the quality of our lives nor our deaths.
Life support can breathe for us, eat for us, and substitute for vital organs. Sometimes a partial (or full) recovery from a terminal illness or incapacitated state is possible; but even when there is no hope of revival, doctors may sometimes take extraordinary measures. Some say that these choices derive from doctors’ training in resisting death at any cost, others point to liability risks if any potentially curative intervention is overlooked. But increasingly, doctors, along with patients and family members, fail to recognize when curative technology is no longer indicated and a different technology—end of life care—should be brought into play.
Talk of dignity, quality, and sanctity of life has been heard ever more frequently in hospitals, medical schools, and the media. These terms have different meanings for each of us, and can sometimes be used as arguments for or against life support. At the same time, dignity and quality of life are important to all of us, especially when we are very ill and potentially near the end of our lives. So who should decide what care is life-saving as opposed to death-prolonging? You.
There are a great many considerations to end of life care, including: emotional and philosophical concerns, deciding where to receive care, and legal options. The one thing that everyone agrees on is that each of us should ponder, discuss, and legally establish our approach to the management of life-threatening illness before a medical crisis occurs.
Emotional and Philosophical Matters
You can begin by asking yourself some tough emotional questions. What are your fears: pain, loss of dignity, machines keeping you alive, or dying in a strange place? Fill in the blank: “My life is only worth living if I can ___”. Is life defined by a heart beat or a working brain? Whom do you want to make decisions for you if you are not able to communicate? Discuss options with your doctor. Seek guidance from your religious leader. Talk with family. Above all, make sure that family members know what your choices would be under a variety of serious situations; if possible, put your choices and values into writing.
The last days of life can be spent in your home, a nursing facility or a hospital. These facilities generally seek to cure, rehabilitate, or support life. If you are seeking curative care or aggressive medical treatment, a hospital is usually the best choice. Today many hospitals are adept at balancing curative and palliative care when the end of life approaches. Palliative care, perhaps most often given in the hospice setting, provides treatment that enhances comfort and quality during the last days of life. This type of care seeks neither to hasten nor to postpone death, but rather to provide relief from pain and discomfort. While services may vary from community to community, in many parts of the country palliative care can be supplied either in a hospice facility or in your home.
For most of us it is very hard to imagine how we are likely to feel when faced with a serious and potentially fatal illness or injury. It is perhaps only human nature to prefer to wait until the crisis is upon us and then communicate our intentions to the nurses and doctors providing our care. Unfortunately, there are many scenarios that can interfere with one’s ability to communicate. For example, it is impossible to tell a doctor your treatment decision while on a ventilator (mechanical breathing apparatus) or when unconscious. Fortunately, there are legal solutions to this problem. Among these legal solutions are:
Health care proxies
Do not resuscitate orders
Here is some information about each of the above:
Advance directives are written legal documents that state your wishes if you can no longer speak for yourself. With these documents in place, medical personnel and loved ones don’t have to guess what you would prefer or make decisions you would not want for yourself.
A Health Care Proxy names someone to make medical decisions for you when you are not able to make such decisions. This person should be someone you trust, who knows what treatments you would want or would reject, and who will respect these preferences. Your proxy does not have to receive specific instructions from you and can make decisions as if she or he were in your situation, but conscious and able to communicate.
A Living Will states your requests regarding life-sustaining medical treatment (for example, a feeding tube, breathing tube, or surgery) and is only effective if you are unable to communicate. These instructions for treatment or refusal of treatment can be made as broad or specific as you wish. For example, you can ask that your life be prolonged as long as possible whatever your state of consciousness, or you can state that you do not want extraordinary treatment to maintain life if as a result you will need constant care or not have an existence that seems of adequate quality to you. You can also address specific circumstances that commonly arise at the end of life (dementia, trauma, or coma).
A Do Not Resuscitate order instructs medical personnel not to bring you back to life if you stop breathing or your heart stops.
Each of these four legal solutions requires that you complete a document that will become part of your personal medical file. This way, you or your family members can ensure that, in the event of a hospitalization, all of your caregivers know about your written wishes and incorporate them into your care plan. For further information, you can talk to a lawyer, explore the numerous books written on this topic, or use the internet resources listed below.
It is important to note that advance directives are not iron clad, and no single one of the four choices above can anticipate every situation that may occur at the end of life. Since it is difficult to anticipate every medical possibility, a living will might not precisely address what actually happens to you. Additionally, no matter how carefully you try to think about what might happen to you as you write your living will, you still run the risk of this document being misinterpreted by doctors or family. So, even with a living will in place, it is still essential to have someone you trust—preferably named as a health care proxy—to make decisions for you in the case of unforeseen circumstances. Your proxy should know you well and spend considerable time discussing your philosophies, expectations, and values. Combining a living will with a designated proxy is a particularly smart way to prepare for your end of life care.
No one wants to think about the unpleasantness of life-support: whether its end result is to prolong our lives or to prolong our deaths. But when life support no longer offers hope of quality living, decision must be made. No one can make such decisions better than you. Choose your options while you can speak for yourself. The questions are tough, but the issues are life and death: yours.
In Her Own Words: Living With Alzheimer’s Disease
As told to Virginia Mansfield
Margaret* was diagnosed with Alzheimer’s disease ten years ago, at the age of 79. Here, her daughter describes her mother’s condition, which led she and her sister to the difficult decision of admitting her to the Alzheimer’s unit at a nursing home. Margaret worked in hospital administration for 32 years and spent many of her retirement years volunteering at the hospital and staying active in church and community activities.
What was your first sign that something was wrong? What symptoms did your mother experience?
She was forgetting more and more. She also became insecure in doing things she had always done, like paying bills, responding to her mail, fixing meals, normal things. She would say, “I just can't do that.” She couldn't put things together in her mind anymore. It kept getting worse. She would be in the car going to the grocery store and realize she didn't know where she was. She would call my daughter or me and we would have to try to figure out where she was and talk her through getting back home. She had also started getting up in the middle of the night at 2:00 or 3:00 in the morning, she'd get her coat on, get her purse, and walk the streets.
What was the diagnosis experience like?
I was taking her to her doctor appointments at that time, and I told the doctor about how forgetful she had become. He wanted to understand what was going on, so he asked me for examples. I told him about how she was wandering out in the night, how she would get lost when she was driving, and sometimes, she would even forget where she was going.
The family doctor recommended that I take her to the nursing home for an Alzheimer’s evaluation. They evaluated her and confirmed that she had Alzheimer’s. At first they put her in a regular room, but within a few weeks, she started to wander off, so they had to put her in the locked area of the Alzheimer’s unit.
What was your initial and then longer-term reaction to the diagnosis?
When we first took her to the nursing home she said she didn't want to be there, and wanted us to take her home. We told her, “ Mother, we fear for your safety. We're afraid someone could hurt you, or you could hurt someone else.” We told her she needed to stay there for a while to see if she could get stabilized to where she wouldn't wonder off. But the Alzheimer’s just consistently got worse, so she ended up staying there for the long term.
It's been ten years since she was first admitted. She would cry a lot and get frustrated with herself and with us, but we would tell her that she needed to be there for her own protection. It was a few years before she settled down, and seemed content at the nursing home. Now, I think she would be uncomfortable if we took her out of the home—she feels safe there.
How is Alzheimer’s disease treated?
My mom is on medications, but I'm not exactly sure what they are giving her now. There are certain medications I don't want her to have because of the side effects. They also do play therapy with the Alzheimer's patients. They have one room that has been made into a playhouse. Mom spends quite a bit of time in there just playing in the play kitchen and playing with the dolls. The staff will do play activities with them, like tossing a balloon back and forth or kicking a ball around on the floor with their feet. These activities help with their motor development.
They also have music therapy where they sing and move to the music. It's amazing that these people can't remember who they are, but can remember all the words to a song. I hardly ever find my mother in bed. She's always up doing some kind of activity, which I guess is a good thing.
Did your mother have to make any lifestyle or dietary changes in response to Alzheimer’s disease?
The first big change was taking her driver’s license away. She was so angry, but it was necessary. It was a few months later that we had her evaluated and admitted to the nursing home. She didn't really make any dietary changes for a while, but in the past year, she has to have her food pureed to prevent her from choking. Other than that, she eats a healthy, well balanced diet.
Did your mother seek any type of emotional support?
My sister and I are probably her main support system. My sister visits her three to four times a week and I usually visit her twice a month. Some of the grandkids are in town, and they visit her occasionally. She also has visitors from her church that see her off and on. Actually, I would consider the staff at the nursing home a good support system. They have really been good to mother. When we first took her there, one of the nurses told us that it would be a good idea to buy her a doll, or teddy bear, or some kind of stuffed animal. We bought her a doll, and she carries that doll around with her all the time and is very protective. She gets mad if anyone else picks it up or even touches it.
Does Alzheimer’s disease have an impact on your family?
My sister and I were having to do a lot more for her, like paying her bills, answering her mail, and picking up groceries. We didn't mind of course, but it was hard to see her having to be more dependent on us. It was a difficult decision to have to put her in a nursing home. We knew how important her home was to her, but it got to the point where it just wasn't safe anymore. My sister had a harder time with it than I did. Until mother started walking the streets at night, my sister wouldn't even talk about a nursing home. She couldn't admit that mother was sick.
Sometimes mother will get hostile and moody. One time my sister bent over to kiss her goodbye, and mother slapped her face. My sister was so upset, but I told her she can't take it personally—mother can't be accountable for her behavior, she’s sick. When she does things like that, she doesn't realize what she's doing. I think now both my sister and I feel relieved. We know she's in a safe place, and that her needs are being met. We don't worry about her getting out and wandering the streets at night or getting lost. She was so vulnerable. It's amazing nothing bad happened to her.
What advice would you give to anyone living with Alzheimer’s disease in their family?
The most important thing is that you keep them safe and healthy, even if that means putting them in a nursing home. It's best if the family can stay united. You can't think about what you want, but you have to think about what is best for them. You also have to keep your sense of humor.
Reducing Your Risk of Kidney Stones
by Jean Baker, MS, RD
Once a kidney stone has been removed or has passed on its own, the focus shifts to prevention—steps that you can take to minimize your chances of developing another stone. While your specific prevention strategy depends on what kind of kidney stone you had and why it developed, some general guidelines are outlined below.
Drink plenty of fluids
Watch your diet
Talk to your doctor about medications for prevention
Drink Plenty of Fluids
One of the goals of preventive therapy is to keep your urine as dilute as possible. This helps to keep the substances that could potentially form a kidney stone, including calcium and oxalate, moving quickly through your urinary tract.
Try to drink at least two quarts (12 cups) of fluids a day. Water is best, although juice and other beverages can add to the total. Limit your intake of caffeine-containing beverages like coffee, tea, and cola to one or two cups a day, since caffeine acts as a diuretic, causing your body to lose fluids too quickly.
A good gauge of whether or not you are drinking enough fluids is urine color. Except for the first thing in the morning—when urine tends to be more concentrated—it should be pale in color. If your urine is dark yellow, that's an indication to drink more fluids.
If you are hesitant to drink too much during the day because you have a bladder control problem, discuss this concern with your doctor.
Points to remember:
Drink at least 12 cups of fluids each day
Limit your intake of caffeinated beverages
Your urine should be pale in color
Watch your diet
Whether or not diet can help you avoid another kidney stone depends on what kind of stone you had and what caused it to form in the first place. If your stone was made up of calcium oxalate, calcium phosphate, or uric acid, what you eat—or don't eat—can help prevent a recurrence.
Note that these are only guidelines. People taking some kinds of medications may need to avoid certain foods. Always follow the advice of your doctor or registered dietitian in making any diet changes.
Nutrients to consider include:
Eat a diet that includes the recommended dietary intake of 1000 to 1200 milligrams of calcium, but try to get it from foods rather than from supplements. It might seem to make more sense to avoid calcium if you suffer from recurrent calcium stones, but research shows that reducing your calcium intake prompts the body to make more oxalate available, the very substance that people who suffer from calcium oxalate stones are trying to avoid.
Good sources of calcium include milk, cheese, yogurt, sardines, and broccoli. Many foods such as orange juice, breakfast bars, and cereals now have added calcium. For more information on foods rich in calcium, click here.
Oxalate is a substance found in certain plant foods that binds with calcium and other minerals in the intestine. If your body is not absorbing and using calcium correctly, you could end up with too much oxalate in your urine. You can reduce the level of oxalate in your system by avoiding these foods:
A diet high in animal protein—from meat, chicken, and fish—may cause your body to release too much calcium into your urine. If you consume a lot of these foods, you may be asked to plan meals that include less meat and more of other kinds of foods, such as fruits, vegetables, grains, and beans.
Likewise, a diet that includes a lot of salt (sodium) can cause your body to excrete too much calcium into your urine. You may be asked to reduce your intake of salty foods and to not use salt in cooking or at the table. Check with your doctor before using a salt substitute.
Foods high in salt include:
Lunch meats, cured meats like ham, sausage, and bacon
Prepared salad dressings, mustard, catsup, soy sauce, barbecue sauce
Pickled foods, olives
Canned soup, bouillon
Alkaline Ash Diet
In some cases, the best way to avoid another stone is to manipulate the pH balance of the urine. Uric acid, calcium oxalate, and cystine stones form more readily in acidic urine, so this prevention strategy hinges on keeping the urine slightly alkaline. This is usually done with medication, but your doctor might ask you to help it along by making some dietary changes as well.
Ask for a written list of instructions if your doctor wants you to follow this diet. Generally, all fruits (except for cranberries, prunes, and plums) and all vegetables (except for corn and lentils) make the urine more alkaline.
Points to remember:
You may be asked to make some changes to your diet
You may need to avoid some foods while taking certain medications
Follow the advice of your doctor or dietitian in making any diet changes
Talk to your doctor about medications for prevention
There may be some medications that can help you from forming another kidney stone. It will depend on what kind of kidney stone you had and why it developed. Talk with your doctor to determine if there are any medications that may be helpful for your particular situation.
Krause’s Food, Nutrition, and Diet Therapy, 10th edition. W.B. Saunders;2000.
Current Trends in Alternative Medicine Use
by Maria Borowski, MA
In today’s world, it seems as if alternative therapies are everywhere. Advertisements for herbal remedies are nearly as prevalent in health magazines and on television as ads for FDA approved medications. Once considered unconventional, yoga, massage, and acupuncture have become nearly mainstream. Judging from the amount of marketing, one might assume that most Americans are using some form of alternative medicine.
What exactly is “alternative” medicine? “Alternative and complementary medicine,” or CAM— the official title, according to the National Institutes of Health, can be defined as any therapy or treatment that is not part of conventional medicine. This broad definition includes interventions as simple as taking an herb, like echinacea or ginseng, to fight off a cold, or as complicated as acupuncture or chiropractic care.
A study published in the January/February 2005 issue of Alternative Therapies compared the results of two surveys to determine if the prevalence of alternative medicine use changed between 1997 and 2002.
About the Study
This study analyzed the results from two national surveys of alternative medicine use by adults. The first survey took place in 1997, and the second in 2002. All of the respondents were age 18 or over, and were interviewed either in person or by phone. The surveys consisted of questions regarding the use of 15 different complementary and alternative therapies during the previous 12 months:
Folk remedies/folk medicine
High dose vitamins
Chelation (use of the amino acid EDTA for cardiovascular disease)
Special diets (including vegetarian, Atkins®, the Zone®, and others)
While the two surveys were not identical, the researchers only compared results for the 15 therapies that were determined to be comparable. The respondents were also asked if any of the therapies they used were covered by insurance.
The results of the study revealed that although the prevalence of some treatments increased and others decreased, overall use of alternative medicine remained stable from 1997 to 2002. The greatest increase in use between 1997 and 2002 was seen for herbal medicine and yoga, and the greatest decrease was for chiropractic care. Nevertheless, chiropractic care remained one of the most common treatments used in 2002, along with herbal therapy and relaxation techniques. Respondents who were most likely to use an alternative therapy were non-Hispanic white females between the ages of 40 and 64, with a household income of $65,000 or higher.
The authors concluded that the prevalence of complementary and alternative medicine use has remained stable from 1997 to 2002. Approximately 72 million Americans use complementary and alternative medicines.
How Does This Affect You?
More than 10 years ago, when it was first discovered that a surprising number of Americans reported using alternative therapies, many critics predicted it was only a fad. This study strongly suggests otherwise. Many people feel comfortable using some form of alternative medicine. Indeed, the results of this study reveal that nearly one in three US adults are willing to seek out their own unconventional therapy for health problems. While most of these therapies are far safer than many conventional treatments, their lack of regulation raises some concern.
The use of herbal therapies increased by 50% between 1997 and 2002, the largest increase of all the therapies investigated. There is currently no system in place in the United States to determine the relative safety and effectiveness of herbal treatments. Currently the FDA places most herbal remedies in the category of dietary supplements, which is somewhere between drugs and foods. Classifying a product as a dietary supplement means that its manufacturer is not legally required to prove that it is safe and effective before being marketed. This means that the Echinacea you take for your cold may be helpful, may do nothing, or may be harmful. Unfortunately, because many alternative therapies are marketed as “all natural,” they may be perceived as safe.
The fact is, most of these therapies are safe, and some studies have supported their effectiveness. However, when considering an alternative therapy, it is important to remember that just like prescribed drugs, they can be helpful or harmful. As with any new drug or therapy, it is important to talk with your doctor before starting, to find the best way to integrate an alternative therapy into your life.
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