A positron emission tomography (PET) scan is a specific type of imaging test that can help your doctor see how your tissues and organs are functioning.

Unlike other scanning techniques, a PET scan isn't designed to show structural detail of organs. Instead, it shows images containing more or less intense color to provide information about chemical activity within certain organs and tissues. This chemical activity may indicate areas of disease not detected by other scanning methods. In certain conditions, this may cause your doctor to alter treatment plans.

PET scanning is useful in evaluating a variety of conditions — including neurological disease, heart disease, infections, certain inflammatory diseases and cancer.

What is a PET scan for?

A PET scan is an effective way for your doctor to examine the chemical activity in certain parts of your body, which may help detect abnormalities in those areas. In particular, a PET scan may be used to detect or monitor:

Cancer. PET scans may be useful in determining the extent of spread of certain cancers, assessing how the cancer responds to treatment, and determining if the cancer has recurred. Cancers may use more energy than surrounding tissues and therefore appear brighter on the PET scan. PET scanning may also be valuable in assessing how certain cancers respond to chemotherapy.

PET scans need to be interpreted carefully because noncancerous conditions can resemble cancer, and many types of cancer do not appear on PET scans. A PET scan can only suggest the presence of cancer; a biopsy is needed to confirm the presence of cancer.

Heart problems. Doctors use PET scanning to detect areas of decreased blood flow in the heart. A PET scan may reveal early coronary artery disease and damaged or dead heart muscle due to a heart attack. It can also differentiate nonfunctioning dead heart muscle from poorly functioning heart muscle that would benefit from a procedure, such as heart surgery, angioplasty or coronary artery bypass surgery, to increase blood flow to heart muscle. A PET scan can be particularly important in people who've previously had heart attacks.

Alzheimer's disease. A PET scan can detect mild physiological changes in the brain even when no signs or symptoms of Alzheimer's disease are evident and before severe damage to brain cells and memory loss occur. PET scanning can also provide visual images of activity in the brain when a person is asked to read, talk or listen to music. Such uses of a PET scan may help scientists to better understand the progression of Alzheimer's disease in different areas of the brain. PET scanning can also be a valuable tool in differentiating Alzheimer's disease from other types of dementia disorders, such as frontal temporal dementia and Huntington's disease.

Doctors and scientists are also combining PET scans with magnetic resonance imaging (MRI) to create 3-D images of the brain, making it possible to measure the rate at which various regions of the brain use, deposit and metabolize certain chemicals.

Other brain disorders. A PET scan can help locate the origin of abnormal brain activity associated with seizures due to epilepsy and assess brain function after a stroke. In the future, doctors may also use a PET scan to detect memory disorders and certain mental health disorders, such as schizophrenia and depression. Such uses are currently being investigated.
How do you prepare for a PET scan?

A PET scan is usually done on an outpatient basis. Your doctor will give you detailed instructions on how to prepare for your scan. Before undergoing the scan, be sure to tell your doctor about any prescription and over-the-counter medications you're taking, as well as any vitamins and herbal supplements. If you're taking certain medications or have certain diseases, such as diabetes, you'll receive specific instructions before your scan.

A general rule is to not eat anything for a minimum of four hours before the scan. If you'll be having your heart scanned, don't use caffeine for at least 24 hours before your test. Be sure to wear comfortable clothes to your appointment. You may be asked to change into a hospital gown for the test. If an area of your body near your bladder needs to be examined, a soft tube (catheter) may be inserted into your urethra to keep urine drained from your bladder during the scan.

If you're pregnant or think you might be pregnant, tell your doctor before undergoing a PET scan. The radioactive substance used during this procedure may expose the fetus to radiation. If you're breast-feeding your baby, tell your doctor. An infant can be exposed to radiation through your breast milk.

How is a PET scan done?
A PET scan measures vital functions such as blood flow, oxygen use and blood sugar (glucose) metabolism. This can help doctors distinguish abnormal from normal functioning organs and tissues.

A PET scan is a special form of nuclear (radionuclide) scanning. These scans commonly use a form of blood sugar (glucose) that all cells in your body use for an energy source. The glucose is combined with a radioactive substance (radiotracer) that's generally injected into your bloodstream and allows the PET scanner to image which areas of your body are using more glucose.

Different tissues in your body take up different radionuclides, and therefore the radioactive substance used during a PET scan depends on the organ your doctor wants to investigate. The radioactive substance gives off tiny amounts of energy (radiation) in the form of positrons. These positrons are detected by a device called a PET scanner or gamma camera. The number of positrons emitted by an organ or area of tissue indicates how much of the radioactive substance the organ or tissue has taken up and, therefore, how chemically active it is. Areas that take up more glucose are more metabolically active and appear brighter on a PET scan. Areas that don't use much energy or that are damaged don't take up as much glucose and therefore aren't as bright on a PET scan.

Information from a PET scanner or gamma camera is processed and converted into images. A PET scan portrays chemical activity in parts of your body as images, or colors, of intensity. Areas of more intense color, or high uptake of the radioactive substance, are called hot spots. Areas of less intense color, which indicate a low uptake of radioactive substance, are called cold spots.

What can you expect during a PET scan?

Radionuclide (nuclear) scanning

A nurse or technologist takes you into a special examination room that houses the PET scanner, which has a hole in the middle and looks like a large doughnut. Within the PET machine are multiple rings of detectors that record the emission of energy from the radioactive substance in your body, creating an image of a part of your body.

First, you lie down on an examination table and receive the radioactive substance (radiotracer) by intravenous injection, which feels like a slight pinprick. It takes about 30 to 60 minutes for the radiotracer to travel through your body and be absorbed by the organ or tissue to be imaged. In the meantime, you'll rest quietly and avoid movement or talking, as this may alter the distribution of the substance. You won't be able to feel the radioactive substance in your body.

While lying on the examination table, you're then moved into the hole of the machine. The images are displayed on a monitor of a nearby computer. You're made as comfortable as possible before you're positioned in the PET scanner. You're then asked to remain still for the duration of the examination, which takes about 30 to 45 minutes. Moving around during the test can reduce the quality of the images. If you're claustrophobic, you may feel some anxiety while positioned in the scanner. Be sure to tell the nurse or technologist about any discomfort.

Depending on which organ or tissue is being examined, additional tests involving other dyes or chemicals may be used, possibly increasing your total appointment time to three to four hours. For example, if heart disease is suspected, you may have a stress test in which a PET scan is first obtained while you're at rest and then again to examine the blood flow to your heart while you exercise.

In general, there are no restrictions on your daily routine after the test. However, drink plenty of fluids to flush the radioactive substance from your body.

Results of a PET scan
Different colors or degrees of brightness on the images from a PET scan represent different levels of tissue and organ function. A radiologist with special training in reading PET scans interprets the images from your PET scan. To enhance the radiologist's study of your PET scan, films from other tests, such as those from recent computerized tomography (CT) or magnetic resonance imaging (MRI) scans, may be compared with those of a PET scan.

Risks of a PET scan
Although a radioactive substance is used during a PET scan, the amount of radiation that you're exposed to is low. The amount of radiation in a radiotracer dose isn't enough to affect the normal processes of your body.

However, the radiotracer may expose radiation to the fetus of a pregnant woman or to the infant of a woman who is breast-feeding. You and your doctor can discuss risk to the fetus or infant versus the reasoning and benefit of having a PET scan performed.

Looking ahead
PET scans offer significant advantages over other forms of imaging, such as CT or MRI scans, in diagnosing disease. However, PET scanning often is used along with a CT or MRI scan to produce a 3-D view of an organ or tissue. Today PET scanners are being made with PET and CT scanning devices all in one.

Until recently, a medical center with a PET scanner required a special laboratory and machine (cyclotron) to produce radioactive substances needed to conduct a PET scan, which made it difficult to afford in-house PET scanning. However, a number of facilities now make and distribute the radioactive substance, making it feasible for more medical facilities to offer PET scanning.

By Mayo Clinic Staff
May 18, 2007

Contact lenses: What to know before you buy

(From the Mayo Clinic)

Here are some pointers on safe disinfection, storage and handling of contact lenses, followed by a rundown of contact lens types.

Avoiding eye infections

Wearing contact lenses increases your risk of corneal infection. Some of the added risk is unavoidable: All types of contact lenses reduce the amount of oxygen that reaches your cornea — the clear tissue that lies over the pupil and iris — and less oxygen can promote infection.

This reduction in corneal oxygen makes proper cleaning and disinfection all the more important. Here are some tips:

Use multipurpose contact lens solutions with caution. While these combination cleaning-disinfectant-storage solutions are convenient, two brands have been withdrawn from the market because they've been linked to serious eye. In 2005 and 2006, 130 contact-lens wearers who regularly used Bausch & Lomb's ReNu with MoistureLoc solution developed Fusarium keratitis, a fungal infection of the cornea, prompting that brand's recall. A year later, in 2007, Advanced Medical Optics voluntarily recalled its Complete MoisturePlus solution, which was implicated in 138 cases of Acanthamoeba keratitis, a parasitic infection of the cornea.
Choose daily-wear contacts, and take them out before you go to sleep. Infections are more common with extended-wear contacts, worn continuously, than with daily-wear contacts.
Wash, rinse and dry your hands thoroughly before handling your contacts.
Follow your eye-care professional's instructions for taking care of your lenses. Make sure you use lens-care products formulated for the type of lenses you wear.
Replace your contact lenses as recommended. If one or both lenses bother you before you're due to replace them, get them checked or try a new set — if you have a supply.

Types of contact lenses

Contact lenses are made of many different types of plastic, but in general, they fall into two main groups: soft contact lenses and gas-permeable contact lenses.

Soft contact lenses
These thin, gel-like lenses conform to the shape of your eye. They're more flexible than gas-permeable contact lenses, so they're more comfortable and easier to get used to.

Types of soft contact lenses include:

Daily-wear contact lenses. Four out of five people who wear contact lenses choose daily-wear, which are lenses you typically insert every morning and remove every night. They should not be worn during sleep. Properly cleaned and stored, one pair of daily-wear lenses should last up to one year.
Disposable contact lenses. These lenses are designed for short-term use during waking hours. Depending on their composition, disposable lenses may need replacement every day — you throw them away after wearing them once — or at longer intervals, up to three months. Most brands are good to wear for two weeks.
Extended-wear contact lenses. Because they're designed to provide adequate oxygen to your cornea even while you sleep, you can wear these lenses continuously — for up to seven days with standard extended-wear contact lenses, and all the way up to 30 days with lenses made of superpermeable silicone hydrogel. The 30-day lenses are somewhat stiffer and less comfortable than the seven-day lenses. Also, 30-day lenses may get scratched more easily and have less clarity than do lenses removed every seven days.

Gas-permeable contact lenses
Gas-permeable contact lenses are generally made of harder plastic materials that don't contain water. Although they aren't as flexible as soft contacts, gas-permeable lenses allow more oxygen to pass through to the cornea than do soft lenses, reducing the risk of corneal irritations.

Gas-permeable lenses can correct a wide range of vision problems, including astigmatism, which is a type of blurred vision caused by an irregularly shaped cornea. After a short period of adaptation, most people can wear gas-permeable lenses comfortably. Gas-permeable lenses are easy to care for, and they're less likely to cause infection and more durable than soft lenses.

Gas-permeable lenses need to be replaced less frequently than do soft contact lenses and may be worn, on average, for two to three years.

Pros and cons of soft vs. gas-permeable contact lenses

How do you choose between soft contact lenses and rigid gas-permeable contact lenses? Here's a look at the advantages and disadvantages of each.

Contact lens type	Advantages	Disadvantages
Soft	Flexible lenses; more comfortable Extended-wear and disposable options available Shorter adjustment period Stay in place better, even with vigorous physical activity	Less durable Require more frequent replacement Not as effective in correcting some vision problems, such as high degrees of astigmatism
Gas-permeable	Optimal vision correction for many conditions More durable Less frequent replacement needed Greater oxygen permeability; better for eye health	Less comfortable initially; require adjustment period Readjustment necessary any time you stop wearing them for an extended period May slip off the center of your eye more easily; could lead to discomfort and blurred vision

Contact lens type

Advantages

Disadvantages

Soft

Flexible lenses; more comfortable

Extended-wear and disposable options available

Shorter adjustment period

Stay in place better, even with vigorous physical activity

Less durable

Require more frequent replacement

Not as effective in correcting some vision problems, such as high degrees of astigmatism

Gas-permeable

Optimal vision correction for many conditions

More durable

Less frequent replacement needed

Greater oxygen permeability; better for eye health

Less comfortable initially; require adjustment period

Readjustment necessary any time you stop wearing them for an extended period

May slip off the center of your eye more easily; could lead to discomfort and blurred vision

Hybrid contact lenses
Hybrid contact lenses, which feature a gas-permeable center surrounded by a soft outer ring, hit the market in 2006. These lenses offer the combined benefits of better visual acuity associated with gas-permeable contact lenses and greater comfort associated soft contact lenses. Hybrid contact lenses may be an option for people needing vision correction for problems such as astigmatism, keratoconus or presbyopia.

Getting the right fit

If you decide you want contact lenses, have a thorough eye examination and fitting by an experienced professional. Follow-up exams are important to monitor any changes to your vision and to update your prescription. If you're a regular contact lens wearer, see your doctor annually for an eye exam and a contact lens evaluation — more often if you have any problems

Cholesterol Isn’t All Bad
(A Report from the Harvard University Medical School)

In practical terms, the bottom line is simple: The higher your HDL cholesterol, the better. But the biological reality is more complex. Research into the molecular biology of HDL is spurring new therapies.

Genes direct the body’s production of HDL. Some of us are lucky enough to inherit genes that result in a lot of HDL, while others are dealt a less favorable hand. But genes are only part of the story. Lifestyle factors and, to a smaller extent, medications can strongly influence HDL levels. Genes re-enter the picture, though, because for some people, balky genes limit their ability to boost HDL levels with exercise and other interventions.

How HDL helps
At first, scientists believed that HDL was simply a garbage collector that picked up cholesterol from an artery’s walls and delivered it to the liver for disposal. That’s still considered the main role of HDL, but research is starting to suggest that HDL can help protect the heart in many ways:

Reverse cholesterol transport. HDL latches onto LDL embedded in an artery wall, lugs it back into the bloodstream, and carries it to the liver. The liver collects cholesterol from the HDL particles, packages it into bile salts and bile acids, and dumps it into the intestines for excretion.
Antioxidant activity. LDL cholesterol in the artery wall is bombarded by oxygen free radicals, which turns it into oxidized LDL cholesterol. Oxidized cholesterol is the stuff that’s actually responsible for arterial damage — and research shows that HDL can help protect LDL cholesterol from free radicals.

Anti-inflammatory action. HDL helps to quiet the inflammation of an atherosclerotic plaque. Elevated levels of C-reactive protein (CRP) reflect the inflammation of such a plaque and HDL may neutralize CRP’s tendency to perpetuate the inflammatory cycle.

Antithrombotic activity. Plaque rupture triggers the formation of an artery-blocking blood clot. By halting the flow of oxygen-rich blood, the clot kills heart muscle cells (heart attack) or brain cells (stroke). HDL reduces clot formation and accelerates the healing process that dissolves clots.
Endothelial function. Blood vessels plagued with atherosclerosis sustain other damage. In particular, the endothelial cells lining the arteries fail to produce normal amounts of nitric oxide, the chemical that allows arteries to dilate (widen) when tissues need more oxygen. HDL helps preserve nitric oxide production and protect endothelial function.

How much does HDL help?

The Framingham Heart Study was responsible for many landmark discoveries about HDL cholesterol, and the Physicians’ Health Study helped confirm that HDL was protective, reporting that various HDL subtypes are all helpful. Data continue to show that the good cholesterol is very good indeed.

Heart disease. Low HDL levels are associated with an increased risk of heart attacks, while high levels are protective. According to the Framingham Heart Study, cardiac risk rises sharply as HDL cholesterol levels fall below 40 milligrams per deciliter (mg/dL). In general, each 1 mg/dL rise in an HDL cholesterol level can be expected to cut cardiac risk by 2% to 3%.

Stroke. Strokes come in many forms, but the most common type, ischemic stroke, shares many risk factors with heart attack. High HDL cholesterol levels reduce the risk of stroke; in several studies, HDL cholesterol is a much better predictor of risk than LDL cholesterol, particularly in people older than 75.

Erectile dysfunction. Normal erections depend on many things, including healthy arteries that produce good amounts of nitric oxide. It’s no surprise, then, that the Massachusetts Male Aging Study found that 16% of men with low levels of HDL cholesterol had erectile dysfunction, but none of the men with the highest levels did.

Longevity. Several investigations suggest that high HDL levels are linked to longevity, particularly exceptional longevity. Other research links high levels of HDL cholesterol to preserved cognitive function in old age. More research is needed to learn if HDL deserves the credit or if other genetic
factors are responsible.

Your goal

When it comes to HDL cholesterol, the higher your level, the better. Still, targets are important. The National Cholesterol Education Program (NCEP) and the American Diabetes Association advise aiming for HDL levels of at least 40 mg/dL. An even more protective goal, according to the NCEP, is 60 mg/dL or higher.

Ways to raise your HDL

Exercise. Exercise is an important way to boost HDL levels. On average, sedentary people who start to exercise regularly can expect their HDL levels to rise by 3% to 20%. The benefit can occur with as little as one mile of walking or jogging a day, but the more you do, the better your result. Brisk walking for 40 minutes a day is a good target, but if you need more help, aim higher.
Watch your dietary fats. Saturated fat won’t affect your HDL cholesterol, but it will raise your LDL cholesterol. The latest American Heart Association (AHA) guidelines call for limiting saturated fat to less than 7% of your total daily calories. Reduce your intake of trans fats to less than 1% of your total daily calories. Trans fat lowers HDL cholesterol and raises LDL cholesterol, a double whammy to health. But unsaturated fats like virgin olive oil may boost HDL levels, and the omega 3 fats in fish, nuts, and canola oil may promote cardiac health even if they don’t affect your HDL reading.

Watch your carbs! Or at least the types of carbs you’re eating. Diets that provide large amounts of rapidly absorbed carbohydrates are clearly linked to low levels of HDL cholesterol. Avoid highly refined carbohydrates in favor of coarsely ground, whole grain, unrefined carbs like whole grain bread, oatmeal, and beans.

Alcohol. Moderate drinking will raise HDL levels by about 4 mg/dL, which should cut cardiac risk by about 10%. This translates to one to two drinks a day for men, and one drink a day for women. For this “prescription,” count 5 ounces of wine, 1½ ounces of liquor, or 12 ounces of beer as one drink.

Weight control. Obesity is linked to low HDL levels, but weight loss can help. Exercise and diet are the dynamic duo for weight loss, but shedding excess pounds will boost HDL levels over and above the independent effects of regular exercise and a healthful diet.

(See Healthy Cholesterol)

Drinking Soda, Including Diet Soda,
Can Trigger Heart Disease & Diabetes

According to Circulation: Journal of the American Heart Association, drinking as little as one can of soda per day--even diet soda--can bring on a 50% increased risk of a cluster of factors considered to be key predecessors of heart disease and diabetes. This is probably a result of the fact that people who consume soda also tend to eat more sweets or have generally poor eating habits. The soda drinker tends to have excessive abdominal fat, high blood-glucose levels, high blood pressure, high blood triglycerides, and low levels of HDL (good cholesterol).

A study of 1,600 people found that those who drank at least one soda per day--including diet soda-- had a 31% chance of becoming obese; a 30% chance of a larger waistline; a 25% higher risk for high blood sugar; and a 32% chance of having bad cholesterol levels.

July 24, 2007 The Los Angeles Times

Could it be my thyroid?

Risk factors for thyroid disease

You are at greater risk for thyroid disease if you

have a family history of an underactive or overactive thyroid
are a woman
are over age 60
are white
have an autoimmune condition
have a family history that includes autoimmune conditions
are pregnant or have given birth within the last six months
are iodine deficient or live in a country where iodine deficiency is prevalent
have been exposed to large amounts of radiation
smoke tobacco
are taking medications that contain high levels of iodine.

Unseen and often misunderstood, the thyroid gland is small but enormously important to human health. Like the director of a feature film, the thyroid works behind the scenes, influencing everything from metabolism to emotion. Many people do not realize how important thyroid health is to their overall well-being, until something goes wrong. Then a faulty performance has an impact on vital organs including the heart and brain as well as mood, strength, energy level, and more.

Normally, the thyroid works day and night producing hormones that control the pace at which each of your cells performs its functions. So when disease causes this busy gland to slack off and underproduce thyroid hormone, or overwork and produce too much of it, you’ll know something isn’t right. But it may take some time to figure out what.

The symptoms of thyroid diseases are so wide-ranging, even doctors often don’t realize that the thyroid is to blame. Hypothyroidism, an underactive thyroid, leads to symptoms as diverse as depression, hair loss, weight gain, dry skin, and feeling cold and continually tired.

Hyperthyroidism, an overactive thyroid, can make you lose weight and feel nervous, anxious, warm, and constantly hungry.

Risk increases with age

The risk of thyroid disease increases with age. Yet, complicating matters, thyroid disease is most difficult to detect in people over 60 because it typically masquerades as another illness, such as heart disease, depression, or dementia. Misleading symptoms may be the reason that many Americans who have thyroid disease—mostly women—do not yet know they have it.

How many people have thyroid disease? Estimates vary widely, in part because experts disagree about how to define a normal result on a blood test used to detect thyroid conditions. The most reliable number available comes from the third U.S. National Health and Nutrition Examination Survey of people ages 12 and older, published in 2002. The survey reported that nearly 6% of the U.S. population, or 12.2 million people, have thyroid disease. Most of these people, about 9.6 million, have hypothyroidism. A much smaller portion, 2.6 million people, has hyperthyroidism. But the population is aging, and the proportion of people with thyroid conditions is increasing.

While many doctors do check thyroid functions periodically, routine screening for the general population is not universal. Therefore, it is up to you to ask your doctor to evaluate your thyroid if you suspect you have a problem and work closely with your doctor to bring your thyroid levels back to normal. See our product THYROID HEALTH

Harvard Medical Publications, July 2007

Massage: A relaxing method to relieve stress and pain

You might think of a massage as a luxury found in exotic spas and upscale health clubs. But did you know that massage, when combined with traditional medical treatments, can reduce stress and promote healing in people with certain health conditions?

During a massage, a therapist manipulates your body's soft tissues — your muscles, skin and tendons — using his or her fingertips, hands and fists. Massage can be performed by several types of health care professionals, such as a massage therapist, physical therapist or occupational therapist. Several versions of massage exist, and they're performed in a variety of settings.

A massage may make you feel relaxed, but it isn't likely to cure everything that ails you. And, if performed incorrectly, it could hurt you. Learning about massage before you try one can help ensure that the experience is safe and enjoyable.

Health benefits of massage

Massage can relieve tension in your muscles, and most people use it for relaxation, relief of stress and anxiety, or to reduce muscle soreness. Massage can also cause your body to release natural painkillers, and it boosts your immune system.

While more research is needed to confirm the benefits of massage, some studies have found it helpful for:

Anxiety. Massage reduced anxiety in depressed children and anorexic women. It also reduced anxiety and withdrawal symptoms in adults trying to quit smoking.
Pain. Pain was decreased in studies of people with fibromyalgia, migraines and recent surgeries. Back pain also might be relieved by massage. However, back pain study results have been contradictory, and more research is required.
Labor pain. Massage during labor appears to reduce stress and anxiety, relax muscles and help block pain.
Infant growth. Massage encouraged weight gain in premature babies and reduced the number of days they stayed in the hospital.
Children with diabetes. Children who were massaged every day by their parents were more likely to stick to their medication and diet regimens, which helped reduce their blood glucose levels.
Sports-related soreness. Some athletes receive massages after exercise, especially to the muscles they use most in their sport or activity. A massage might help increase blood flow to your muscles and may reduce muscle soreness after you exercise.
Alcohol withdrawal. Massage during withdrawal from alcohol has shown benefits when combined with traditional medical treatment by increasing feelings of support, safety and engagement in the therapy.
Immune system. People with HIV who participated in massage studies showed an increased number of natural killer cells, which are thought to defend the body from viral and cancer cells.
Cancer treatment. People with cancer who received regularly-scheduled massage therapy during treatment reported less anxiety, pain and fatigue.
Self-esteem. Because massage involves direct contact with another person through touch, it can make you feel cared for. That special attention can improve self-image in people with physical disabilities and terminal illnesses. And using touch to convey caring can help children with severe physical disabilities

Risks of massage

Massage is generally safe as long as it's done by a trained therapist. But massage isn't for everyone. And for some people it can even be dangerous. Discuss massage with your doctor before making an appointment if you have:

Burns or open wounds on the area to be massaged
Had a recent heart attack
Cancer — you'll want to avoid direct pressure on the tumor area
Deep vein thrombosis
Unhealed fractures
Rheumatoid arthritis in the area to be massaged
Severe osteoporosis

In addition, talk to your doctor before getting a massage if you're pregnant.

Massage done properly rarely leads to severe injuries. Ask your massage therapist about his or her training and qualifications — some states require licensing. And if any part of your massage doesn't feel right or is painful, speak up right away. Most serious problems come from too much pressure during massage. In rare circumstances, massage can cause:

Internal bleeding
Nerve damage
Temporary paralysis

Talk to your doctor and your massage therapist if you have any concerns about your risk of injury. Asking questions can help you feel more at ease.

What to expect during a massage

No matter what kind of massage you choose, you should feel calm and relaxed during and after your massage. When you go for a massage, you can expect to:

Answer a few questions. Your massage therapist will want to know what you want from your massage. Are you looking for help with a pulled muscle? Massage therapists will also want to know about any medical conditions you may have, so they can decide if massage is safe for you or how to make it safer.
Disrobe. You'll be asked to remove your clothes, or at least most of them. Your massage therapist should give you privacy while you take your clothes off and provide a robe or a towel to cover yourself. A good massage therapist will understand your modesty and keep you covered as much as possible throughout the massage. If taking your clothes off doesn't sound relaxing or if you're pressed for time, try a chair massage. These massages are conducted while you sit in a special chair that slopes forward so the massage therapist can work on your back. You keep your clothes on for this massage — it's often done in the open, rather than in a private room.
Be asked to lie down. Most massages will require you to lie on a padded table. Pillows or bolsters might be used to position you during the massage. This allows you to relax completely during the massage. Music usually plays softly while you're massaged.
Have oils and lotions used on your skin. Some massage therapists use oils or lotions to reduce friction while massaging your body. If you're allergic to any ingredients commonly found in body oils and lotions, tell your massage therapist. He or she might have products without that ingredient. You may opt not to use oils and lotions.
Never feel significant pain. Pain that's more significant than momentary discomfort could indicate that something is wrong. If a massage therapist is pushing too hard, tell him or her to lighten the pressure. Your massage therapist will expect feedback from you to understand how best to massage you. Occasionally you may have a sensitive spot in a muscle that feels like a knot. It's likely to be uncomfortable while your massage therapist works it out. But if it becomes painful, speak up.
Spend about an hour. Most table massages are about an hour, though some can be 30 minutes to 90 minutes long. It's your preference.

A health care tool

For many conditions and injuries, massage may be a means to help you feel more relaxed and less anxious and to reduce pain. It's one of several useful tools for managing your health, but it doesn't take the place of standard medical treatment and exercise.

Mayo Clinic, July 2007

9 ways to protect your heart from diabetes

Diabetes and heart disease often go hand in hand. Here’s how you can uncouple them.

Diabetes and heart disease were once thought to be entirely unrelated disorders. New thinking suggests that they may actually spring from the same underlying cause — chronic, systemwide inflammation — or at least be influenced by it. This intertwining is a bad thing, since developing diabetes usually means developing heart disease as well. It also has a silver lining: Protecting yourself against one of these chronic conditions works against the other, too.

More than one million Americans are diagnosed with type 2 diabetes each year. Traditionally, up to 80% of people with diabetes develop some form of cardiovascular disease, from heart attack and stroke to peripheral artery disease and heart failure.

The connection between the two diseases isn’t ironclad. The American Heart Association and the American Diabetes Association have joined forces to fight both heart disease and diabetes. Their latest effort focuses on helping people with diabetes whose hearts seem healthy keep them that way.

As you scan the tips below, remember that almost every recommendation is good for diabetes as well as heart disease.

1. Know your risk

Goal: Knowledge is power. Calculate your risk of heart disease, or ask your doctor to do it.

Getting there: The Framingham calculator is a general heart disease–risk estimator. Specific ones for people with diabetes have been developed by two diabetes groups.

2. Exercise

Goal: Aim for at least 150 minutes a week of moderate exercise (like walking) or 90 minutes of vigorous exercise.

Getting there: If you do just one thing on this list, choose exercise. It is a key to controlling blood sugar, strengthens the heart and lungs, improves blood pressure, corrects out-of-whack cholesterol, and has other beneficial effects.

3. Control your weight

Goal: If your weight is in the healthy range, work to keep it there. If you are overweight, try to lose 5% to 7% of your weight over the next 12 months. (That’s about a pound a month for someone weighing 200 pounds.)

Getting there: Cutting out just one 12-ounce can of sugared soda a day (150 calories) is enough to help you lose a pound a month. You can easily double that by burning more calories with exercise.

4. Improve your diet

Goals:

Cut back on unhealthy fats: Lower saturated fat to under 7% of calories (about 17 grams), and keep trans fat intake as close to zero as possible.
Add more unsaturated fats from fish, grains, and vegetable oils.
Include at least 30 grams of fiber a day.
Watch the salt — reduce your intake to under 2,500 milligrams a day.
Choose whole grains and other slowly digested carbohydrates.

Getting there: The foods you eat can help you control blood sugar and protect your arteries. The main strategy is to get more fruits, vegetables, beans, whole grains, fish, and vegetable oils (especially olive oil), and less fast food, salty or fried food, and rapidly digested carbohydrates. There is no one-size-fits-all “diabetes diet.” The American Diabetes Association released a comprehensive set of nutrition recommendations in January 2007. But rather than trying to wade through these, ask your doctor to refer you to a nutritionist.

5. Lower your blood pressure

Goal: A healthy blood pressure is 120/80 or below. If you have high blood pressure, aim for a systolic pressure of 130 or lower and a diastolic pressure of 80 or lower.
||
Getting there: Measure your blood pressure often; home monitors are a good investment. If it is above the goal, try exercise, the DASH diet, and, if needed, weight loss, smoking cessation, or medications.

6. Control your cholesterol

Goal: Aim for and LDL under 100 mg/dL, an HDL above 40 mg/dL, and triglycerides under 150 mg/dL.

Getting there: A healthful diet and exercise can do a lot to reverse risky lipid levels. A cholesterol-lowering statin can help protect against heart attack and stroke even when LDL levels are near the recommended goal. Niacin or a fibrate can improve HDL and triglyceride levels.

7. Quit smoking

Goal: If you smoke, try to stop. Avoid secondhand smoke whenever possible.

Getting there: The most effective quitting strategy includes talk therapy plus nicotine replacement therapy along with drugs such as bupropion (generic, Wellbutrin, Zyban) or varenicline (Chantix).

8. Control your blood sugar

Goal: Aim for hemoglobin A1c to be at least under 7% and, ideally, as close to 6% as possible without causing bouts of low blood sugar.

Getting there: Managing carbohydrate intake and switching to whole grains can help ease the blood sugar roller coaster. Exercise is vitally important. Use medications such as metformin, thiazolidinediones, and insulin as needed.

9. Prevent clots

Goal: Take a low-dose aspirin (75–162 milligrams) every day unless your doctor tells you not to.

Getting there: Aspirin prevents platelets from latching onto each other, an early step in clot formation. Preventing clots helps prevent heart attack and stroke.

Harvard Medical News, July 3, 2007

Stress-reducing techniques that work

Glance at the most recent National Vital Statistics Report listing the 10 leading causes of death in America, and you won’t find the word “stress” anywhere. Yet many well-respected studies link stress to heart disease and stroke — two of the top 10 killers. Stress may also influence cancer and chronic lower respiratory diseases, which rank as numbers two and four, respectively, in the top 10.

Stress has implications for many other ailments as well. Depression and anxiety, which afflict millions of Americans, can be caused or exacerbated by stress. It also triggers flare-ups of asthma, rheumatoid arthritis, and gastrointestinal problems. And illness is just the tip of the iceberg. Stress affects you emotionally as well, marring the joy you draw from life and loved ones.

In the course of a lifetime, odds are good that you’ll experience some very stressful events. You’ll also face a gamut of far smaller, day-to-day stressors. How you deal with these stressful events, big and small, will determine the impact on your physical health and emotional well-being.

Several decades ago, two psychiatrists at the University of Washington devised a scale for researchers that weighed the stress of major life events. The death of a spouse — which ranks highest — was later shown to have a serious impact on the health of the surviving spouse. Although most of the events on the scale would be considered traumatic, many of the life events aren’t obviously negative. An outstanding personal achievement, a new baby or a marriage may seem like cause for celebration. But many life events can be construed as uplifting or upsetting — or perhaps a bit of both.

While most symptoms of stress may be obvious, many symptoms are more subtle. The first line of defense is to recognize that certain physical and emotional changes may indeed be caused by stress itself. Although most individuals might attribute headache, sleep disturbances or irritability to stress, less obvious symptoms can include ringing in the ears, a frequent, urgent need to urinate, and difficulty swallowing. Understanding the many ways that stress can manifest itself in physical and behavioral symptoms and identifying the triggers for stress are the first steps toward achieving relief.

Many causes exist for stress, and there are almost as many techniques, practices, and treatments for dealing with it. From ancient relaxation techniques to the latest thinking on proper nutrition, from breathing exercises to repetitive prayer, we have numerous tools to help us cope. Some techniques can be especially beneficial under certain circumstances, but not as helpful under others. Understanding what works for us as individuals and for the stressful circum-stances at hand can require an exploration of a number of stress-reduction methods. And as always, it is important to know when to seek professional help. Yet these efforts can reward you richly with better health, greater peace of mind, and a smoother course through life.

Mini-relaxations

Mini-relaxations can help allay fear and reduce pain while you sit in the dentist’s chair or lie on an examining table. They’re equally helpful in thwarting stress before an important meeting, while stuck in traffic, or when faced with people or situations that annoy you. Here are a few quick relaxation techniques to try.

When you’ve got 1 minute. Place your hand just beneath your navel so you can feel the gentle rise and fall of your belly as you breathe. Breathe in slowly. Pause for a count of three. Breathe out. Pause for a count of three. Continue to breathe deeply for one minute, pausing for a count of three after each inhalation and exhalation.

Or alternatively, while sitting comfortably, take a few slow deep breaths and quietly repeat to yourself “I am” as you breathe in and “at peace” as you breathe out. Repeat slowly two or three times. Then feel your entire body relax into the support of the chair.

When you’ve got 2 minutes. Count down slowly from 10 to zero. With each number, take one complete breath, inhaling and exhaling. For example, breathe in deeply saying “10” to yourself. Breathe out slowly. On your next breath, say “nine,” and so on. If you feel lightheaded, count down more slowly to space your breaths further apart. When you reach zero, you should feel more relaxed. If not, go through the exercise again.

When you’ve got 3 minutes. While sitting down, take a break from whatever you’re doing and check your body for tension. Relax your facial muscles and allow your jaw to fall open slightly. Let your shoulders drop. Let your arms fall to your sides. Allow your hands to loosen so that there are spaces between your fingers. Uncross your legs or ankles. Feel your thighs sink into your chair, letting your legs fall comfortably apart. Feel your shins and calves become heavier and your feet grow roots into the floor. Now breathe in slowly and breathe out slowly. Each time you breathe out, try to relax even more.

Harvard Medical School, July 2007

Liver problems:
Common problems and how to avoid them

Your liver is one of your body's largest and most important organs. It's very resilient, but it isn't indestructible. Learn about liver problems and how to avoid liver problems.
Your liver is located just under your rib cage on the right side of your abdomen, it's about the size of a football, weighs 3 to 4 pounds and performs hundreds of vital functions. Without it, you couldn't digest food and absorb nutrients, get rid of toxic substances from your body or stay alive.
Serious complications can arise if you develop liver problems. Some liver problems can't be prevented, such as those that are inherited, but you can take an active role in preventing other liver problems. Learn to identify symptoms of liver problems and how to avoid them.

Your liver's role in keeping you healthy
Everything you eat, drink, breathe and absorb through your skin eventually reaches your liver. It controls a process called metabolism, in which your liver breaks down nutrients into usable byproducts. These byproducts are delivered to the rest of your body by your bloodstream. Your liver also breaks down toxins into byproducts that can be safely eliminated.

Your liver serves as a storage depot for sugar (glucose), which it releases when you need energy. Your liver also works as a chemical factory, producing many substances that perform vital tasks in your body. Examples include bile, a fluid that carries away waste and helps digest fat in the small intestine, and cholesterol, a substance needed by every cell in your body.

Liver problems: What can go wrong
Your liver is very resilient in the face of liver problems. It can remain functional after losing most of its cells to disease. It can regenerate in a few weeks — even after much of it has been removed during surgery.

But your liver isn't indestructible — liver problems are possible. Excessive alcohol consumption over many years is a leading cause of liver disease. Too much alcohol can make a normal liver swell with fat, causing a condition called fatty liver. If the fat becomes inflamed, it can lead to either alcoholic hepatitis, a liver problem that causes serious but often reversible liver damage, or cirrhosis, which causes irreversible liver damage. Because of extensive scarring, a cirrhotic liver shrinks to a fraction of its normal size.

Viral hepatitis can lead to serious liver problems and is the most common type of liver disease. Hepatitis causes inflammation of the liver. The three types of hepatitis viruses — hepatitis A, hepatitis B and hepatitis C — can all be prevented.

Signs and symptoms of liver problems: What to watch for
Signs and symptoms of liver problems include:

Discolored skin and eyes that appear yellowish
Abdominal pain and swelling
Itchy skin that doesn't seem to go away
Dark urine color
Pale stool color
Bloody or tar-colored stool
Chronic fatigue
Nausea
Loss of appetite

To keep your liver healthy and avoid any potential liver problems, see your doctor if you have any signs or symptoms that concern you.

Prevent liver problems: How to protect your liver
Here are the most important things you can do to protect your liver:

Drink alcohol in moderation, if at all. Over many years, more than one drink a day for women and more than two drinks a day for men may be enough to lead to cirrhosis. Use of certain drugs, including some illegal drugs, also can cause liver disease.
Don't mix other drugs with alcohol. Acetaminophen (Tylenol, others) can be toxic to the liver even if you drink in moderation.
Get vaccinated. If you're at increased risk of contracting hepatitis or if you've already been infected with any form of the hepatitis virus, talk to your doctor about getting the hepatitis B vaccine. A vaccine is also available for hepatitis A.
Use medications wisely. Only use prescription and nonprescription drugs when you need them and take only the recommended doses. Talk to your doctor before mixing herbal supplements or prescription or nonprescription drugs.
Beware of certain supplements. Herbal supplements that can be toxic to the liver include kava, comfrey, chaparral, kombucha tea, pennyroyal and skullcap. Also avoid high doses of vitamins A, D, E and K.
Avoid contact with other people's blood and body fluids. Hepatitis viruses can be spread by accidental needle sticks, improper cleanup of blood or body fluids, and sharing intravenous needles. It's also possible to become infected by sharing razor blades or toothbrushes or by having unsafe sex.
Be careful with aerosol sprays. When you use an aerosol cleaner, make sure the room is ventilated, or wear a mask. Take similar protective measures when spraying insecticides, fungicides, paint and other toxic chemicals.
Watch what gets on your skin. When using insecticides and other toxic chemicals, cover your skin with gloves, long sleeves, a hat and a mask.
Don't eat too many fatty foods. Your liver makes all the cholesterol your body needs. Eating a well-balanced, nourishing diet will help your liver do its job properly. A regular exercise program will help keep your liver healthy, too.
Watch your weight. Even if you don't drink alcohol, obesity can cause a condition called nonalcoholic fatty liver disease, which may include fatty liver, hepatitis and cirrhosis.

Mayo Clinic June 2007

Children's swimming: Should your child be in the pool?

Is your diaper-clad toddler begging to splash in the local pool? Are you worried about your child's cast or ear tubes in the water? Does the thought of bacteria lurking in the pool give you the creeps? Before you help your child suit up — or abandon any thoughts of splashing in the pool — here's some practical advice from Jay Hoecker, M.D., a pediatrics specialist at Mayo Clinic, Rochester, Minn.
Can babies or toddlers wear diapers in the pool?
Various brands of diapers are designed for underwater use. They're water-repellent and fit snugly around a child's thighs and waist. But they're not waterproof. If your child has a bowel movement in the pool, fecal material may escape the diaper. If that happens, all swimmers must leave the pool while the water is treated with additional chlorine — a bacteria-killing agent that keeps water safe for swimming.
A dirty diaper may contain diarrhea-causing germs, including the parasite cryptosporidium. This parasite can contaminate pool water or other swimming areas. In otherwise healthy people, a cryptosporidium infection causes severe diarrhea lasting from one to two weeks. The consequences can be more severe — even fatal — for people who have severely weakened immune systems.
Urine in a pool is less risky than feces. But when you have a child who wears diapers, it's difficult to separate the two. I generally discourage parents from allowing children in diapers to enter a pool.
Can children who have casts go swimming?
With the doctor's OK, children who have water-safe casts — made of fiberglass and lined with a water-repellent material — can safely swim. But children who have plaster casts over cloth wrappings must stay out of the water. Trying to protect a plaster cast with plastic bags generally doesn't work.
Can children swim if they have ear tubes?
Swimming with ear tubes is a controversial topic. Some doctors argue that ear tubes prevent ear infections by draining fluid — so if water gets into the middle ear while swimming, it'll probably drain out through the tubes. Other doctors, however, don't want children who have ear tubes to swim. They say that mixing water and wax in the ear canal may lead to certain bacterial infections, which could jeopardize the ear tubes.
I'd suggest a reasonable compromise. For children who simply want to splash in the water without submerging their heads, swimming is fine. For children who want to swim with their heads underwater, provide individually molded earplugs. Tightfitting swim caps may help, too. Diving is off-limits for children who have ear tubes.
What's the best way to prevent swimmer's ear?
You might try a homemade eardrop solution to help prevent the growth of bacteria and fungi that can cause swimmer's ear. Mix 1 part white vinegar with 1 part alcohol — preferably pure ethanol, but rubbing alcohol is OK, too. Before and after swimming, pour 1 teaspoon of the mixture into each of your child's ears. Let the solution roll in and then drain out.
Please note that this home solution isn't a treatment for an ear infection. It's only a preventive measure. Don't use the solution in children who have ear tubes or who already have swimmer's ear.
How long should swimmer's ear be treated before swimming again?
Swimmer's ear is often treated with prescription eardrops. While the infection is healing, it's important to keep water out of the ears. Have your child wear a shower cap over the ears while showering or bathing. Swimming is usually OK after one week of treatment or when the ear canal no longer hurts.
Are red eyes after swimming a concern?
Red or puffy eyes after a long day of swimming in a pool may indicate chlorine sensitivity. To prevent red or puffy eyes, have your child wear goggles in the pool. To ease discomfort and reduce redness after swimming, rinse your child's eyes with a sterile eyewash or an artificial tears solution.
Is it risky for children to swallow pool water?
Children are bound to take a few gulps of pool water at one time or another, especially when first learning to swim. A little swallowed pool water isn't cause for concern, but drinking too much pool water can make a child ill.
Are indoor pools any more or less likely than outdoor pools to contain bacteria?
Indoor pools are just as safe as outdoor pools. In threatening weather, however, outdoor pools are strictly off-limits.
What's the best age to begin swimming lessons?
There's no magic age for a child's first swimming lesson. Readiness depends on a child's comfort in the water. Most children can start learning to swim about the time they learn to ride a bike, often at age 5 or 6. Remember the importance of close supervision in the water, even for children who are experienced swimmers.
Can children swim when they're sick or have cuts and scrapes?
It's fine for children who have colds or other minor illnesses to swim, as long as they feel well enough to do so. Likewise, it's OK for children to swim with cuts and scrapes, as long as the wounds aren't bleeding.
What about swimming after eating?
It's OK to swim immediately after a light meal or snack. If your child feels lethargic after eating a heavy meal, encourage him or her to take a break before swimming.
Are hot tubs safe for children?
Children can quickly become overheated in a hot tub. Children should stay out of hot tubs until they're tall enough to keep their heads completely out of the water with their feet firmly touching bottom. Even then, their visits should be brief. Never allow children to submerge their heads in a hot tub. Because high temperatures encourage the growth of certain microorganisms, an earful of water from a hot tub can lead to an external ear infection. Far worse, long hair can get caught in a hot tub grate and cause drowning.

Mayo Clinic June 2007

Help for allergy sufferers

In springtime, when trees burst with leaves and flowers open, are you distracted by sneezing, sniffling, and itchy eyes? In summer, do you shut out the breeze and hide indoors? Year-round, do you wage a constant battle with dust mites or pet dander? If so, you are all too familiar with the symptoms of an allergy attack.

The American Academy of Allergy, Asthma, and Immunology estimates that 40 million to 50 million Americans suffer from allergies. Allergies can range from irritating inconveniences to chronic debilitating conditions. They can even be life-threatening, as in the case of allergic shock. Because of their potential severity and increasing prevalence, allergic reactions have been the focus of rigorous research. This work has resulted in a greater understanding of the complex nature of allergic reactions, which in turn has led to more effective treatment options.

Hay fever, or rhinitis, is the most common allergy in the United States, affecting about 40 million Americans. There are two categories of rhinitis: allergic rhinitis caused by allergens, and non-allergic rhinitis caused by irritants, such as fragrances, tobacco, and wood smoke. Pregnancy can also bring on non-allergic rhinitis symptoms, as can certain medications and conditions, such as thyroid hormone deficiency.

Generally, an allergic rhinitis reaction occurs when you breathe airborne, outdoor or indoor allergens. Within minutes, the whole shebang of sneezing, runny nose, nasal congestion, and itchy eyes is in full swing. Regular exposure to these allergens leads to persistent symptoms.
When the trigger is pollen — from trees, grasses, or weeds — or mold, and your allergies kick in seasonally, the common term is “hay fever.” But allergic rhinitis can also be a year-round condition that can lead to and exacerbate other allergies, such as allergic asthma and allergic conjunctivitis. And repeated exposure to allergens hypersensitizes the nasal mucosa, so that ever lower amounts of allergens can spark a reaction, as well as make you sensitive to non-specific irritants.

Allergies can be successfully managed but not cured. Educating yourself about your allergy — what triggers it, how it works in your body, and the various treatment options available — can make a big difference in the quality of your life. Especially if you are predisposed to allergies, you may have more than one type of allergy, making it even more important to understand how to manage your allergies.

Increased medical knowledge and new developments in modifying existing medicines are making allergy treatments safer and more effective. As a result, your doctor can tailor medications to you and your lifestyle.

Allergy tip: To reduce hay fever symptoms, start taking your allergy medicines (antihistamines, nasal steroids, and so forth) several weeks before you anticipate your allergy season will start. Clinical trials have demonstrated that this strategy is more effective than starting the same medicines after you have already developed

Harvard Medical School, April 12, 2007

Teens with Food Allergies Often Take Life-Threatening Risks

Science Daily, April 18, 2007

(HealthCentersOnline) - An alarming number of teenagers with food allergies admit to purposefully ingesting problem foods, according to a new survey. Many teens also fail to carry life-saving medication with them, depending on the circumstances and perceived risks.
A food allergy is a potentially fatal response by a person's immune system to a food or food component. After a susceptible person ingests a problem food, the immune system reacts with the release of histamines and other chemicals that trigger symptoms ranging from mild to severe.

There is no way to know whether a person with a food allergy is likely to have a mild or life-threatening reaction, called anaphylaxis, after eating the problem food. Therefore, individuals with a food allergy are advised to completely avoid all foods to which they are allergic. Since accidental ingestion is also a possibility, people with food allergies may also be advised to carry an allergy kit containing epinephrine, a life-saving medication used to treat severe allergic reactions, with them at all times.

Although there are steps people with food allergies can take to lower their risk for a serious reaction, fatal food reactions still occur. These reactions are most common among adolescents and young adults. According to new research, this may be due to members of this age group using poor judgment, particularly when they are out with friends.

Researchers from the Mount Sinai School of Medicine in New York and the Food Allergy & Anaphylaxis Network (FAAN) used an anonymous Internet questionnaire to survey 174 food allergy patients between the ages of 13 and 21.

The survey data revealed that more than half of the respondents admitted to knowingly consuming a potentially unsafe food. Only 61 percent of subjects always carried their epinephrine, and the carrying rates varied by activities or circumstances. Activities such as traveling and going to restaurants had high carrying rates. However, the rates were much lower for certain peer-related social activities, such as going to a friend's home, participating in sports activities, wearing tight clothing or attending a school dance.

"For a teen or young adult with a food allergy, risk taking while eating certain foods can be deadly. In a previous study of fatal reactions, we found that 69 percent of those that died were between age 12 and 21," Anne Muñoz-Furlong, founder of FAAN and one of the authors of the study, said in a press release.

The majority of respondents also indicated that education of their friends would make living with a food allergy easier. However, they did not want to educate their peers themselves.

After reviewing the study data, the researchers also concluded that patients who take the most risks by eating problem foods and not carrying epinephrine are the ones who are likely to feel "different" because of their food allergies.

These findings are significant because they suggest that the education of teenage food allergy patients and their peers may reduce risk taking behavior and its consequences.

Details of the study were provided by the Food Allergy & Anaphylaxis Network (FAAN) in a press release. The full study appears in the June issue of the Journal of Allergy and Clinical Immunology.

Copyright 2000-2006 HealthCentersOnline, Inc.
©2007 Healthology, Inc.

Aging parents: 10 things to know for an emergency

Prepare for an emergency by gathering the information you might need should your parent be hurt and unable to respond to doctors' questions.

If your aging parents were to have a medical emergency, could you provide the vital information doctors would need to care for them? Do you know the names of your aging parents' doctors? Is your mom taking any medications? Has your dad ever had any surgery?

If you're like most, you probably don't know the answers to some of these questions about your aging parents. It only takes a few minutes to collect and write down this vital information. And it can save precious time in an emergency.

"Sometimes a parent isn't able to give medical information when an emergency arises, so emergency medical personnel must rely on the adult children or a spouse for that information," says Paul Takahashi, M.D., a specialist in geriatrics at Mayo Clinic, Rochester, Minn. "These are things you should know. Just as you fill out those emergency cards for your kids in school, you should have similar information available about your parents."

Below — in order of importance — is a list of 10 things you need to know about your aging parents' health.

Names of their doctors. If you don't know anything else, this is probably the most important piece of information. Why? Chances are good that your parents' doctors can provide much of the rest of the information needed as well as more details about your parents' specific health histories.
Birth dates. Often medical records and insurance information are cataloged according to birth date. This can improve communication in an emergency or a crisis.
List of allergies. This is especially important if one of your parents is allergic to medication — penicillin, for example.
Advance directives. An advance directive is a legal document that outlines a person's decisions about his or her health care, such as whether or not resuscitation efforts should be made and the use of life-support machines.
Major medical problems. This includes such diseases as diabetes or heart disease.
List of medications. It's especially important that a doctor know if your parent uses blood thinners.
Religious beliefs. This is particularly important in case blood transfusions are needed.
Insurance information. Know the name of your parents' health insurance provider and their policy numbers.
Prior surgery. List past medical procedures, such as cardiac bypass surgery.
Lifestyle information. Do your parents drink alcohol or use tobacco?

Knowing these 10 things should help you take care of your parents in an emergency.

HIPAA and privacy
During conversations with medical staff, the issue of privacy may come up. Staff may want to make sure they're allowed to speak with you regarding your parent's care. In the United States, patient privacy is governed by rules often referred to as HIPAA, or the Health Insurance Portability and Accountability Act.

HIPAA does not prevent a doctor, nurse or health plan employee from discussing your parent's care with you if it's in the best interest of your parent. For example, if discussing your parent's care would help a doctor take care of your parent, that's considered in your parent's best interest.
To help you care for your aging parents, fill out this downloadable emergency medical information form and keep it with you in your wallet or purse.

April 18, 2007, Mayo Clinic

9 tips for your health and the planet’s

Suggestions for how to be healthy and “green”

Aside from pesticide use and a few other issues, most of us haven’t worried much about the connections between health issues and the environment. For our health, we work on our waistlines and fret over our cholesterol levels. For the environment, we recycle and maybe drive a fuel-efficient car.

But because of accelerating climate change and the havoc it could wreak, it’s not so easy to send environmentalism off into its own separate compartment these days.

We thought we’d bring personal and environmental health together and provide nine “green” and perhaps surprising health tips.

1. Go to bed early. This may help you lose weight and will put a damper on energy use. Americans weigh more and are sleeping less. Average daily sleep time has decreased from about nine hours a century ago to about seven now. Studies have identified a correlation between short sleep and being overweight or obese. Hormones may be why: Lack of sleep depresses the levels of leptin, the hormone that tells the brain we’re full, and increases ghrelin, the hormone that makes us hungry. Household use of electricity has increased by over 50% since the early 1980s. By turning in earlier, we’ll dial down our appetite for kilowatts and maybe food.

2. Turn down the heat and the air conditioning. By adjusting your thermostat, you may keep your metabolism burning more calories but use less of another kind of energy. Humans, like other mammals and birds, control their body temperature by continually adjusting their metabolisms. When the air is cool, metabolism revs up to produce more heat. When it’s hot, sweating and other responses also burn up extra energy. But when air temperatures are in the thermoneutral zone (TNZ) — which for humans with their clothes on tends to be in the mid-70s — our metabolisms don’t have to work so hard to maintain body temperature, and we burn fewer calories. We’re spending more time in our TNZs these days because of heating and — particularly — air conditioning. Some experts believe all that time in the comfort zone is contributing to the obesity epidemic.

3. Eat fish, but the right kind. Fish needs no introduction as a healthful food, especially in these pages. As the main food source of long-chain omega-3s, it’s good for your heart and probably your brain. But the sterling health credentials have some environmental tarnish. Some species are contaminated with pollutants — mercury and PCBs are the main concern. Stocks of others have been dangerously depleted by too much fishing. Some groups are working to steer consumers to species that are in good supply. The Marine Stewardship Council, a British group, certifies fisheries as sustainable. Environmental Defense, a New York-based environmental group, has posted a helpful list of best and worst fish choices at www.oceansalive.org. The Blue Ocean Institute has a useful guide at www.blueocean.org/seafood.

4. Switch to energy-saving light bulbs, but don’t throw them in the regular trash. Those curlicue compact fluorescent light bulbs that Home Depot wants you to buy are the real deal. They use two-thirds less energy than a regular incandescent bulb and last up to 10 times longer. The Natural Resources Defense Council, a mainstream environmental group, estimates that each compact bulb keeps half a ton of carbon dioxide out of the air over its lifetime. But all fluorescent bulbs need mercury to work, and the compact versions contain about five milligrams of the metal. That’s not much — an old-fashioned home thermometer contains a hundred times that amount — but if you throw them out in the regular trash, that mercury may end up in the air or water, and, by climbing the food chain, in the fish on your plate. The environmentally good deed you performed by buying the light bulbs would be completely undone by the way you got rid of them. Call your town or city’s public works department to find out where you can dispose of fluorescent light bulbs safely. A corporate-sponsored Web site, www.earth911.org, lists businesses and local governments that handle household hazardous waste.

5. Learn a lesson from palm oil and good intentions gone awry. As the tide turns against trans fat, food manufacturers are scrambling for substitutes. Palm oil has emerged as a candidate. Some varieties of trans fat–free Oreos are made with palm oil and another trans fat replacement, high-oleic canola oil. In Europe, palm oil has also been touted as an environmentally friendly renewable “biofuel” alternative to fossil fuels like coal and gas. But to satisfy the growing demand for the tropical oil, huge tracts of Southeast Asian rainforest are being cut down and planted with palm trees. Farmers are also draining and burning huge swathes of peatlands, which help offset greenhouse emissions by soaking up carbon. The New York Times described palm oil as a green fairy tale that is beginning to look more like an environmental nightmare. Palm oil is an improvement over trans fat as far as personal health is concerned, but that’s not saying much. About half of the fat molecules in palm oil are saturated, and saturated fat increases cholesterol levels. The moral of the story is not to be dazzled by alternatives in either the environmental or personal health realms. They, too, may have dark sides. As best we can, we need to look before we leap.

6. Eat local fruits and vegetables. By all means, eat fruits and vegetables. Good health depends on it. But Michael Pollan’s book The Omnivore’s Dilemma raises some questions about the means by which we get them. Flying kiwis in from New Zealand and grapes up from Chile is an energy-intensive way to fulfill the fruit-and-vegetable imperative. It’s possible only if energy is cheap, and cheap energy in this fossil fuel era of ours means tons of greenhouse gas emissions and global warming. The Pollan book has inspired the buzzword “food miles” — how far food has been transported to reach our plates. “Local and sustainable” is flaunted as a virtue on restaurant menus. Some economists take issue with putting “local” on a pedestal. Their point: Global trade may entail high transportation costs, but it also organizes food production to occur where it’s most efficient. Besides, isn’t it wonderful to have fresh produce out of season? The reasonable middle ground is to give some preference to locally grown food. Is that shiny Granny Smith apple from New Zealand worth the greenhouse emissions when a Macintosh from a nearby orchard might do? And shopping at farmers’ markets is a good way to reduce your food mileage. You’ll be even “greener” if you walk or bike there.

7. Don’t take more medications than you need to. In most cases, our bodies use only a fraction of any drug we take. The rest gets excreted, but it doesn’t disappear once we’ve flushed. Scientists are still sorting out which drugs are causing significant harm and at what levels. But there’s already evidence that pharmaceuticals in waste water adversely effect aquatic ecosystems. In 2005 Swedish environmental scientists reported that some beta blockers and antibiotics, and carbamazepine (Tegretol, other brands), an antiseizure medication, seemed to be especially persistent in a small river in the southern part of the country. All drugs have side effects, so for your own health, you should take medications that are necessary but no more. Now the environmental consequences may be another reason to be prudent in your pill intake. And if you’ve got old medications, don’t flush them down the toilet. Leave them in the container and throw them in the regular trash, although be sure to scratch off any identifying information for privacy reasons. Mix a little cat litter into liquid medicines and put some water in pill bottles.

8.Walk or bike to work. At a bare minimum we’re supposed to get 20–30 minutes of exercise most days of the week. The Institute of Medicine says that isn’t really enough and recommends a full hour of moderately intense activity a day (biking and walking at a 4-mile-per-hour clip meet the moderately intense standard). But we’re a nation of drivers, not walkers or bikers, and almost every driving statistic you can think of is headed in the direction of a hotter planet. The average fuel economy of new cars has declined since 1988 because of the popularity of minivans and SUVs. Vehicle miles traveled per person have grown twice as fast as the American population in recent years. Households with four or more cars now outnumber those with no car. And the proportion of commuters who carpool or walk or bike to work has slid since 1980, while the percentage of those driving alone has crept up from 64% to 76%. Could there be a better good-for-you, good-for-the-planet twofer than the walking or biking commute? Combining exercise and a commute builds exercise into your day, which means you don’t have to summon extra willpower, to say nothing of time, to go to the gym. If you live too far away, consider walking or biking to public transportation or driving only part of the way.

9. Get behind the greening of hospitals and medical buildings. American hospitals are on a building spree that rivals the post–World War II boom. Hospitals aren’t getting bigger — the number of beds is declining. But they’re getting more deluxe, with additional private rooms and more sophisticated technology. Health economists worry that these gold-plated facilities will put further pressure on health care costs. In some cases, though, hospitals are seizing the opportunity to build “greener” buildings, which have attributes that may also improve the health and well-being of patients. Building a hospital or nursing home with more natural light not only saves energy but may also enhance the mood of patients (and staff!) and keep them more oriented. Some hospitals are taking steps to improve indoor air quality with proper ventilation and use of materials that don’t emit volatile organic compounds. As individuals we can’t go build a green hospital the way we can buy an energy-efficient car. But we can encourage their construction by writing a letter (hospitals are very public relations conscious) and supporting policies and programs that encourage energy-efficient construction.

April 23, 2007
Harvard Medical School

Surprising advice for insomniacs — sleep less

Changing your behavior, rather than medication, may be the first step to a better night’s sleep. And surprisingly, for chronic insomnia, the best treatment may be to cut back on the time you spend trying to sleep.

People with insomnia often find that spending less time in bed promotes more restful sleep and helps make the bedroom a welcome sight instead of a torture chamber. As you learn to fall asleep quickly and sleep soundly, the time in bed is slowly extended until you obtain a full night’s sleep.

Some sleep experts suggest starting with five or six hours at first, or whatever amount of time you typically sleep at night. Setting a rigid early morning waking time often works best. If the alarm is set for 7 a.m., a five-hour restriction means that no matter how sleepy you are, you must stay awake until 2 a.m. Once you are sleeping well during the allotted five hours, you can add another 15 or 30 minutes, then repeat the process until you’re getting a healthy amount of sleep.

Reconditioning
In the 1970s, a Northwestern University professor developed a technique to recondition people with insomnia to associate the bedroom with sleep. These are the rules:

Use the bed only for sleeping or sex.
Go to bed only when you’re sleepy. If you’re unable to sleep, get up and move to another room. Stay up until you are sleepy; then return to bed. If sleep does not follow quickly, repeat.

During the reconditioning process, get up at the same time every day and do not nap.
The idea is to train your body to associate your bed with sleep instead of sleeplessness and frustration.

Relaxation techniques
For some people with insomnia, a racing or worried mind is the enemy of sleep. In others, physical tension is to blame. Fortunately, there are ways to release physical tension and relax more effectively. Relaxation techniques that can quiet a racing mind include meditation, breathing exercises, and progressively tensing and relaxing your muscles starting with your feet and working your way up your body — a technique known as progressive muscle relaxation.

In biofeedback, people use equipment that monitors and makes them aware of involuntary body states (such as muscle tension or hand temperature). Immediate feedback helps people see how various thoughts or relaxation maneuvers affect tension, enabling them to learn how to gain voluntary control over the process.

Biofeedback is usually done under professional supervision. Other relaxation techniques — such as progressive muscle relaxation or meditation — can be learned in behavior therapy sessions or from books, tapes, or classes.

If thoughts distract you, gently ignore them and return your attention to your breathing. Your worries and thoughts will be there when you are ready to acknowledge them.

--Harvard Medical SDchool, April 26, 2007

Age of parents could relate to autism in children

The age of a child's parents and how 1-year-olds respond to a simple name test could provide clues on autism, according to two studies published today by Northern California researchers.
The studies, by scientists at Kaiser Permanente and the University of California, Davis, were published in the Archives of Pediatric and Adolescent Medicine in a special issue on autism.
In one study of more than 132,800 children born at Kaiser Permanente hospitals in Northern California over a five-year period, Kaiser researchers found that the risk of having an autistic child rose with maternal and paternal age.

Women age 40 and older had a 30 percent higher risk of having an autistic child than women ages 25 to 29. Risk among fathers 40 and older increased by 50 percent over men in their mid-to-late 20s, according to the study.

If both parents are older, the risk is even higher, said Lisa Croen, an epidemiologist with Kaiser and lead author of the study.

"As both the mother and father get older, their chances of having a child with autism increases in a statistically significant way," Croen said.

Still, the findings should be put into perspective. Women who give birth between the ages of 25 and 29 have a 1 in 156 chance of having an autistic child, while a woman over 40 has a slightly higher risk - a 1 in 123 chance of having an autistic child.

Men in their mid-to-late 20s have a 1 in 176 risk of having a child with autism. Men in their 40s at the time of their child's birth have a 1 in 116 chance of having an autistic child, according to the study.

Researchers reviewed the medical records of 132,844 children born at Kaiser Northern California hospitals from 1995 to 1999. They determined maternal age by those records, and paternal age by birth certificates obtained through the state. Nearly 600 of these children were later diagnosed with an autism spectrum disorder.

"What our study suggests is there are biological or social or lifestyle factors related to older parenthood that increase the risk of having a child with autism," Croen said. The study was funded by the Centers for Disease Control and Prevention and the Kaiser Foundation Research Institute.

Mutations in cells that become sperm or other biological factors related to aging parents could play a role, Croen said.

Advanced maternal age has been associated with autism risk in some previous studies. The role of father's age has been linked to miscarriage and childhood cancers.

Kaiser soon will begin recruiting children and their parents for a five-year study to further explore genetic and environmental factors that could cause autism. The Study to Explore Early Development, SEED, involves six research centers nationwide and will be housed at Santa Teresa Kaiser in San Jose.

In another study published today, researchers at UC Davis suggest that a quick test could indicate risk of an infant developing autism later on.

The test is simple: Seeing if a 1-year-old responds when his or her name is called.
In the study involving about 100 infants, three-fourths of 1-year-olds who did not respond to their name when called were identified with developmental problems at age 2. Of children later diagnosed with autism, half failed the name test at age 1.

The authors, who are researchers at the MIND Institute at UC Davis, one of the nation's leading centers on autism, suggest incorporating the test into pediatric checkups.
They note that earlier interventions can lead to better outcomes in autistic children. Autism is typically diagnosed at age 3 or 4.

"Failure to respond to name at the well-child one-year check-up may be a useful indicator of children who would benefit from a more thorough developmental assessment," the authors write. "It will not, however, identify all children at risk for developmental problems."

Anecdotal evidence has suggested that response to name is an early indicator of autism but this is the first controlled study to confirm the link. The study was funded by the National Institutes of Health.

Autism affects about one in 150 children born in the United States, according to the CDC.

(By Rebecca Vesely, MediaNews, April 2, 2007)

Not Your Blood Type? Don't Sweat It

A new technique can convert type A and type B red blood cells into type O, the "universal donor" blood type that can be transfused into all patients. The advance could help avoid blood shortages.

The four primary human blood types--A, B, AB, and O--arise from differences in molecules called antigens that dot the surface of red blood cells and provoke responses from the body's immune system. Individuals with the type A antigens make antibodies to type B antigen, which causes their bodies to attack and reject transfused type B blood as foreign. The same grim scenario unfolds for type B individuals who get type A blood. Blood from type O individuals lacks both antigens and can be safely transfused into people with all four blood types. Type O individuals can receive only type O blood, however, which means that during blood shortages, they may want for blood that’s been donated to patients with other blood types.

To alleviate type O blood shortages, Henrik Clausen, a glycobiologist at the University of Copenhagen in Denmark, and a team of scientists at ZymeQuest, a biotechnology company based in Beverly, Massachusetts, hunted for enzymes that convert other blood types to type O. The A and B antigens consist of similar branched carbohydrate molecules that differ in the sugars that cap their tips. The researchers searched for enzymes that would snip the sugars off the two antigens without damaging red blood cells.

The company had previously isolated a coffee-bean enzyme that stripped the B antigen that worked, but too inefficiently. To identify and mass-produce more efficient enzymes, they tested extracts of 2500 kinds of bacteria and fungi. They focused on two enzymes: One, from a bacterium that causes infant meningitis, converted type A blood into type O, while another, from a human gut bacterium, converted type B to type O. (The two enzymes together convert type AB to type O.)

Each enzyme stripped so much of its target antigen from red blood cells that the antigen could not be detected by a U.S. Food and Drug Administration-approved blood-typing test and by a subsequent chemical test, the researchers reported online yesterday in Nature Biotechnology. ZymeQuest is testing the type-A-converting enzyme for effectiveness in blood clinics and hopes to conduct a clinical trial of the type-B-converting enzyme beginning later this year, Clausen says.
"I was impressed" by the study, says transfusion scientist Geoff Daniels of the Bristol Institute for Transfusion Sciences in Bristol, U.K. Type O blood runs short any time blood is in short supply, Daniels says. If the technology proves safe and effective in humans and financially viable for blood banks, he concludes, in a few years the new enzyme technology "would be able to reduce the pressure on [type] O."

(By Dan Ferber, ScienceNOW Daily News, 2 April 2007)

Do grapes and grape juice protect the heart like wine does?

Q: For the health of my heart and arteries, how does regular consumption of red wine compare with grape juice or the equivalent in grapes?

A: You are asking a question that science hasn’t caught up with. Let’s start by looking at what benefits you get from grapes and grape juice. Grapes of all colors are chock-full of antioxidants and a myriad of other phytonutrients. Some that have been identified as possible cardio-protectors are flavonoids such as resveratrol and quercetin, procyanidins, tannins, and saponins. But keep in mind that the grapes you find in the grocery store aren’t necessarily as hearty as those us

Are your eyes at risk? Praying for Lower Blood Pressure? Is your hearing really getting worse, or are you just imagining things?

Contact lenses: What to know before you buy

Avoiding eye infections

Types of contact lenses

Pros and cons of soft vs. gas-permeable contact lenses

Getting the right fit

Risk factors for thyroid disease

Risk increases with age

Massage: A relaxing method to relieve stress and pain

Health benefits of massage

Risks of massage

What to expect during a massage

A health care tool

1. Know your risk

2. Exercise

3. Control your weight

4. Improve your diet

5. Lower your blood pressure

6. Control your cholesterol

7. Quit smoking

8. Control your blood sugar

9. Prevent clots

Stress-reducing techniques that work

Mini-relaxations

Are your eyes at risk?
Praying for Lower Blood Pressure?
Is your hearing really getting worse, or are you just imagining things?