Monday, October 8, 2007

Less Stress Leads To A Better Rest

In the modern world of today we are constantly being bombarded with high levels of stress and anxiety. These stresses can be physical, mental or environmental. They place an enormous strain on our physical and mental health.

Most of us are aware that excessive stress can affect our ability to think straight, our digestive system, adrenal glands and heart. Research has however shown that whenever a stressful situation arises, there is a knock on effect. Firstly stress limits the blood supply going to the stomach, this hampers the digestive system and a temporary shut down of our immune system may follow. If we are overwhelmed with stress for an extended period we are likely to experience fatigue and exhaustion.

Although it may not be possible to avoid these stress factors in our lives there is help available. There are many natural herbal supplements, known for they’re relaxing properties which assist in combating the harmful effects of anxiety and stress. Several herbs are usually incorporated together to make a powerful formula.

We will take a look at some of the individual herbs, which go to make up some of these potent anti- anxiety supplements: -

* Jujube Seeds: - hypnotic and anti-anxiety effect used for hysteria, fatigue, sleeplessness, debility and restlessness.

* Magnolia Bark: - has anti anxiety, anti stress properties, lowers the cortisol, promotes relaxation and improves the mood.

* Potassium: -sustains the fluid and electrolyte balance, discharges energy from carbohydrate, protein and fat, assists in conveying nerve impulses.

* Magnesium: -is a trace mineral and its chief role is manufacturing and transporting energy, relaxing and contracting the muscles, assisting some enzymes with their task in the body and mixing proteins.

* Valerian Root: - It supports a feeling of calmness, improves sleep, reduces anxiety levels and facilitates relaxation of the central nervous system. Valerian root is non addictive and does not cause morning tiredness. It also is useful in slowing the heart in those who have the condition known as tachycardia.

* Melatonin: -is one of the most dominant antioxidants in the brain. It restores metabolism, improves the quality of sleep and slows down degenerative diseases of the brain such as Parkinson’s. Melatonin can control extreme cortical production and is therefore effectual in reducing stress levels and regulating sleep cycles.

* Vitamin B complex contains Vitamins B1, B2, B3, B5,

B6 and B12 are all essential vitamins for the nervous system


Fitness and Exercise Guide And Advice

According to few insulin levels play the largest role in losing weight. Other experts determine that our body type is the key to finding the proper exercises and diet plans that work with the body. To find out your body type you will need to talk to your doctor, or else visit the World Wide Net to find answers to your questions. Other details are available over the Internet that can help you decide on which diet is best for you, as well as which exercises works best with your body.

To achieve a healthier status and maintain weight diet must combine with exercise, since one without the other will not work. Combining healthy provisions with correct exercises can bring you good health and physical fitness, which will enhance your quality of life. It will also help you keep your body’s zone to a level.

The body and mind is complicated, however both work together to produce results. Many experts, including theorists, doctors, scientist, and philosophers are continuing to find answers to the body’s functions.

Some of the confusion comes when people diet, exercise and take care of them self, yet they still gain weight. Barry Sears wrote a compelling book titled A Week in the Zone, which produced some outstanding advice. Some of the information in the book helps us to decide on exercises and diets that suit us best, since insulin plays a large part in healthier living. The author lets us know that the hormones consequence of intakes of carbohydrates and caloric differ from the hormones that produce protein and calories. , he continues letting us know that the effects of hormones that produce fats and calories too differ in the direction of health. (p. 3)

The author brings us to see that a balance is needed, yet the balance is factored by the different hormonal levels. Thus, eating healthy, giving the body proper fluids and exercising is the only answer to living a productive and quality lifestyle.

One of the biggest setbacks that people adhere to is making excuses to avoid dieting and exercise. Countless of people find it easier said than done to stick with diet and exercise programs that facilitates them to remain healthy while maintaining weight.

One of the largest reasons is that most people do not understand their body and its type, or have difficulty adhering to a schedule. One of the largest reasons why this happens is that many people find it difficult to plan, set goals that work, and find solutions that help the person maintain a schedule. The threesome is the ultimate tools for working toward good health and fitness. If you are uncertain of the types of exercises, this too can hold you back. Walking up and down the stairs is an aerobic exercise. Mowing the lawn is another type of exercise. Anytime the body is in motion, producing actions it is exercising. Lifting 12’ ounces of beer is not an exercise. Alcohol if overused will affect the body and mind dramatically.

About The Author

Peter Curtis is a full time aerobics instructer in Las Vegas. In his spare time he writes articles andguides for various website and online publications.

Check out these great Health Fitness tips or the more specific Aerobic Exercise advice.

Does Human Insulin Come From Humans?

QUESTION: Does human insulin come from humans?
ANSWER: Does cotton candy come from cotton? Think of it that way because
human insulin does not come from the human body but is made synthetically to
imitate the look and qualities of insulin from the human pancreas. Most
diabetics in this country who take insulin today receive preparations that are
taken from the pancreas' of animals--namely, pigs and cows.
Synthetically-made human insulin, however, is becoming more and more popular,
not only because of its decreased cost, but because doctors find that some of
their patients experience allergic reactions to animal insulins and others,
over time, build up a resistance to the drug that they so desperately need to
stabilize their diabetic condition. It seems that human insulin does not
cause these reactions as often as animal insulins do. So, it is also
preferred by doctors when they prescribe insulin for special situations. For
instance, I would prescribe human insulin for a pregnant diabetic woman
because animal insulins might interfere with the immune system of the fetus.
I would also suggest human insulin for the newcomer to insulin therapy. And I
would advise any diabetic on oral medications, who is in the hospital for
surgery or whatnot, to use the human insulin during his or her hospital stay.
If someone needs to use insulin from time to time, I would recommend human
insulin. In addition, researchers are hopeful that human insulin can somehow
work against the complications that many diabetics experience from diabetes;
complications that involve nerve, eye, and kidney damage. No proof of this
exists yet, though. If you know someone who is stable on a purified pork or
mixed beef/pork insulin, there is no reason to change to human insulin,
unless, of course, his or her doctor recommends such as switch.

Vaginal and Urinary Tract Infection Treatment

QUESTION: Is it possible to treat vaginal and urinary tract infections with
just one dose of medicine?
ANSWER: Many vaginal and urinary tract infections can be treated with one
dose of medication, but not all. This is an important development because
these infections are among the most common conditions seen by physicians, and
one dose treatments greatly reduce costs and the risk of side effects.
Single dose treatments can be used in four types of genitourinary
infections: candidal vulvovaginitis (yeast vaginitis), trichomonal vaginitis,
bacterial vaginosis, and cystitis. In candidal vulvovaginitis, 89% of women
treated with one vaginally administered dose of clotrimazole were cured.
Similar cure rates were found with other medications for bacterial vaginosis,
trichomonal vaginitis, and the bladder infection cystitis.
The drawback to a single dose treatment is that it may not clear up every
case. Still, for uncomplicated cases of genitourinary infections, single dose
treatments should be considered.
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical

Recurring Vaginitis and Trichomonas Infection

QUESTION: Help! I have a recurring vaginitis. The employee health nurse
feels sure that it is a "trichoma" infection, but my normal cleaning routine
isn't helping. Can you?

ANSWER: Trichomonas vaginitis is a vaginal infection that can be a problem to
get rid of. Unlike most other vaginal infections, which are bacterial,
trichomonas is caused by a protozoa, a microscopic one-celled animal.
A trichomonas infection is a sexually transmitted disease, although women
can become infected through nonsexual contact as well. If you have the
infection, your sexual partner usually has an undiagnosed case also. If you
take medication and your sexual partner does not he will remain infected and
after you have conquered your infection, may reinfect you. If he gets
treatment, and you don't clear up your infection, you will transmit the
disease back to him. Doctors have a descriptive term for such situations,
calling them "ping-pong" infections. This may be occurring in your case.
The usual first-line treatment for trichomonas is one dose of an oral
drug called metronidazole. If the partner is treated at the same time as the
infected woman, a single dose is 95% effective. However, if you fall in the
other 5%, the only recourse is to try a seven-day course of lower doses of
metronidazole, and perhaps, in addition, a topical drug called clotrimazole.
In any case, this is not the time for self medication and trial and error
treatment. You deserve to see a physician, obtain a careful and correct
diagnosis, and receive the appropriate treatment. A discussion with your
partner is in order as well.

Tick Removal

QUESTION: What's the best way to remove a tick?
ANSWER: Although there aren't quite as many ways to remove ticks as there are
cures for hiccups, there are quite a few. The best way may be to use tweezers
and pull the tick straight out and up. This has become the most commonly
recommended method because it is simple and quick. Even if the mouthparts of
the tick are left in place, there is little danger of the spot becoming
Other methods may not work as well. Touching the tick with a hot match
or placing the burning end of a cigarette on the bugger may cause it to burst
or burn the skin. Worse still it may cause the tick to regurgitate and
salivate, increasing the possibilities of disease transmission. Covering the
tick with alcohol, petroleum jelly, or fingernail polish takes a long time and
may still not budge the tick.
As you know, ticks carry diseases such as Rocky Mountain Spotted Fever,
Lyme disease, and tularemia, which is why removing them is so important.
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical

What is Shingles?

QUESTION: What is shingles? Is there anything that can be done for it?
ANSWER: Shingles is a painful condition that primarily affects skin and
nerves. The most visible symptom is a blistering rash. It is also called
herpes zoster since it is caused by one of the herpes family of viruses,
varicella-zoster. Varicella-zoster is also the virus that causes chicken pox.
Shingles is, in reality, not a disease that is "caught." It is a reactivation
of the virus that has been dormant in the nervous system since a childhood
bout of chicken pox.
The virus reactivation is apparently due to some physical stress to the
affected area, such as surgery, trauma, or other infection. Before the rash
appears, you may have a mild fever or feel tired or there may be stinging,
burning, or pain in the affected area. The fever subsides when the first red
patch breaks out and small to large blisters develop within a day or two that
last for up to two weeks. In most cases, the blisters fill with pus within a
few days, scab over, and heal by themselves. The rash can be painful or
itchy, which can be relieved by using compresses wet with Burow's solution
(Domeboro powder dissolved in water). Your physician may prescribe one or two
antiviral drugs; Zovirax (acyclovir generically), which is taken orally or
intravenously, or Vira-A (vidarabine), an ointment or intravenous injection.
An uncomplicated case of shingles may not need these medications, however, and
your physician may choose only to prescribe pain relievers.
Uncomplicated shingles usually heals well without scarring, and unless
the blisters are popped or punctured, is unlikely to become infected.
Shingles is not contagious in the usual sense, but you should be careful to
avoid adults who are ill or have an impaired immune system or children who
have not had chicken pox, since these people are susceptible to
varicella-zoster. People who are immune compromised are more likely to get
shingles that last longer and extend over a much wider area of skin.
Usually shingles occurs on the back or trunk, but it can occur on the
face and around the eye. This is a more serious situation, since ophthalmic
shingles can damage the eye or lead to a brain infection called herpes zoster
Another complication is pain that lasts after the rash disappears. This
is known as post-herpetic neuralgia and is more common in elderly shingles
sufferers. Several medications can be used for this, but not everything works
on every patient.

Mononucleosis: Treatment and Recovery

QUESTION: My son has mononucleosis and his doctor has simply recommended he
stay home from school and rest for several weeks. The doctor hasn't
prescribed any medication other than for aches and pains. This worries me to
no end since I once knew someone who died from mono. What do you think?
Should I worry? Please tell me more about mono.
ANSWER: Death is an extremely rare occurrence in mononucleosis patients.
Complications due to mono that are cause for concern, however, are an enlarged
spleen, which could rupture, or asphyxiation due to an airway passage
obstruction. This usually results from the massive enlargement of the tonsils
and adenoids. As I've already said, these complications are very rare.
Infectious mononucleosis is caused by an Epstein-Barr virus infection. The
disease is usually transmitted in adolescents and young adults by the intimate
exchange of saliva, which is why mono is often referred to as the "kissing
disease." The first symptoms of mono include headache, sore throat, weakness,
and mental and physical fatigue. Swollen eyelids are common.
The symptoms may occur anywhere from one to three weeks after infection.
Many mono sufferers initially think they have the flu, since the symptoms are
very similar. Within a few days, however, victims begin suffering from
painful swollen glands. The swelling may occur in the neck, armpits, and/or
the groin. Although many of the physical symptoms may disappear, the
weakness, fatigue, and overall lack of energy persist. What's actually
occurring within the body is this: the Epstein-Barr virus has invaded the
body's cells which are responsible for antibody formation and many of those
cells are immortalized. Fortunately, other cells generally launch an
immunologic counterattack.
The primary battlefields for these attacks and counterattacks are the
lymph organs, which include the tonsils, lymph nodes and spleen.
Ten percent of patients develop jaundice. Five to fifteen percent may
develop skin rashes. In rare cases, the heart, lungs, lower gastrointestinal
tract or joints may become involved. One percent of patients may experience
neurological complications. Most cases are not very dangerous, though, and no
specific therapy exists.
Rest is essential to recovery. Recent studies on Harvard students show
that strict bed rest is not mandated in most cases. In fact, light to
moderate activity seemed to quicken recovery rather than impede it.
In general, it takes at least a month until mono sufferers can return to
their normal daily activity. As far as medication goes, antibiotics don't
help, because mono is a viral disease.
Aspirin or an aspirin substitute is advised to relieve discomfort.
Lozenges and salt water gargles can ease throat pain.
During regular checkups, your doctor will carefully examine your son to
monitor the size of the spleen. Blood tests will be taken that check on the
function of the liver, and reveal how rapidly the patient is recovering. It's
also a good time to get a general evaluation of the amount of activity that
can safely be performed, and perhaps when school can start up again.
I don't think you should be overly worried about your son. Just see that
he takes the problem seriously and gets plenty of rest and checkups, and he
should recover properly.

Seasonal Affective Disorder

QUESTION: I've had it with winter! It's getting me down and I know there
must be something you doctors have to say. What's my problem, and how can I
cure it without running up big medical bills?
ANSWER: Seasonal affective disorder (SAD) is the term now being used to
describe recurrent episodes of depression that occur only during fall and
winter. The symptoms include weight gain due to increased appetite and
carbohydrate craving and over sleeping that starts in October or November and
is relieved in March or April. Most people with SAD are women in their 30's
or older.
SAD is responsive to light. Most SAD sufferers have noted their
condition gets worse if they move further north, where winter is longer, and
that they feel better on sunny days or in well-lit areas. Researchers then
found that simply having the patient sit in front of a bank of bright lights
during the day relieves the depressive symptoms of SAD. Why bright light
works is not fully understood but it may be linked to increases in certain
hormones in the blood and brain. The therapeutic effect is a factor of
looking at the light rather than of the light hitting the skin.
The National Institute of Mental Health has tested phototherapy (therapy
with light) for SAD and found that 80% of 112 patients showed a significant
improvement in their depression. For best results, the patient should sit
about three feet in front of a bank of 40 watt full-spectrum fluorescent
lights. This is the equivalent of looking out a window on a sunny day. The
patient should look at the lights for a few seconds every few minutes. Most
patients are started on four hours of daily treatment in two 2-hour sessions
(the amount needed for best results varies), which should continue through
Your medical bills may be small, but I wonder what it is going to do for
your electric bill?

Adult Rumination or Merycism

QUESTION: Have you ever heard of a man chewing his cud? There is a man who
lives in our community who, I am sure, does this quite often. Does he need
ANSWER: There is a rather rare condition called Merycism or adult rumination
that might explain what you believe you are seeing. While involuntary
regurgitation is normally seen in infant, it has been known to occur in
adults. It usually occurs within a half hour of eating, and the patient will
rechew the small amounts of food that have returned to the mouth before
swallowing it again. It's often a very private action, not usually noticed by
others, but during periods of stress the individual may be less careful to
hide what is going on. It occurs in individuals with some emotional disorder,
who suffer no nausea or pain during the episode. The explanations of why and
how this occurs offer little help, but some psychiatrists believe it expresses
and unconscious wish to attack or reject a threatening person or object. If
this is the situation here, the individual might benefit from medical and
psychiatric help.
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical

What's a "Psychotropic Drug"?

QUESTION: What's a "psychotropic drug"? Are they dangerous to take? Is it
all right for any kind of doctor to prescribe them or are psychiatrists the
only ones with the right to use them?
ANSWER: The answer to your first question can be found by analyzing the Greek
origins of the word. "Psyche" means "soul" or "mind", while the Greek word
"tropos" means "to turn" and when used in combination with another word can
mean" tending to change". So a psychotropic drug is one that changes our
minds, the way we think, and can correct alterations in thought brought about
by illness. There are many types of such medications, useful in a variety of
conditions, and having different chemical formulas and effects. Their
development have greatly altered the way psychiatric illnesses can be managed,
and their relative safety and effectiveness allow many patients to be treated
at home with consultations in the doctors' offices rather than periods of
hospitalization formerly considered necessary. All medications have unwanted
side effects and risks, but the proper choice of a medication used in a
specific situation can pay big dividends. Any properly licensed physician may
use any approved medication, but usually do so only when they are certain of
their knowledge of the proper use and effects of the medication. While
psychiatrists may use larger doses of stronger medications for the difficult
case, family physicians can an do successfully treat many psychological and
emotional disorders in their offices.

Progressive Muscle Relaxation

QUESTION: A friend of mine seems to have become a totally new person. He
used to be one of the most uptight people I knew. Now there's a new relaxed
way about him. He told me he does something called Progressive Muscle
Relaxation. Please tell me what this is.
ANSWER: Progressive muscle relaxation is a technique that aids in stress
reduction by working through each muscle group in the body to remove stress.
It is based on the concept of the mind-body connection--that relaxation of
the musculature produces mental relaxation. The technique involved is
actually quite simple, the effect quite successful. The best way to do
Progressive Muscle Relaxation is in a recliner with head and foot rests, but a
couch or a pad on the floor with a pillow under the head will serve well too.
The room should be quiet and peaceful, with no phones or other interruptions.
Soft background music can be used if you want. Clothing should be loose and
comfortable and no shoes should be worn.
You should begin by lying down and stretching comfortably. Arms and legs
should not be crossed. Breathe deeply, then begin by clenching each hand to a
tense state, and then release that tension. Concentrate on the difference
between the tense and relaxed muscles. Proceed to tense and relax each part
of the arms--the forearms, biceps, triceps, neck, shoulder, upper back. Then
go on to the facial area. Wrinkle up your forehead, then release the tension.
Tense up your eyebrows, then release. Proceed to the jaws, lips, tongue,
throat area, and neck. Now do the same tensing and relaxing procedure going
down slowly through your entire body.
Take time several times a week to practice this relaxing technique, and
perhaps you too will feel like a new person.

Panic Disorder, Treatment, and Therapy

QUESTION: For the longest time we thought my wife had some undiagnosable
heart problem. Every time she went into a stressful situation her heart
started pounding, she experienced chest pains, became off balance, sometimes
started choking and was out of breath. Then a doctor told us it wasn't her
heart at all, but something called "panic disorder." That was a relief, but
we don't know what to do about this disorder. Is it treatable? Please tell
me about it. Right now my wife is just avoiding all stressful situations.
ANSWER: Panic disorder is a very treatable problem that may occur as
frequently as in 3% of American women and 1% of American men. The symptoms of
the disorder include all of the ones you mentioned that your wife experiences,
plus many more.
"Panic" patients may go through times of excessive sweating, a sensation
of rubbery legs, nausea, stomach problems, hot flashes and cold chills,
tingling or numbness, a strange, unreal or foggy feeling, trembling, diarrhea,
feeling tired and weak, difficulty sleeping, rapid mood swings, or the
recurrent feeling that they are dying or something terrible is about to
happen. People who fall victim to panic disorder often suffer from many
phobias. They'll naturally try to avoid the situations that bring on the
panic attacks, and therefore create a list of things they absolutely cannot
Treatment should be given by a doctor or psychiatrist who is experienced
in dealing with panic patients.
To begin with, the patient should understand that the condition is a
malfunction of certain central nervous system receptors. The patient is not
crazy--but merely experiencing panic responses at inappropriate times.
The treatment begins with medications which can bring the attacks under
control--that is, by bringing the autonomic nervous system under control. The
patient must know that having this problem is not life-threatening and that
she will not die during an attack.
Once the medication kicks in, the panic attacks will subside. Then it's
time to begin behavioral therapy.
The doctor may ask you to help your wife in the behavioral therapy. She
must be gradually reintroduced to the situations she has been avoiding because
of her attacks. You can provide her with the emotional support she needs and
gently press her to continue to face the difficult situation.
For example, some panic patients have developed phobias about using
elevators. Your assistance could be enlisted to help. You might take your
wife to an elevator bank, and just stand there with her, watching people
getting in and out. When she no longer experiences any symptoms while
standing there, it may be time to get in the elevator, but keep the doors
open. If she can stand in the elevator for a few minutes without becoming
phobic, she may be ready to try a one or two flight elevator ride. If the
panic symptoms occur while she is taking the short ride, go back to the step
before of just standing in the open elevator.
With such behavioral therapy for this and other phobias, your wife should
be able to overcome her anxieties and eventually resume a normal life.


QUESTION: My wife flirts with other men. Is there anything I can do about
ANSWER: Of course there is, and a lot of your actions may be dictated by
common sense and your concern for her. First, maybe you'd better think about
why she is flirting with other men. Flirting, or any other behavior that
upsets you, may be her way of telling you that something is bothering her.
Some spouses flirt with other people in an effort to gain more attention from
their own spouse. Sometimes the flirting is not done consciously, and
sometimes the flirting is an indication of a need for attention that is so
great that no amount is ever enough.
In a healthy marriage between two mature adults, the problem of a
flirting spouse is usually best confronted with some honest communication.
Have you discussed the problem with your wife? Is she aware that her behavior
is upsetting you? If she is unaware that her flirting is a problem, the first
step is to talk about it. Ask her if she is flirting because something is
troubling her. Be willing to talk about her feelings as well as your own. If
the flirting continues despite such communication, or if you cannot talk about
the problem, seek the assistance of a qualified marriage counselor. If you
don't know of a qualified counselor, ask your family doctor to recommend one

Anxiety Treatment and Drug Cautions

QUESTION: With all the news cautioning against the use of drugs, is there any
way you can still treat anxiety?
ANSWER: Anxiety is one of the most common psychological symptoms dealt with
in clinical practice, and for this reason, alternate forms of treatment should
be explored before drug therapy is used. In cases of mild anxiety, many
patients respond to meditation or exercise which can relieve some of the
edginess they experience. Relaxation techniques can also be quite helpful for
patients who wish to learn them. Anxious patients who suffer from insomnia
can frequently find relief by trying to establish a regular sleeping pattern
and by engaging in exercise early in the day.
It is important to bear in mind, however, that anxiety can vary a great
deal in intensity and treatment decisions must be based on the degree of
stress and disability suffered by the patient. In light of recent research,
it is now believed that anxiety can sometimes be a biologically determined
disorder. Therefore, physicians feel less guilty than they did in the past
about using drugs for its treatment. During the past year, a new drug called
buspirone has been introduced for anxiety treatment, and it offers some
promising advantages over previously prescribed drugs. To begin with, it is
nonsedating and therefore does not interfere with the patient's ability to
maintain normal functions. Use of the drug also poses a very low potential
for dependence or abuse. There is no cross-tolerance or cross-dependence with
alcohol, so it is unlikely to be abused by alcoholic or drug-dependent people,
and even with prolonged use, no withdrawal reactions occur. Therefore, as a
drug option, buspirone seems to be a good choice.
Like all drugs, however, busiprone does have a few minor disadvantages.
The drug has a delayed onset of action, taking two to three weeks before it
become effective. For this reason, it should not be used for patients needing
immediate relief for acute anxiety. In addition, since some patients desire a
sedative effect to help them sleep, buspirone's nonsedative formula seems
lacking. In such cases, benzodiazepines are usually prescribed. They have
been the antianxiety drugs of choice for the past 25 years and are still
considered quite effective.
In any case, when drug therapy is in order, it should always be used with
discretion. It is best to start with the lowest dose possible and increase as
needed. Once symptoms have been relieved to a tolerable degree, the drug
should then be discontinued. As your question implies, nondrug management of
any disorder is usually preferable. It is therefore our hope that as we
continue to gain insight into the mechanisms that produce anxiety, we will
eventually discover new and effective treatments.

What is Agoraphobia?

QUESTION: What is agoraphobia? Can it be successfully treated?
ANSWER: A person with agoraphobia suffers from undue anxiety that interferes
with the usual activities of daily living. It is more common in women than
men. The most frequent description of the person with agoraphobia is that she
is most afraid of fear itself. The symptoms of fear are especially upsetting
to the agoraphobic.
Some experts estimate that between 3 and 6 percent of Americans suffer
from this problem, and 75 percent of agoraphobics are women. Most of the
time, agoraphobia first shows symptoms in late adolescence or early adulthood.
A common symptom is panic attacks, during which the agoraphobic becomes very
agitated, feeling quite certain that she is going to die. In the panic
attack, the symptoms of fear are magnified, and the patient feels her heart
race, her breathing increase, and her body feel out of control. The panic
attack is often the problem that first brings the patient to the attention of
the physician.
Physical complaints are a common problem to agoraphobics for several
reasons. Sometimes, they focus their anxiety on their bodies. They know the
symptoms of fear are very real, and they may see a physician because of the
symptoms of increased heart rate and hyperventilation. Another reason for
many physical complaints may be because they find it easier to see a physician
for a physical problem than for an emotional one. The astute physician may
hear the unvoiced problem--one of anxiety--and treat it instead of the
perceived physical problem.
This is tricky for the physician, because the physical problems may or
may not be real, and the patient may not be able to recognize the emotional
component of her physical complaints. Unchecked anxiety can in fact cause
physical problems, and physical problems can cause anxiety. It is important
for the physician to sort through the sometimes confusing situation and
establish trust with the patient so that effective communication occurs. In
this way, the real root of the problems can be discovered and treated.
Sometimes an agoraphobic patient goes to many different physicians, and this
complicates diagnosis and treatment. If a doctor does not see the patient
regularly and for all complaints, the pattern of anxiety may not be
You ask whether there is a successful treatment for agoraphobia. Some
physicians prescribe medications alone, but this is rarely effective without
therapy. Antidepressant medications in combination with counseling that
involves a spouse or other family member is most effective. The most
important part of the therapy involves gently exposing the agoraphobic to
situations she finds frightening, and supporting her while she finds that the
situations hold no real danger for her. The best results are obtained when
spouses are included in the therapy, and even better results are achieved when
several agoraphobics from the same neighborhood or social group are treated

Is a High Carbohydrate, High Fiber Diet Good for Reducing Fat in the Blood?

QUESTION: I'm trying desperately to get my cholesterol down by dieting. Is a
high carbohydrate, high fiber diet good for reducing fat in the blood?
ANSWER: When it comes to diets, it seems that everyone has a different
opinion. Here's mine. A high fiber diet that is also high in carbohydrates
is an excellent way of lowering both blood lipid (fat) levels, including
cholesterol and triglycerides. High blood cholesterol readings are a risk
factor for heart disease, as are high triglyceride levels.
The traditional approach to lowering cholesterol levels is to lower the
amounts of cholesterol in the diet by cutting down or eliminating eggs, dairy
products, and red meats. The trouble with this diet is that, no matter how
closely it is followed, it usually only lowers blood cholesterol levels about
5% and has even less effect on triglyceride levels (another form of blood
fat). On the other hand, a diet low in red meats, dairy products, and eggs
that is also high in carbohydrates and fiber will lower cholesterol levels up
to 32% and lower triglycerides up to 24%.
Carbohydrates are foods like potatoes, breads, pastas, rice, and sugars.
Fiber is roughage and is either water soluble or water insoluble. Soluble
fiber is found in oats, fruit, barley, and dried beans. Insoluble fiber is
found in vegetables and wheat. Both types have a role in lowering blood lipid
levels, but soluble fiber such as oats may be more useful.
A good high carbohydrate, high fiber diet would consist of 55% to 60% of
a day's calorie intake coming from carbohydrates, 15% to 20% of calories
coming from protein, and 20% to 25% of calories coming from fat. If you need
advice about such a diet, talk to your physician. I'm sure you will obtain
another valuable opinion.

Treatment of Patients with Overactive Thyroid Glands

QUESTION: Could you discuss the treatment of patients with overactive thyroid
ANSWER: Your thyroid is a small gland in the neck that fits around the
esophagus and windpipe. It creates several hormones that are important in
regulating the body's metabolism. Underactivity or overactivity of the
thyroid means that the levels of these hormones are either too high or too low
and metabolism is thrown off.
Symptoms of hyperthyroidism, or thyroid overactivity, include sweating,
palpitations, insomnia, hyperactivity, tremor, and anxiety.
Hyperthyroidism is diagnosed with tests that evaluate the blood levels of
both hormones that the thyroid creates and hormones that control the thyroid.
Your physician may also run a 24-hour radioiodine uptake test, that finds out
how much iodine your thyroid is using.
There are several causes for an overactive thyroid. It is often
associated with Graves' disease or toxic diffuse goiter. Too little iodine in
the diet is another possible cause of hyperthyroidism, as is infections or
inflammations of the thyroid gland. In some cases, hyperthyroidism is treated
by treating the cause of the overactivity, rather than the gland itself.
Possible treatments for hyperthyroidism include antithyroid drugs,
radioactive iodine, and surgery. Antithyroid drugs halt or reduce thyroid
activity by interrupting a step in hormone synthesis in the gland. Because
the thyroid can store a large amount of already made hormone, it takes 6 to 8
weeks of drug therapy before blood hormone levels are reduced to normal.
After several months, some patients may go into remission and need no drugs
for a time, but relapses frequently occur. Some patients are given potassium
iodine supplements in addition to antithyroid drugs.
Radioactive iodine inhibits overactivity because the thyroid takes up the
iodine. This is a safe therapy for most patients, but cannot be used for
either children or pregnant women. After radioactive iodine therapy, the
patient usually has an underactive thyroid--hypothyroidism--and must take
iodine or thyroid supplements.
Surgical removal of the thyroid is rarely used now and only for patients
who cannot take antithyroid drugs or radioactive iodine. As with radioactive
iodine, hypothyroidism often occurs after surgery.
Hyperthyroidism symptoms can be treated with drugs called beta-blockers
that are more commonly used to treat heart conditions and hypertension

Does Alcohol Help the Heart?

QUESTION: Does alcohol help the heart?
ANSWER: A few years ago, researchers announced that drinking alcohol in
moderation might reduce one's risk of coronary heart disease. In two
studies--done in Hawaii and Boston--the medical records of several hundred men
were evaluated and the statistics showed that those who drank lightly or
moderately had a lower incidence of heart disease than those who didn't drink.
Other researchers postulated that, like exercise, alcohol raises the blood
levels of high density lipoprotein cholesterol, the so-called "good"
cholesterol that protects coronary arteries from the "bad" cholesterol.
There is also evidence that light drinking may reduce risk of stroke in
men. However, heavy drinking increases the risk of stroke fourfold.
There is still a lot of debate going on over this question. Edward
Eichner, M.D., of the University of Oklahoma Health Sciences Center, pointed
out that people who drink moderately also eat moderately, which reduces risk
of heart disease by itself. Moderate drinking simply goes along with other
moderate habits that reduce risk, rather than changing the risk by itself. He
also notes that drinking alcohol raises blood pressure, can lead to weight
gain, and reduces glucose tolerance, which all increase the risk of heart
No one has ever doubted that heavy drinking is bad for anyone's health.
Before anyone decides to lift an elbow using the motive of it being medically
advisable for his or her health's sake, more evidence that it really is good
is needed.

Spells or Seizures?

QUESTION: My 70-year-old father has begun having spells. It's pretty
frightening, as he never suffered with them before. We would feel better if
we knew more. What causes them?
ANSWER: "The child is father of the man," and we seem to be on a track toward
childhood physiologically in our life process. Spells or seizures occur as
frequently in the population over 60 as they do in infants under 1 year. Of
course, the causes are different. Seizures in the elderly population spring
from ailments of aging: an increased tendency toward stroke and other
vascular accidents; an inability to maintain normal bodily stability; brain
tumors; infections; and the increased dependency on medication coupled with a
greater sensitivity to drugs. First let's zero in on the exact type of
seizure your dad is experiencing. If they are very frequent, your father
might have epilepsy, if they involve a complete stoppage of blood supply to
the brain, they are called syncope in medicine. Barring these two
possibilities, the common spells of the elderly involve either a part of the
brain, partial seizures involve no loss of consciousness. Generalized
seizures can begin with a partial seizure that becomes generalized. As we
discussed earlier, the cause of the seizure must be discovered.
Cerebrovascular disease, brain tumor, infection may be the cause. A drug
reaction, alcohol or drug withdrawal may also be at fault. The causes can be
determined only through extensive testing, including EEG. If a cause can be
found in your father's case, then treatment is geared to that cause. If the
cause is discovered to be brain tumor or stroke, then the seizures will
reoccur and not only the cause must be treated, but also the seizures
themselves. A good anticonvulsant drug is usually recommended for stopping
the seizures, and usually the success rate is good. So your father should be
under the care of a physician, knowledgeable in geriatrics, who will treat
both the cause of the seizure and the seizure itself.

What is Otitis Media?

QUESTION: I know there can be many forms of infections to the ears. My
youngster was recently found to have a form called "Otitis Media". What is
otitis media and how did he get it?
ANSWER: Otitis media is any inflammation of the middle ear. Bacterial
infection of the upper respiratory tract is the most common cause of otitis
media, which is frequently associated with obstruction of the eustachian tube
(the canal between the middle ear and the area above the soft palate). The
eustachian tube is responsible for maintaining proper pressure in the middle
ear, and obstruction of the tube can result in negative middle ear pressure
and/or effusion (escape of fluid).
With the discovery that frequent reexposure to an allergen can cause
inflammation that leads to eustachian tube obstruction for extended periods of
time, allergic rhinitis has been implicated in otitis media as well. The role
of viruses is unclear because they are extremely difficult to culture.
The condition occurs most frequently in children aged one to four years.
The incidence decreases gradually through ages six and seven, and it drops
abruptly after age ten. However, it can occur at any age.
In cases where the otitis media is accompanied by fluid forming in the
middle ear, antihistamine-decongestant therapy may be effective, but results
of various studies about this yield differing results. Because bacteria are
found in most cases, antibiotics are the mainstay of therapy. In those
patients who don't respond readily to antihistamine-decongestant therapy or
antibiotics, other treatment options include corticosteroids, cromolyn, or the
insertion of a tympanostomy tube (a small tube inserted through the membrane
that separates the middle ear from the outer ear canal) to permit drainage of
the middle ear.


QUESTION: What can you tell me about neurofibromatosis?
ANSWER: Neurofibromatosis is a genetically-linked disorder involving tumor
formations around various nerves. The disease can have additional widespread
effects on many of the body's systems. Two distinct forms of the disease
exist. The first type, NF-1, affects about one in 4,000 people and is
characterized by tumors along peripheral nerves and cafe-au-lait spots, which
resemble large freckles, that can appear anywhere on the body. The second
type, NF-2, is ten times less common and involves additional tumors of the
nervous system, as well as a possible loss of hearing.
Other signs of the disease, occurring in both types, include small, soft,
purplish tumors, called cutaneous neurofibromas, which can appear anywhere on
the body. Plexiform neurofibromas, causing a thickening of a large nerve
trunk, develop in some patients as well. In serious cases, these can cause
overgrowth and deformity of nearby bones. Small growths on the iris, called
Lisch nodules, freckling in skin folds such as the groin, and severe learning
disabilities are other symptoms specific to NF-1. Thus, as anyone can see,
the disease in either form can be quite disfiguring.
Exact factors leading to neurofibromatosis are still unknown, but recent
research indicates that the gene for NF-1 is located on chromosome 17 and the
gene for NF-2 is located on chromosome 22. The specific genes responsible for
the disease remain undetermined. Since afflicted women sometimes show their
first signs of the disease during pregnancy, it is further believed that
hormonal stimulation may be responsible for the growth of the neurofibromas.
However, the specific hormones have not been identified.
As yet, there is no primary treatment for the disease, so management is
aimed at early detection of treatable symptoms. Afflicted people should
receive regular physical and neurological exams and special attention should
be given to monitoring significant changes in the size or number of
neurofibromas. With NF-2 patients, acoustic nerve function must be monitored
so attempts to preserve hearing can be made. In both cases, however, genetic
counseling is of vital importance since there is a 50% chance of transmitting
the disease to offspring.
Though much about the disease is still a puzzle, promising efforts are
being made to identify the gene or genes that carry the disease. Once they
are discovered, a means for treating the disease may not be far behind.

Huntington's Disease: its Symptoms and Effects

QUESTION: Can you tell me about Huntington's Disease? Where does it come
from, and what are its symptoms and effects?
ANSWER: It is sometimes called Huntington's Chorea or more precisely,
progressive hereditary chorea. It is an inherited disease, carried by a
single dominant gene, which means that if present in the genetic makeup of an
individual, it will always cause the disease. The tragedy of Huntington's is
that the disease doesn't begin to manifest itself until middle age (35-50
years old) when many sufferers have already married and had children. The
odds are that 1 out of 2 children will also have the disease which strikes men
and women equally. It begins in an insidious fashion, striking at the mind
and body. The patient's personality changes, as he/she becomes irrational or
apathetic, or a manic-depressive or schizophrenia-like illness may develop
before the beginning of the muscle problems. The patient cannot walk, may
have difficulty in swallowing, eventually cannot care for themselves as the
choreic (spastic, involuntary, irregular) movements of the muscles become
worse. The disease continues to the inevitable end, as there are no cures or
treatments, and medications can only partially reduce the symptoms. The
recent discovery of a genetic marker for Huntington's permits physicians to
offer considered counsel. Members of families in which the gene is present
are generally advised to avoid child bearing, but should seek genetic
counseling to aid them in the decision which they alone can make.

Amblyopia or the "Lazy Eye"

QUESTION: Our daughter came home with a note from the school nurse informing
us that she may be suffering from amblyopia, and suggested we take her to an
ophthalmologist. What can you tell us about this condition?
ANSWER: Amblyopia is the most common preventable form of vision loss, and is
marked by reduced vision in one eye without an apparent physical condition as
its cause. Often, the brain is unable to combine the information it is
receiving from both eyes, and simply disregards one of the two visual signals,
leading to the condition known as "lazy eye." Amblyopia is diagnosed in
children through standard eye tests, and in infants by alternately covering
each of the eyes; if the infant is upset when one eye is covered but not the
other, there is a strong likelihood of vision loss in the uncovered eye.
Treated early with corrective lenses or vision therapy, the "lazy eye" can
learn to be equally effective, and prevent a lifetime of impaired sight.
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical

What is New Concerning Alzheimer's Disease?

QUESTION: You could do many people a great service by dedicating a column to
a problem that many of your readers must deal with. Please tell us what is
new concerning Alzheimer's Disease.
ANSWER: There is some good news to report. Progress has been made in
diagnosing and managing patients suffering from Alzheimer's disease.
As you may know, Alzheimer's disease is a condition of unknown cause
where the brain cells die prematurely and progressively. That produces memory
loss and generalized intellectual deterioration. The course of the disease is
highly variable, anywhere from two to twenty years from the time it begins
until the patient dies.
Nearly 10 percent of persons over age 65 have Alzheimer's disease and
another 10 percent of persons in that age group are caregivers to loved ones
with the disease.
Areas of progress against the ravages of Alzheimer's disease include
advances in diagnosis, communicating it to the patient and family, and helping
them manage the diseased patient following diagnosis.
The condition is diagnosed much more frequently today than previously for
two reasons. One, as life expectancy improves, many more people are reaching
advanced old age and are facing increased probabilities of suffering
Alzheimer's disease. Two, doctors have more techniques for making the
diagnosis and are now aware that 50-65 percent of all cases of dementia are
due to Alzheimer's.
We have learned also that communicating the condition to the patient and
family needs to be tailored to the individual's condition. Most patients may
be told that they have a memory problem, will need to rely on others to assist
them, will need continuing medical care, and that research is progressing on
some solutions to the problem. Family members, in private, usually are told
exactly what to expect as the disease worsens. Because the news can be so
upsetting, the family may need two or more visits with the physician to fully
comprehend what is happening.
Managing Alzheimer's disease is where the most progress has been made
recently. Many resources now are available to patients and caregivers.
The number of services are great. For patients they include: ongoing
medical care--treating various symptoms, such as anxiety, depression,
agitation, etc.; or families--continuing communication with the physician,
peer support and counseling groups, community day-care services, in-home or
institutional respire care services, legal and financial assistance and
While research advances are being made on possible new medical
treatments, unfortunately none are yet available that arrest or cure
Alzheimer's disease. We still do not know what causes the disease or how we
might prevent it but scientists are working intensely on it.

Effect of Aluminum Kitchenware on Alzheimer's Disease

QUESTION: I write to inquire concerning the possible detrimental effect of
aluminum kitchenware on Alzheimer's disease. Is this true, and if so, is the
use of aluminum foil hazardous to one's health?
ANSWER: The cause of Alzheimer's disease remains unknown to date. However
there are at least four theories which have some merit, one of which concerns
aluminum. The link between the disease and the metal comes from two recent
findings. In one, it was found that animal brains developed similar, but not
identical, structures to those found in humans suffering from Alzheimer's
after injections of aluminum into the brain. It has also been found that the
aluminum content in brains of Alzheimer patients is higher, although other
reports indicate this element increases in all brains as they age.
The source of this aluminum is thought to be from natural sources, where
aluminum is part of a chemical compound, rather than directly from simple
metallic (elemental) aluminum, as in pots or foil. Whatever the source,
however, according to the best current thinking, the importance of aluminum as
a cause of Alzheimer's remains uncertain, with more study necessary to clear
up this connection, if any.

Post-Traumatic Stress Disorder

QUESTION: I didn't go to Vietnam, but a group of my old buddies did. Well,
it's nearly 20 years since they got out, but they still seem to be messed up
and stressed out because of it. Several of them are still into drugs, while
others are alcoholics. Some of them seem to be in trouble with the law all
the time, and can't hold jobs. I've been told this is typical. Is it, and
what can be done to help?
ANSWER: It sounds to me like some of your friends are suffering from
post-traumatic stress disorder. The disorder is seen in some veterans of all
wars, but seems to be most common in Vietnam Vets. Those who suffer from this
problem experienced an unusual, life-threatening experience that evoked
extreme distress. Since life-threatening experiences were a regular way of
life for combat vets in Nam, this disorder is associated with abnormal
autonomic nervous system conditioning, high unemployment, marital problems,
alcoholism, drug abuse and the inability to adjust after war-induced trauma.
Doctors who've studied vets with post-traumatic stress disorder say the
victims report recurrent dreams of combat, sweaty palms, jumpiness,
irritability with children, family problems, fatigue, palpitations, started
responses and difficulty in holding jobs. Studies in which combat vets and
university students were subjected to combat sounds and light flashes, showed
distinctly different responses in the nervous system. The vets reacted to the
combat sights and sounds with increased pulse and respiratory rates. In
another similar study, the combat vets reacted with intense feelings of fear,
rage, sadness and guilt. Noncombat veterans did not react with intense
Some of the reasons Vietnam veterans suffer from this problem more often
than other vets include the continuous stress of guerilla warfare, atrocities,
terrorism, language barriers, the limited and vague military objectives of the
war in Vietnam, and the failure to debrief troops returning to the U.S.
A national survey of more than 1,300 Vietnam Vets showed combat
experienced soldiers had a 23% post-combat arrest rate and 12% conviction
rate--much higher than for noncombat soldiers. Treatment of post-traumatic
stress disorder involves a combination of psychotherapy and pharmacotherapy
(drug therapy). Readjustment depends on integrating the vets' pre-Vietnam and
post-Vietnam experiences.
Some veterans are getting disability benefits that would end if they
recover. Some drugs appear to be promising in treating this disorder, helping
the patients to feel more relaxed, and less angry. The psychotherapy must
also take into account severe feelings of guilt that many combat vets suffer.
Many are haunted with thoughts that they might have killed innocent people.
There's also something called survivor guilt--feeling guilty that they
survived the war, while their friends in the battlefields were killed.
We are learning now that all of the statistics of the costs of war are
not easily added up into neat columns that provide mere dollar amounts and
casualty numbers. The pain and human suffering continues long after the
battles have ceased and affect civilian and combatant alike.

What is Organic Dust Toxic Syndrome?

QUESTION: I thought I had a bad case of the flu. Instead the doc diagnosed
my case with a rather frightening name, that I still don't understand. What
is organic dust toxic syndrome?
ANSWER: It is a nonallergic, noninfectious respiratory illness caused by
the inhalation of organic dust or exposure to agricultural products such as
hay or spores from moldy silage in a confined area. The disease,
scientifically termed pulmonary mycotoxicosis, is also known as silo-loader's
syndrome since its periodic outbreaks usually occur amongst farmers when they
remove cured feed from silos.
Symptoms of the illness include muscle aches and a pronounced cough,
accompanied by shakes, chills, fever, headaches, shortness of breath,
sweating, chest pain and anorexia. The duration of the illness can last
anywhere from a couple of hours to an entire week depending on the length of
exposure and how adequately or inadequately the area is ventilated. There has
been no evidence of an allergic or viral cause of the illness and there is
rarely, if ever, a need for an afflicted person to require hospitalization.
I'm sure that if you go back over your history, you will discover why
this diagnosis was made, and will now provide you with important clues to
prevent its reoccurrence.

What is Emphysema?

QUESTION: I keep reading the term, but have absolutely no idea what it refers
to. Perhaps you can help. What is emphysema? How is it treated?
ANSWER: Emphysema is a lung condition that is marked by shortness of breath.
It is diagnosed when the small air sacs that make up our lungs have become
weakened and lose their elasticity. Normally, these sacs, called alveoli,
expand with each breath and then return to their normal small size between
breaths. In emphysema, each sac is stretched out like an old balloon and do
not return to a small size. In addition to being stretched out, the weakened
alveoli don't exchange carbon dioxide for oxygen as they should.
Because the alveoli are not working properly, the respiratory muscles of
the chest must work harder. This leads to a barrel-chested appearance in many
emphysema sufferers. They also lose weight and tire very easily.
Emphysema has a biochemical cause that is created or worsened by
environmental factors. Normally, chemicals called proteases fight off
bacteria and viruses in the lung and are regulated by another chemical called
alpha-1-antitrypsin. In emphysema, alpha-1-antitrypsin is inactivated or
missing and the proteases go wild and start to attack healthy lung tissue.
Smoking inactivates alpha-1-antitrypsin, which is why smoking is the leading
cause of emphysema. Some cases of emphysema are related to genetic
biochemical defects, however.
There is no treatment for emphysema nor is there any way to reverse the
damage once it has begun. However, stopping smoking will prevent lung damage
from progressing.

What Can Be Done for Emphysema?

QUESTION: I've been told I have a moderate case of emphysema. What can be
done for me?
ANSWER: Emphysema is one disease that leads to chronic obstructive pulmonary
disease, or COPD. It is caused by a loss of elasticity in the air tubes and
air sacs that make up the lungs. This lack of elasticity means that the lungs
become permanently distended and cannot force air out with each breath to
allow new air in. The lungs have become like stretched-out rubber balloons.
The main symptoms of emphysema is breathlessness, especially on exertion.
Most cases of emphysema are caused by smoking or exacerbated by it.
Like many diseases, emphysema can be severe, or, as in your case,
moderate or mild. Unfortunately, emphysema is irreversible; the best that can
be done is to try to keep it from progressing. The first step is, if you
smoke, stop immediately. Your physician can recommend smoking cessation
programs for you.
Because of your condition, you should also try to avoid catching colds or
respiratory diseases. You're a prime candidate for an anti-influenza vaccine
Emphysema can be treated with drugs called bronchodilators, which as
their name implies dilate the bronchial tubes to allow easier breathing. Some
of these drugs can be inhaled from metered dose "puffers," while others are
taken as oral medications. Many patients with emphysema take oral
theophylline in addition to an inhaled bronchodilator.

Home-Based Cardiac Rehabilitation Programs

QUESTION: I had a heart attack recently. Thanks to a lot of good care, I
pulled through nicely. I am now determined to keep things in working order
and want to join a cardiac rehabilitation program. Is a home-based
rehabilitation program as good as going to the hospital every day for
ANSWER: It can be, but a lot depends on your condition and how well you stick
with the program. Cardiac rehabilitation programs have grown in popularity in
the last few years because we have learned they can help people recuperate
from a heart attack and avoid future ones. Many hospitals and health centers
have set up cardiac rehabilitation centers where patients come for physical
therapy, exercise, and education.
But for various reasons, only 15% of eligible cardiac patients use these
hospital-based programs. A home-based program, where you diet and exercise at
home, is more convenient and cheaper. And by involving the whole family, it
can reduce their risk of heart attack as well.
The drawback to a home-based program is that you're on your own for a
great deal. Although your physician and other health professionals will give
you instructions about exercise, diet, and monitoring your heart, they will
not be able to follow you as closely as with a hospital-based program.
Another drawback is that you won't have the camaraderie that other heart
patients in rehabilitation can provide. The combination of reduced follow-up
and camaraderie can mean poor compliance for some home-based patients.
Your physician will help you decide whether a home-based program is right
for you. Some people need the supervision that a hospital-based system
provides to obtain all of the benefits that these important programs offer.

What is Raynaud's Phenomenon?

QUESTION: My sister has a strange problem in which her fingers sometimes turn
blue. She says its called Raynaud's Phenomenon. She's gone to a doctor, who
has prescribed medication, but she doesn't seem to do anything else to help
stop these weird attacks. I know her doctor told her that to a large extent
she can help herself prevent some of the attacks. What can I encourage her to
do and not to do? Could you please explain what Raynaud's Phenomenon is?
ANSWER: Raynaud's Phenomenon is usually brought on by exposure to cold or
emotional stress. The typical patient is female, between the ages of 15 and
50 years old. An attack usually begins with one finger becoming very cold and
sensitive. It may progress to the entire hand and even the other hand. At
first the involved fingers may turn red, then blue. This results from an
abnormal narrowing of the arteries and arterioles in the fingers. As a
response to the cold stimulus, they are undergoing "vasospasm ", contracting
in a manner which diminishes the normal blood flow to the tissue.
Raynaud's Disease may be differentiated from secondary Raynaud Phenomenon
by affecting both sides of the body, being symptomatic for two years without
becoming worse, and showing no evidences of underlying causes.
Raynaud Phenomenon is often associated with other problems, so it is
imperative that the patient get a thorough examination. Smoking may
contribute to the symptoms, as may certain drugs or chemicals to which the
patient has been exposed.
Diseases such as arthritis, systemic lupus erythematosus or scleroderma
may be associated with this problem. In fact, any problem that affects the
body's connective tissues, blood vessels, skin, tendons, joints and other
tissue may lead to a greater incidence of Raynaud's Phenomenon.
In addition to medication, there are a lot of precautions your sister can
take to limit her Raynaud's attacks. If she is a smoker, she must quit.
Smoking is a contributing factor in this problem because it tends to narrow
blood vessels. In her case, she is already suffering from an abnormal and
exaggerated response to stimulation which narrows blood vessels, and to
continue the habit is to ask for the problems and complications that far
outweigh any possible satisfaction gained from smoking.
Raynaud's patients should avoid drugs that cause blood vessels to narrow.
Included on this list are birth control pills, some heart, blood, and migraine
headache drugs. Above all, Raynaud's patients should keep warm. Extra
precautions include keeping all rooms in their homes warm at all times, using
electric or thermal blankets or a heated water bed.
Whenever removing food from a freezer, use potholders or hand mitts.
Wash dishes and vegetables in tepid or warm water. Wear gloves or mittens
even on short trips out of doors, such as going to the mailbox. The best way
to always remember the gloves is to have an extra pair near the door.
When going out in cold weather, wear layered clothing. In addition to
keeping the hands covered, make sure the wrists are covered and kept warm.
And when taking walks, stay on the sunny side of the street.

Leg Pains From Diabetes

QUESTION: My doctor says leg pains come from my diabetes. What's he talking
about? What should I do?
ANSWER: This is an important issue, for peripheral arterial disease is a
frequent problem amongst diabetics and a major health problem in the United
States. It is caused by diminishing blood flow to the legs and feet due to
the narrowing or constriction of an artery in the lower abdomen or legs. In
the diabetic patient, where circulation in secondary or smaller blood vessels
is particularly poor, vessel complication can become quite serious. The
arteries of diabetics frequently contain high levels of calcium which cause
the arteries to harden, carrying less blood to the muscles. Since blood is
the key supplier of nutrients and oxygen to our vessels, these conditions are
responsible for the pain felt in the lower extremities.
The most severe symptom of arterial disease is intermittent claudication,
a condition that brings on pain in the muscle after brief exercise, which
disappears after a few moments' rest. Fortunately, 60 to 90 percent of
patients can be managed medically. Initial treatment should involve an active
walking program for at least 30 to 60 minutes a day, or until painful symptoms
occur. Walking develops and increases circulation and can significantly
increase a patient's mobility.
Smoking greatly increases risk factors, and diabetics are urged not to
use tobacco in any form. If they are overweight, diet and exercise are
encouraged. Normalizing blood sugar levels are vital to diabetic management,
as well, especially since research confirms that blood sugar control can
prevent or delay vascular complications.
Exposure to extreme heat or cold should also be avoided. Thus, hot foot
or leg soaks, heating pads, and hot water bottles should never be used for
relief. Loose-fitting clothes and comfortable shoes are advised, since
circulation can be affected by anything constricting the body.
Vasodilating drugs are unsuccessful in treating peripheral arterial
disease since they lower systemic pressure and decrease circulation.
Propranolol and other beta-blockers have the same effect, so if you take any
medications of this kind, they may have to be discontinued so improvement can
be measured. Fortunately, there is a new drug called pentoxifylline which has
been successful in alleviating intermittent claudication. It works by making
red blood cells more flexible and allows them to pass through smaller vessels,
thus bringing oxygen and nutrients to areas suffering from arterial blockage.
Its important to check with your doctor about these prescription medications.
Plenty of bed rest is advised and it may be a good idea to raise the head
of your bed in an effort to increase circulation to your lower body. If your
feet swell for any reason, they should be elevated as well. It is also
advisable to avoid activities such as carrying heavy items which strain the
Your doctor certainly seems to be on the right track, and it is important
that you continue your care. You can help him and yourself by providing him
with valuable information about your condition. Note what you feel and keep a
record that you can bring along when you talk to your doctor. He will be
better able to advise you and obtain any special tests that may become

New Ways to Take Nitroglycerin

QUESTION: Can you tell me about the new ways to take nitroglycerin?
ANSWER: Nitroglycerin is the drug most often given for angina, which is chest
pain and pressure caused by coronary artery disease. In coronary artery
disease, arteries that supply the heart with blood are blocked by plaques
(also known as "atheroma") which are composed of fatty materials like
cholesterol. The blocked heart arteries can't carry as much blood as the
heart muscle needs, and the result is angina. Nitroglycerin temporarily
widens those blocked arteries, allowing more blood to flow to the heart
You are probably most familiar with the tiny "nitro" pill that is placed
under the tongue and allowed to dissolve there. This immediate-acting
nitroglycerin is also available in a spray that can be sprayed under the
tongue, or it can be injected straight into a vein. Any of these forms of
nitroglycerin are short-acting, effective for only about 15-20 minutes.
Intermediate-acting nitroglycerin lasts for a few hours and is used to
prevent angina instead of to treat it. This pill or capsule is either
swallowed or placed in the mouth between the cheek and jaw. It begins to work
within about half an hour.
Longer-acting nitroglycerin is prepared as an ointment that is absorbed
through the skin. It is supplied in a tube like toothpaste and is squirted
onto a piece of paper that is printed with a ruler. The exact prescribed
amount of ointment is applied to the ruler paper, then the paper is used to
spread the ointment on an area of skin that is about six inches long by at
least three inches wide. Most people apply it to the chest, but it can be
applied to any nonhairy part of the upper body. Do not apply the ointment to
your legs or feet, because many people with heart disease have decreased
circulation there. If the circulation is poor, the nitroglycerin won't be
absorbed properly.
Another way to use nitroglycerin is in the form of a patch that is
already prepared, requiring no ointment or preparation by the user. Many
people prefer these "transdermal patches" because they are convenient. These
patches are available in several doses, and should be used as packaged, and
not cut in half.

Help for Easy Bruising

QUESTION: I have a problem that I can't get a satisfactory answer for from
any of the doctors I've seen. It's that I bruise so very easily, even when I
haven't knocked myself or fallen. Except for being advised not to take
aspirin, I have gotten no help. Can you help me?
ANSWER: I'm not sure that my answer will please you any more than the other
doctors, but I will be happy to tell you what I know about your situation.
You are probably a sufferer from Purpura Simplex, the most common vascular
bleeding disorder. It represents a situation where the vessels which carry
the blood are more fragile than normal and break or rupture easily. Most
often we find this condition in women, who like you complain of bruises on
the thighs, buttocks and upper arms, that seemingly have no cause. Sometimes
the history may reveal that another member of the family has suffered from the
same problem, but laboratory tests of the blood fail to show anything abnormal
in the mechanisms that control clotting and coagulation. There are no
medications effective in controlling the condition, and because we know that
aspirin and aspirin containing medications can reduce the way blood clots,
many doctors advise avoiding this chemical, even in the absence of any real
evidence that the bruising is caused by aspirin. The good news is that it is
not at all a serious condition, and aside from producing some unsightly
bruises, will not effect your general health in any way.

What is TMJ?

QUESTION: What is TMJ? Would you please discuss it and its treatment?
ANSWER: "TMJ" stands for "temporomandibular joint" and usually refers to
problems with that joint. The joint is the one that allows your jaw to open,
shut and slide your chin forward. It's a joint that takes a lot of stress,
even under the best of conditions. Its proper alignment and function depends
on many factors, including your teeth, the muscles of your face and mouth, and
your ways of coping with stress.
The range of problems with TMJ is broad, but any disruption of its
function usually results in a misalignment of the teeth and jaw and gradual
deterioration of the joint.
The causes of TMJ problems are varied; I'll discuss a few of them. Mouth
or jaw injuries, such as those occurring in auto accidents or sports injuries
often start the TMJ problems. The jaw becomes misaligned due to the injury,
and the joint wears unevenly due to the misalignment. The TMJ problems may
develop slowly, over a period of years after the injury. Personal habits such
as chewing pencils or ice, grinding teeth, or clenching the jaw from tension
can also create a TMJ problem.
What are the symptoms of TMJ? Face or jaw pain, noises such as a
clicking when the jaw is opened, or difficulty in opening the jaw are all
symptoms. Some people report that the jaw pain travels to the head, neck,
ears, shoulders and arms. TMJ should be suspected in anyone who suffers from
frequent headaches that have no known cause. The symptoms worsen over the
years unless the problem is treated.
Accurate diagnosis of TMJ is important before treatment can be begun.
Specialized x-rays, especially a process called video arthrography, are part
of the diagnostic workup. Determining exactly how the different parts of the
temporomandibular joint function in relation to one another is crucial to
treating the problem with success.
The problem may not be in the joint itself; it may be located in the
powerful muscles of the jaw. If this is the case, muscle relaxation is the
goal. This may be accomplished by learning to control stress, using physical
therapy to exercise the jaw muscles, or using local anesthetic pain control.
Sometimes, muscle relaxants are prescribed to help the jaw muscles relax and
heal. In some cases, a special mouthpiece is designed to realign the mouth
and ease the pressure on the jaw joint.
If the problem is severe and does not respond to less permanent
treatment, the alignment of the jaw and mouth must be altered. This can be
accomplished in a variety of ways, but should only be undertaken when other
methods fail, because the treatment is permanent and cannot be reversed.
Changing the alignment of the teeth and jaw should only be attempted by
someone who is well-experienced in successful treatment of TMJ. Sometimes the
alignment of teeth is altered by grinding the surfaces so that the upper and
lower teeth meet more harmoniously. In more severe cases, surgery is
performed to repair the temporomandibular joint. If the jaw joint is found to
be deteriorated beyond repair, an artificial joint can be used to replace it.
In some parts of the country, arthroscopes are being utilized to diagnose
and treat some forms of TMJ disorder. This shows great promise, because the
physician can see directly into the joint with only a minimal incision, and he
can treat the problem without extensive surgery.

Alcohol and Pancreatitis

QUESTION: I have had several flare-ups of pancreatitis and my doctor is now
insisting I totally abstain from alcohol. Is this really necessary? This
will be very difficult for me as my buddies always go out for a couple of
beers after work. What do you think?
ANSWER: Alcohol abuse is considered a contributing factor that may cause some
people to develop acute pancreatitis. The pancreas is responsible for
producing powerful digestive enzymes, plus the hormones insulin and glucagon,
which help the body metabolize sugar. When you have pancreatitis, the
digestive enzymes attack pancreatic tissues and the pancreas becomes inflamed.
Researchers don't understand fully why this happens. In severe cases, the
inflammation is accompanied by bleeding in the pancreas, cysts, or abscesses,
and tissue degeneration in the pancreas.
Alcoholism has been noted as the most common cause of chronic relapsing
Chronic pancreatitis can lead to poor digestion because the pancreas is
not secreting the necessary amounts of the enzymes needed to break down food.
This can inhibit the body's ability to absorb nutrients.
Doctors have found that patients with alcohol related pancreatitis can
prevent the painful attacks by totally abstaining from alcohol. Patients who
give up drinking (alcohol) totally often have improved absorption of nutrients
and malnutrition may improve. It would certainly be very wise for you to take
your doctor's advice. You then have a shot at getting this very serious
disease under control.