Women's Health Newsletters 1/11/04 - 3/21/04
****** Woman's Health Newsletter ******* January 11, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Mood and food - Understanding the relationship 2. Omega 3 fatty acids and cardiovascular disease 3. Reader submitted Q&A - Is dementia hereditary? 4. Coffee consumption and diabetes 5. Health tip to share - Humidifier in winter 6. Humor is healthy The next newsletter will be in two weeks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Mood and food - Understanding the relationship ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Negative moods, such as stress, anger, anxiety, boredom, sadness and loneliness can often be counteracted by chemical pain killers that the body releases when certain foods are digested. The problem is that we can become addicted to using these foods to ease our negative feelings. As a result we eat more calories than we need in order just to feel better. If we could learn to recognize our negative moods and and deal with them by methods other than eating, we might all be a few pounds lighter. Fats and simple carbohydrates seem to release the most pleasurable body chemicals; but who ever heard of eating just a piece of lean beef or piece of uncoated fish when we were trying to perk up from a negative mood. Complex carbohydrates, such as most vegetables, also take longer to digest and do not seem to ease negative moods. We might not immediately feel better if we reached for carrots and celery but we would certainly not put on as much weight as when we use chocolate, ice cream, pasta or bread to boost our moods. Whether we gain weight when trying to emerge from negative emotions may also depend upon what's handy to eat wherever we are. So what can you do if you seem to be addicted to eating to blunt or erase a negative mood? Some suggestions from Mayo Clinic include: learn to identify quickly when you are having a negative emotion learn to recognize true hunger, an empty stomach rather than a mental need learn what triggers a mental need for food look elsewhere or use methods other than eating to improve your mood do not keep starchy, high-fat, high-calorie comfort foods in the house or handy at your p[lace of work exercise regularly - it also helps to relieve negative moods by producing advantageous body chemicals and it is the opposite of fattening On the other hand, if you think your depressed, irritable, anxious or stressed out mood is a chronic problem, seek medical help for diagnosis and treatment. Mood and food ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Omega 3 fatty acids and cardiovascular disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Omega 3 fatty acids from fish and fish oils have been shown to be protective against coronary heart disease. This was first discovered because the Greenland Eskimos had very low incidences of coronary heart disease in spite of a diet very high in fat. Since then studies have looked at the relationships of these polyunsaturated fats and coronary heart disease. Overall, Omega 3 fatty acid supplements aid in the prevention of coronary heart disease. The fish oil derived fatty acid supplements have been shown to reduce the risk of sudden death following initial survival from a heart attack by about 45% and the overall mortality by about 20%. This compares very favorably with many of the statin drugs although how the omega 3's prevent this is not understood. The supplements also tend to reduce blood triglycerides if that is a problem. The current recommendations of the American Heart Association are: Patients without documented coronary heart disease: Eat a variety of (preferably oily) fish at least twice weekly. Include oils and foods rich in linolenic acid Patients with documented coronary heart disease: Consume 1 gram of eicosapentanoic and docosahexanoic acid daily, preferably from oily fish. Supplements could be considered in consultation with a doctor Patients with hypertriglyceridemia: Take 2-4 grams of eicosapentanoic acid and docosahexanoic acid daily, provided as capsules under a doctor's care The side effects of most supplements are very low and include only occasional abdominal bloating. Omega 3 fatty acids and cardiovascular disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Is dementia hereditary? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "My mother's sister has dementia, and my mother's memory is becoming worrying. My grandmother was in a mental institution for many years and I am now wondering if she may have had Alzheimer's or dementia but went undiagnosed back then. I am concerned that there may be some hereditary factors? My grandmother also had Parkinson's disease and deep depression." "I am age 42, with hypertension, diabetes, and have complex ovarian cysts" - DLP Your question centers on a current medical frontier, i.e., determining the types and causes of what is known as late onset dementia. To summarize in general, there seems likely to be both genetic components and environmental components in many of the dementias but the science is far from conclusive at this point. So far, no one single factor has been identified as a cause for late onset Alzheimer's disease. It is likely that a combination of factors, including age, genetic inheritance, environmental factors, diet and overall general health, are responsible. Early onset dementias, occurring before the age of 60-65, often do have genetic differences which have been described. Fortunately most of these early onset degenerative brain diseases are relatively uncommon or rare. There is an early- onset Alzheimer's disease and a Familial Alzheimer's disease (FAD) and a Pick's Disease that fall into this category among others. These have been found to have definite genetic findings but their onset is almost always before age 60. The most common of the late onset dementias is Alzheimer's disease. Next comes vascular dementia at about 25% of the cases and the third most common (10-15%) is Dementia with Lewy Bodies (DLB). The latter has a 70% association with Parkinson's Disease. After these types come a whole host of rarer types of dementias some of which are known to have a genetic basis; most are unknown in their causes. In the vast majority of late onset Alzheimer's, however, the effect of inheritance seems to be small. If a parent or other relative has Alzheimer's disease, your own chances of developing the disease are only a little higher than if there were no cases of Alzheimer's in the immediate family. I would say that right now, the most important thing would be to be sure what type of dementia your mother's sister has. This needs to be diagnosed by a neurologist or a geriatric specialist. Assuming this turns out to be a late onset Alzheimer's (you did not mention your Aunt's age) then it is still very unlikely you will develop this problem. Actually you may have to worry more about vascular dementia at an elderly age because of your high blood pressure and diabetes. These both have been associated with with the mini-vascular strokes in the brain which are associated with vascular dementia. You should keep you blood pressure and diabetes under control with medicine and undergo as much weight reduction as possible since that will help both diabetes and hypertension. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Coffee consumption and diabetes ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ By this time many of our reader's will have heard news reports indicating that those who drink coffee have a lower incidence of adult onset diabetes. As we have cautioned before in this newsletter, it is important to realize that this is merely a statistical association and not necessarily a cause and effect. Here are some of the facts of the study. In women, less than 4 cups of coffee per day did not lower risk of diabetes At 4-5 cups of coffee per day the risk of diabetes was 70% as it also was with 6 or more cups a day (please not that 5 cups (500 mg of caffeine) of coffee per day is considered caffeine toxicity) Women who drank 4 or more cups of decaffeinated coffee a day had an 85% risk of diabetes I do not think this study should be used either to start taking in more caffeine in order to prevent diabetes nor should it be used as justification for continuing to drink coffee in the range of caffeine toxicity. It is just an association for scientists to know about when they perform further studies. It is not an article to take any action upon in my opinion. Coffee consumption and diabetes ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Humidifier in winter ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Many conditions are worsened when you are in an overly dry environment (humidity less than 30%). This commonly occurs during the winter as heat comes on indoors. Flu, a sore throat, colds, bronchitis, sinusitis, asthma, and dry skin or eyes or nasal linings will all benefit from a using a room humidifier. Keep it in mind this season. If you have discovered ways of coping with a disease or condition and it works for you, please share it with us: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Phone Call" A woman, calling a local hospital, said, "Hello, I'd like to talk with the person who gives the information regarding your patients. I'd like to find out if the patient is getting better, or doing as expected, or is getting worse." The voice on the other end of the line said, "What is the patient's name and room number?" She said, "Sarah Finkel, in Room 302." "I will connect you with the nursing station." "3-A Nursing Station. How can I help you?" "I would like to know the condition of Sarah Finkel in Room 302" "Just a moment. Let me look at her records. Oh, yes. Mrs. Finkel is doing very well. In fact, she's had two full meals, her blood pressure is fine, her blood work just came back as normal, she's going to be taken off the heart monitor in a couple of hours and if she continues this improvement, Dr. Cohen is going to send her home Tuesday at twelve o'clock." The woman said, "Thank heaven! That's wonderful! Oh! that's fantastic that's wonderful news!" The nurse said, "From your enthusiasm, I take it you must be a close family member or a very close friend!" "Not exactly, I'm Sarah Finkel in 302! Nobody here tells me nothing!" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter ******* January 25, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Everyday muscle aches and pains 2. Internet breast cancer screening info 3. Reader Q&A - Post menopausal vaginitis 4. Chronic pain after surgery 5. Health tip to share - Extra sleep 6. Humor is healthy The next newsletter will be in two weeks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Everyday muscle aches and pains ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Many individuals In their 40's,50's and older seem to complain of the new onset of increased muscle aches and pain. The health question becomes "Does this mean I am developing a disease"? Many times there is no disease present but lifestyle habits may significantly contribute to the problem. Lack of a proper amount of sleep time is a common cause of increased muscle aches and pains. In patients who have fibromyalgia, decreased sleep time significantly worsens their symptoms. Loss of sleep does this also in normal people. Recommended sleep for most people is 7 1/2 - 8 1/2 hours a night. It is not uncommon for some people to only get 6-7 hours of sleep a night or less. They think that is enough or else they are so busy that's all they can get. If you are running at 90 miles an hour during the day and going to bed late and getting up early, this high stress makes people ache the next day from too much constant tensing of the muscles. You can even have muscle tenseness from sitting at a desk or computer terminal all day just from the lack of movement and intense concentration and muscle tensing. Does exercise help or hinder? It depends upon how much exercise you are doing. If you are pushing the muscles further and further with each exercise session, then they will hurt the next day. If you reach a steady state of exercise then the muscle aches and pains improve or go away. Your mattress and pillow may also make a difference. Too firm and too soft, sagging mattresses contribute to daily aches and pains. Different firmness of pillows can also make a difference with neck pain. So what can you do? A hot shower and stretching exercises in the morning can help. Getting enough sleep at night is also a cornerstone of treatment.The important thing is to make sure your lifestyle is not contributing to the problem before you seek medical diagnostic tests. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Internet breast cancer screening info ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ All of us look for medical information on the Internet. The accuracy of that information we find can be difficult to assess. The site may have accurate, unbiased information or it may be trying to downplay risks and overestimate benefits in order to get us to agree with their point of view. How do you tell if the information is correct? In a recent article in the British Medical Journal, investigators looked at the quality of information about screening for breast cancer with mammography on 27 web sites all over the world. Thirteen sites were from professional advocacy groups, 11 from governmental institutions, and three from consumer organizations. The conclusions of the study were quite interesting. They felt there was a significant bias in favor of mammography screening on the governmental and advocacy group sites; whereas the consumer sites seemed to present a more accurate discussion of not only the benefits but especially the disadvantages and hazards of mammography screening. Some of the findings included: over diagnosis of breast cancer of 33-35% and over treatment of carcinoma in-situ of 30% were ignored on many of the non consumer sites some web sites alleged that breast cancer screening leads to less mastectomies when in fact the opposite is true many sites did not let people know that screening leads to overuse of radiation therapy treatment and also downplayed the complications of radiotherapy false positive mammography findings were often downplayed as sometimes merely creating "anxiety" when in fact "more than 10% of women screened will at some point experience important psychological distress for many months" The authors concluded that as a whole, the consumer run sites were less biased and tended to present the pros and cons of breast cancer screening more accurately while many of the governmental and advocacy group sites tended to gloss over the disadvantages and potentially harmful effects of screening. This is an interesting article that all women should read. Internet breast cancer screening info ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader Q&A - Postmenopausal vaginitis ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "I am 46 years old and am currently being treated for candidiasis with Nystatin(R). I am also menopausal having severe night sweats and hot flashes that kept me up all night. I started HRT 4 months ago to relieve the menopausal symptoms since none of the natural products had any effect. The problem I am having is that the hormones feed the yeast problem, and I am unable to get rid of the yeast. I am in a real catch 22 situation. Have you heard of this condition before, and how do other women handle it?" - anonymous Yeast vaginal infections (candidiasis) is very common before menopause but much less frequent after menopause unless a woman has diabetes. Actually the most common cause of vaginal discharge, itching and burning after menopause is atrophic vaginitis. Atrophic vaginitis is basically a bacterial infection when the normal resistance of the vaginal skin lining is very weak. The "weakness" is usually from low estrogen levels although it can also be from antibiotic therapy or high blood sugar levels just as it can premenopausally. Even though you are taking hormone replacement, if you are still having hot flashes then your estrogen levels are too low. Even if the hot flashes are controlled on HRT, the vaginal skin lining may still not be getting enough estrogen to sustain the normal lactobacillus acidophillus that the vagina depends on to fight of bowel and skin bacteria. Most of the time the doctor's initial therapy for the problem you describe is to prescribe topical estrogen cream (eg., Estrace® vaginal cream or Premarin® vaginal Cream) to the vagina or use the estrogen impregnated silicone rings (eg. Estring®, Femring®) that are placed in the vagina to continually provide estrogen to the vaginal skin. This therapy is often sufficient on its own to prevent the vaginal symptoms whether the source of discharge is bacterial or yeast. In other words, for this problem women do not necessarily need any anti-yeast therapy or anti-bacterial therapy because those are only secondary invaders of a weakened vaginal lining. After a woman used the topical estrogen product for several months, it can be discontinued to see if the problem returns or not. Many times it does not return even if the estrogen levels are still low. Finally, I am not aware of any over-the-counter, non prescription substitute for this except perhaps taking lactobacillus acidophilus supplements. If the estrogen therapy does not work, then you need to have your doctor take a specific bacterial culture of the vagina to see what organism predominates. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Chronic pain after surgery ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ When giving you informed consent about an upcoming surgical procedure, many doctors forget to tell you that chronic pain can often result from any surgery about 5-10% or more of the time. The doctors focus on telling you about curing pain or curing the symptom for which you are undergoing operative treatment but neglect to tell you that sometimes, not often, any body incision can result in a chronic, daily pain that was not there before the surgery. Post operative pain is a significant problem for many surgeries including gall bladder removal, hernia repair, breast surgery, hysterectomy, Cesarean section, lung or heart surgery (thoracotomy) and most orthopedic procedures among others. Some procedures have a lower incidence of post-operative pain while others have higher incidences. The pain may reside mostly at the incision or deeper in internal tissues. No one is absolutely sure what causes the new post surgical pain but many doctors postulate that nerve injury in the skin and sometimes in deeper tissues is the initiating stimulus. As the nerve or nerves try to heal, they may develop a focus of electrical irritation that makes the nerve send a signal to the brain that is painful. Doctors are working on methods to try to lessen the incidence of persistent post surgical pain but for now, the important concept is that you should be aware that this can happen if you are to undergo an operation. Chronic post-surgical pain ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Extra sleep ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ " I enjoy being an early riser but sometimes on the weekends I like to just laze in bed. On a lark, I bought a sleep mask made of silky material at the Dollar Store and tried it. I could not believe the difference it made. I slept an extra hour or two when I wanted to and couldn't believe the sun was so bright when I woke up at 8:30 a.m." - dmg ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ From Joke Du Jour "Best Deal Yet" No nursing home for me. I am checking into the Holiday Inn! With the average cost for a nursing home per day reaching $188.00, there is a better way when we get old and feeble. I have already checked on reservations at the Holiday Inn. For a combined long term stay discount and senior discount, it's $49.23 per night. That leaves $138.77 a day for: 1. Breakfast, lunch and dinner in any restaurant I want, or room service. 2. Laundry, gratuities and special TV movies. Plus, they provide a swimming pool, a workout room, a lounge, washer, dryer, etc. Most have free toothpaste and razors, and all have free shampoo and soap. They treat you like a customer, not a patient. $5 worth of tips a day will have the entire staff scrambling to help you. There is a city bus stop out front, and seniors ride cheap. To meet other nice people, call a church bus on Sundays. For a change of scenery, take the airport shuttle bus and eat at one of the nice restaurants there. While you're at the airport, fly somewhere. Otherwise, the cash keeps building up. It takes months to get into decent nursing homes. Holiday Inn will take your reservation today. And you are not stuck in one place forever, you can move from Inn to Inn, or even from city to city. Want to see Hawaii? They have a Holiday Inn there too. T.V. broken? Light bulbs need changing? Need a mattress replaced? No problem. They fix everything, and apologize for the inconvenience. The Inn has a night security person and daily room service. The maid checks to see if you are OK. If not, they will call the undertaker or an ambulance. If you fall and break a hip, Medicare will pay for the hip, and Holiday Inn will upgrade you to a suite for the rest of your life. And no worries about visits from family. They will always be glad to find you, and probably check in for a few days mini-vacation. The grand kids can use the pool. What more can you ask for? So, when I reach the golden age, I'll face it with a grin. Just forward all my email to: me@Holiday.Inn ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Health Newsletter ******* February 8, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Breast augmentation and mammography accuracy 2. Red yeast rice for cholesterol lowering 3. Reader submitted Q&A - Nighttime arm numbness 4. Complex carbohydrate low fat diet 5. Health tip to share - Sleep tips 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Breast augmentation and mammography accuracy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ doctors do not believe that breast augmentation is associated at all with causing breast cancer. However, some doctors and many patients are worried that an implanted breast prosthesis makes it more difficult to diagnose an early breast cancer using mammography. In order to test the accuracy of mammography in patients who have had a breast augmentation, investigators from several centers across the U.S. looked at women who had breast augmentations and who also had mammography and compared them with women without augmentations. They checked the outcomes of stage of cancer, size and spread to the lymph nodes in both groups of women. The findings showed several things: mammograms were less sensitive in discovering cancers in women with augmentations versus in those without (45% vs 67%) even though mammograms did not pick up as many of the breast cancers in women with augmentations, the severity and size and spread of the breast cancers when they were finally found were the same in both groups. In other words, not finding the cancers as soon did not result in eventually finding more advanced cancers there were not more false positive mammography results when a woman had a breast augmentation The bottom line of the study is that mammograms are less accurate when a woman has had a breast augmentation, but not so low in accuracy that the breast cancer is significantly more advanced when it is finally found.If a woman has had a breast augmentation, she should still have regular mammograms Breast augmentation and mammography accuracy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Red yeast rice for cholesterol lowering ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Nutritional supplements containing rice that has been fermented by a strain of red yeast (Monascus purpureus) have been shown to have cholesterol lowering properties by about 20-40%. In fact, red yeast rice was found to have statin chemicals in it that are identical to a manufactured drug called lovastatin (Mevacor(R)). Apparently the lovastatin was a natural fermentation product in this preparation and the FDA challenged that they should regulate its sale as a drug because this is identical to a drug that they currently regulate. This position was initially defeated in the courts and then reversed so that most of the red yeast rice was removed from the food supplement market. Since that time some products have reappeared and are available. It is important to remember that even though the red yeast rice is a natural product, the statin chemical in it has the same risks as the prescribed statin, ie., possible liver or muscle toxicity. If someone takes red yeast rice they also should have their liver enzymes checked periodically and be sure to report any excessive fatigue or muscle weakness to their physician. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Nighttime arm numbness ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "About 4 hours into my sleep at night, I wake up and my right arm is numb. It goes down my whole arm and into my fingers. My fingers feel tingly. I have to get out of bed and stand up and wait for my arm to return to normal. What's going on with me?" - PJS Numbness and tingling of any extremity or large area of the body is commonly due to some compromise or abnormality of the nerve or nerves supplying the skin and muscles of the area that has gone numb or tingly. This can be due to a nerve being compressed (sleeping on it), abnormally stretched, or any disease or trauma that has involved a nerve. The fact that your symptoms only occur at night when sleeping and resolve with change in position make me suspect that there is nerve compression taking place while you sleep. It might be due either to your arm position or clothes that band tightly across the upper arm when you are asleep. If your right arm is almost always the problem, I would think you are probably lying on your right side and somehow putting pressure on the nerves to your right arm. If the numbness is at the shoulder or above then the compression is near the spine or neck. If the numbness starts below the shoulder, the compression is likely on the upper arm just between your armpit (axilla) and your elbow. If this is the case, you might try arranging some pillows to either force yourself to lie on your left side or to cushion between your chest/breast and right arm when you lay on your right side. Tingling and numbness of the arm are called paresthesias and can be due to many other reasons, however. If this persists in spite of making changes in your sleeping position, you should see your physician. Conditions such as diabetes, multiple sclerosis, tumors of the arm or spine, arthritis or spinal disc problems, vitamin deficiencies, and circulatory disorders, among other things, can cause the symptoms you describe. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Complex carbohydrate low fat diet ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ While low carbohydrate diets ala Atkin's are quite the rage now, they are not tolerated by everyone. Older adults, especially those over age 60 do not do well with high protein and fat consumption. In fact most older adults tend to normally eat more carbohydrates than younger adults. Investigators in Arkansas looked at giving a diet high in complex carbohydrates and low in fat to men and women (average age 66) with impaired glucose tolerance. They had two diet groups and one control group. Both diet groups received a high carbohydrate diet (18% fat, 19% protein, 63% carbohydrates, and 26 gm of fiber per 1000 kcal) and one of the diet groups additionally had an aerobic exercise program while the other one did not. The diet groups actually were not restricted in their number of calories at all but just the ratio of the protein, fats and carbohydrates. Both of the diet groups lost more weight (7-11 lbs on the average over 12 weeks) than the controls. The diet group with an exercise program lost slightly more than the diet group not on an exercise program. The interesting aspect about this study is that the people were not restricted in the amount they were allowed to eat, just in the proportion of fats and proteins in the diet. Thus this is very similar to a vegetarian diet that is high in complex carbohydrates. Complex carbohydrate low calorie diet ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Sleep tips ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "My proven tips on getting more and better sleep: 1) Make your room dark. Purchase black-out blinds or simply nail up an old dark blanket. 2) Purchase a 'white noise' device. It will mask noise such as barking dogs and traffic. (I use an air cleaner, but a humidifier works well also.) 3) If you live in a colder climate, purchase and use an electric blanket. Sleep like a baby!" - Val ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dear Dogs When I say to move, it means go someplace else, not switch positions with each other so there are still two dogs in the way. The dishes with the paw print are yours and contain your food. The other dishes are mine and contain my food. Please note, placing a paw print in the middle of my plate and food does not stake a claim for it becoming your food and dish, nor do I find that aesthetically pleasing in the slightest. The stairway was not designed by NASCAR and is not a racetrack. Beating me to the bottom is not the object. Tripping me doesn't help, because I fall faster than you can run. I can not buy anything bigger than a king size bed. I am very sorry about this. Do not think I will continue to sleep on the couch to ensure your comfort. Look at videos of dogs sleeping, they can actually curl up in a ball. It is not necessary to sleep perpendicular to each other stretched out to the fullest extent possible. I also know that sticking tails straight out and having tongues hanging out the other end to maximize space used is nothing but doggy sarcasm. When I am playing the pinball machine, jumping up and trying to grab the ball through the glass is not helpful. Barking at me because I'm not helping you achieve your goal does not win you any extra brownie points. My compact discs are not miniature Frisbees. For the last time, there is not a secret exit from the bathroom. If by some miracle I beat you there and manage to get the door shut, it is not necessary to claw, whine, try to turn the knob, or get your paw under the edge and try to pull the door open. I must exit through the same door I entered. In addition, I have been using bathrooms for years, canine attendance is not mandatory. The proper order is kiss me, then go smell other dogs butt. I can not stress this enough. It would be such a simple change for you guys to make. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
********** Health Newsletter *********** February 22, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Protect your arthritic joints to prevent pain 2. Spider veins - what can be done? 3. Reader submitted Q&A - Zocor concern 4. Risk factors for new onset kidney disease 5. Health tip to share - Numb, tingling arm 6. Humor is healthy The next newsletter will be in two weeks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Protect your arthritic joints to prevent pain ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Our joints wear and tear with aging often causing some discomfort with certain activities that stress the joints. Even if age is not a problem but you have arthritis, the joints may become quite painful, lasting a long time even with minimal physical motion at the joint bone connection. Protection is necessary for not only the large joints like the hip, knee and shoulder, but also fingers, wrists, elbows and feet can benefit from change in our everyday movement habits in order to function without pain. The experts at Mayoclinic.com have come up with some tips to guard those joints from unnecessary pain and stiffness: Move each joint through its full pain-free range of motion at least once a day. Learn to Understand the difference between the general discomfort of arthritis and pain from overuse of a joint. Be careful how you use your hands - avoid tight grips; avoid bending the large knuckles of your hand while keeping the middle and end joints straight and your thumb parallel to your fingers; avoid pinching items between your thumb and your fingers -- rather hold the objects in your entire palm if possible. Use proper body mechanics when sitting or standing for a long time, when lifting or carrying heavy objects and when picking objects off of the floor. Use the strongest joint available for the job. Avoid keeping the joint in the same position for long periods of time Intermix periods of joint rest and activity during the day. Do not be afraid to use assistant devices to help carry, move or open items. You may want to use utensils with larger handles or add extenders to knobs or dials for leverage to turn them. You may even benefit from items to help you get dressed or even to walk. All of these aids will help protect the joints from becoming painful or will assist a stiff joint to still do the job. Arthritis: Protect your joints to prevent pain ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Spider veins - what can be done? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Spider veins are small red, blue or violet veins that often occur on the thighs, calves and ankles. They may look not only like a spider with "legs" radiating out from a central body, but also like a series of lines or branches. Sometimes the veins may cause aching, burning, swelling or night cramps although most of the time they do not produce any physical symptoms. These veins are not the same as varicose veins which actually are much larger; usually a 1/4 inch diameter or more. Many people consider spider veins simply as unattractive and they may wish to have them treated. Doctors are not absolutely sure what causes these small veins but several factors seem to contribute to their development: heredity, pregnancy, weight gain, physically straining occupations or activities requiring the use of certain medications. Even though these small surface skin veins are part of the larger vein system of the body, they are not essential to the vascular blood flow. This allows doctors to go ahead and use lasers or inject scarring chemical solutions (sclerotherapy) that seal off the vessel from allowing any more blood to go through it. When the blood flow is cut off, the redness of the spider vein on the surface of the skin disappears. Sclerotherapy is commonly used by plastic surgeons and dermatologists to get rid of these veins although lasers are being used more and more. There may even be a response from using Vitamin K cream on the spider veins. With sclerotherapy, the veins are injected with a chemical to seal off the vein but it may take more than one session to effectively do this. Serious complications are rare but can happen. One may develop blood clots in nearby veins, severe inflammation of the skin, or even allergic reactions to the sclerosing solution and skin injury that could leave a small but permanent scar. Less serious, but not rare, complications include: some pigmented (splochy) areas that take awhile to go away and, developing new spider veins around the previously injected vein. If you think you might be interested in this procedure, check out the article at the American Society of Plastic Surgeons. Spider veins - what can be done? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Zocor(R) concern ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "I am now taking 80 mg. of Zocor(R) (simvastatin). I hear of the serious side-effects of this drug. Please give me an herbal alternative." - anonymous Zocor belongs to a class of drugs called statins. They are used to lower bad cholesterol (LDL) and many times they also raise good cholesterol (HDL). There are studies that show they not only lower cholesterol but also can reduce adverse cardiovascular events in people who have risk factor for heart attacks and strokes. There is still a question as to whether or not they reduce the death rate overall in patients who do not have risk factors other than the high cholesterol. You are correct that any of the statin drugs can cause some major complications although not very frequently. One of the worst complications is killing off the body's muscle cells (rhabdomyolysis) which can lead to extreme and permanent muscle weakness. This probably happens in about one person per 10,000 or more. Muscle soreness is more frequent at about 2%. Liver toxicity is also a rare (less than 0.5%) but serious problem. Dietary lowering of LDL cholesterol can be brought about by following a low saturated fat diet that includes added fiber, soy protein and almonds. Red yeast rice has been shown actually to have statins (lovastatin) in it. We wrote about it in the newsletter in the last issue. It can lower cholesterol by about 20-40%. I would not consider it an herb but rather a nutritional supplement. You still should have your liver enzymes checked periodically when using it. This has the most data with it as a non prescription way of lowering cholesterol but it probably should be considered almost the same as the drug lovastatin (Lipitor(R)). Red wine with or without the alcohol in it and grape juice from red grapes lowers the absorption of lipids from meals as well as raising good cholesterol (HDL) blood levels. Other herbs that are in the literature about lowering cholesterol but of which I have no experience are: fenugreek (Trigonella foenum-graecum), artichoke leaf extract (Cynara scolymus) red glory bower (Clerodendron colebrookianum Walp (family, Verbenaceae) from China Indian gooseberry (amla - Emblica officinalis) It seems if you are going to go to the trouble of taking either a medicine or a supplement to lower cholesterol, it would be smart to permanently change eating habits to increase fiber as much as you can and regularly use red grape products, almonds and soy. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Risk factors for new onset kidney disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Chronic kidney disease is much less common than it was in the days before widespread use of antibiotics, yet many individuals still develop life-threatening kidney disease. If the kidney impairment becomes bad enough and you lose too much function, kidney hemodialysis several times a week is the only way to stay alive. While several diseases are known to be associated with chronic kidney disease, the factors associated with the new development of kidney disease are not well studied. In a recent study of over 2500 individuals living in a community, investigators looked at risk factors for the development of chronic kidney problems in individuals who were not known previously to have kidney problems or active medical diseases. Both men and women who averaged 43 years of age at the start of the study were followed for almost 20 years. Over 9% of the study individuals developed chronic kidney impairment over that time. The major risk factors associated with this were diabetes, hypertension, smoking and obesity. The biggest risk, however was with preexisting low kidney blood flow (glomerular filtration rate or GFR). This is a measurement based on a collection of urine for 24 hours along with a blood test called a 24 hour creatinine clearance. It measures GFR on the average how much blood is being cleared of waste products by the kidneys. A mildly reduced GFR (<90 mL/min per 1.73 m2) predicted a 3-fold chance of progression to kidney disease. This means to me that kidney impairment can develop over a fairly long time, many years before any other disease or risk factor is present. While doctors do not order this 24 hour urine test as a screening for future kidney disease, it appears that maybe they should. I do not know if you asked your doctor to order such a test - a 24 hour creatinine clearance - that he or she would comply with your request, but it is not an expensive test. It might not hurt to ask especially if you have high blood pressure, diabetes or are moderately overweight. If the test indicated slightly low flow, it might be more incentive to lower your blood pressure, weight or blood sugar through dietary or lifestyle modification than you have at the present time. Risk factors for new onset kidney disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Numb, tingling arm ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "I have carpal tunnel syndrome. I would wake up with a numb, tingling arm. My entire arm was aching. I bought a special splint designed specifically for the carpal tunnel syndrome. I found almost instant relief. I take 100 mg of vitamin B6, along with other B vitamins. I hope this information helps others!" Jennifer ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "English Nouns, Male or Female" In many languages, nouns are considered wither masculine or feminine and take different words as modifiers. From the Washington Post Style Invitational in which it was postulated that if English were to have male and female nouns, and readers were asked to assign a gender to nouns of their choice, and explain their reason. The best submissions: Detective Novel -- f., because you're not supposed to peek at its end the minute you pick it up. Swiss Army Knife -- m., because even though it appears useful for a wide variety of work, it spends most of its time just opening bottles. Kidneys -- f., because they always go to the bathroom in pairs. Penlight -- m., because it can be turned on very easily, but isn't very bright. Hammer -- m., because it hasn't evolved much over the last 5,000 years, but it's handy to have around and is good for killing spiders. Tire -- m., because it goes bald and often is over-inflated. Hot air balloon -- m., because to get it to go anywhere you have to light a fire under it. And, of course, there's the hot air part. Web page -- f., because it is always getting hit on. Web page -- m., because you have to wait for it to reload. Shoe -- m., because it is usually unpolished, with its tongue hanging out. Copier -- f., because once turned off, it takes a while to warm up. Because it is an effective reproductive device when the right buttons are pushed. Because it can wreak havoc when the wrong buttons are pushed. Magic 8 Ball -- m., because it gives monosyllabic answers that usually indicate it did not pay attention to your question. Ziploc bags -- m., because they hold everything in, but you can always see right through them. Sponges -- f., because they are soft and squeezable and retain water. Critic -- f. What, this needs to be explained? Subway -- m., because it uses the same old lines to pick up people. Hourglass -- f., because over time, the weight shifts to the bottom. Cars -- f., most of the time they're ok, but if you mistreat them or don't service them often enough, they soon break down and/or turn into a wreck. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
********** Health Newsletter *********** March 7, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Using antibiotics sensibly 2. How long to treat a UTI? 3. Reader submitted Q&A - Weight and OCPs 4. Massages to relieve muscle tension 5. Health tip to share - Too many fluids 6. Humor is healthy The next newsletter will be in two weeks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Using antibiotics sensibly ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Why not take an antibiotic when you have a cold, sore throat or flu symptoms? It can't hurt you can it? Yes it can hurt. The overwhelming majority of upper respiratory tract infections in otherwise healthy people during the cold and flu season are caused by viruses. Antibiotics have no effect against viruses, only against bacteria. The viral caused cold, flu or sinus drainage symptoms do not go away any quicker when you take an antibiotic. Viral infections are usually self-limited and do go away on their own but the clearing of symptoms is not because you took an antibiotic. If you take left over antibiotics or pressure your doctor to prescribe them when you really do not need them, you run not only the risk of an allergic reaction, a bowel infection or vaginal yeast infection, but also you contribute to letting other bacteria in your body become resistant to that antibiotic. The bacteria themselves form a defense against the specific antibiotic. The next time you get a bacterial infection, that antibiotic might not work. It may take a week or more to find out that the antibiotic does not work and all the time the infection causes damage to your body. You may end up needing hospitalization for the infection or a more expensive antibiotic; there may not be any antibiotics that are effective for the infection. When antibiotics are overused, infections caused by these bacteria may not respond. Illnesses from the infection can last longer. Complications from such an infection and even the risk of death can rise. Failure of an antibiotic to treat a particular infection leads to longer periods in which a person is contagious. That person, possibly your best friend, has a longer time to spread the resistant strains to others. Since most upper respiratory tract infections are viral, assume that is the case until you have reason to suspect otherwise. Then if you are not sure, do not self medicate but rather seek a medical opinion. If the doctor still thinks antibiotics are not needed, go along with that rather than pressuring for an antibiotic prescription. Using antibiotics sensibly ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. How long to treat a UTI? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If you have ever have had urinary tract infections (UTIs), you may know that sometimes you receive antibiotics for 1 day, 3 days, 5 days, 7 days, 10 days or 14 days. You may think it depends upon which antibiotic the doctor prescribes but many times it does not. Doctors do not always know the optimal length of time needed to treat uncomplicated urinary tract infections. A recent study in Canada looked at treating urinary tract infections in older women who did not have signs of a higher kidney infection (pyleonephritis), diabetes, recent treatment with antibiotics, urinary tract abnormalities or contraindications to the specific antibiotic used. In other words, they had uncomplicated UTIs. The drug used was Cipro(R)(ciprofloxacin) and they tested two doses: 250 mg twice a day for 3 days and 250 mg twice a day for 7 days. The authors looked at both immediate treatment success, as measured by a urine culture two days after completion of antibiotics and also the relapse rate of infection by urine culture at six weeks after treatment. The investigators found that for the 3 day course and the 7 day course, the immediate cure rates were 98% and 93% (yes better in the 3 day group) and the relapse rates were approximately 15% in each group. In addition, the group taking only 3 days of antibiotics had significantly less (about half) side effects from the antibiotics such as nausea and vomiting, drowsiness, loss of appetite, headache, abdominal pain or diarrhea. This study suggests that at least for Cipro(R) treatment of uncomplicated UTI, the duration of treatment is best confined to only 3 days rather than 7. How long to treat a UTI? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Weight and OCPs ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Recently, my obgyn informed me that I have to change my birth control pill because I am too heavy (195 lbs). He informed me that a new study indicated that heavy patients need to take birth control pills with high content of estrogen (35mg). I was using the Ortho Evra(R) patch which was falling off my skin! Does taking high doses of estrogen effect my chances of having any side effects (breast cancer or blood clots formation)?" "I am 26 years old and do not smoke! I am not on any medications, I do exercise and am in a good health" - KRA The question you raise stems mainly from one article in 2002 from the University of Washington that suggests there is a higher risk for oral contraceptive failure in heavy women (greater than 155 lbs or 70.5 kg). To understand what the magnitude of risk is to you and whether switching to a higher dose oral contraceptive (Ortho Evra has only 20 mcg of estrogen) will lower your pregnancy rate, you need to know a little background of what the study actually found. Failures of contraception that result in pregnancy are measured in 100 women-years, i.e., 100 women taking the pill for 1 year or 50 women taking the pill for 2 years for example. Using that definition, the overall failure rate of all oral contraceptives is about 3-4%. This takes into account all women, even the ones that tend to forget their pills. The best case failure rate of women who are "good pill takers" is about 1% overall. Most modern oral contraceptives come with estrogen doses of about 20-25 mcg (very low dose), 30-35 mcg (low dose) and 50 mcg (high dose). Your patch birth control would be considered very low dose. In the 1960's, estrogen doses above 80mcg were linked to increasing rates of blood clots (vein thrombosis). Average doses came down very quickly. In the 1990's there became questions about different progestins (not the estrogen dose) that seemed to have different blood clot rates. As far as we know at these modern estrogen doses, there is no higher incidence of thromboses. In fact your weight alone is probably more of a risk for thromboembolism. Also, there is no known increase of breast cancer with any of these doses either. Doctors will still caution you to be on the lowest dose possible and I agree fully with that. If we look at the different weight ranges and the pregnancy rates for the different estrogen doses in the pills in the above mentioned study we see: Pregnancy rate/100 women yrs estrogen dose (Weight in lbs) 20-25mcg 30-35mcg 50mcg =+ less than 125 1.8 3.2 1.6 125-137 3.4 2.7 3.3 138-155 2.3 2.0 8.2 155 and plus 6.8 5.2 5.4 As you can see, women over 155 lbs have in general higher pregnancy rates (5-7%) than women under 125 lbs (1.8-3.2%). However, you do not gain very much lowering in rate (6.8 to 5.2 or 5.4) if you, at the higher weight, switch to a higher dose pill. You will need to decide for yourself if these differences are worth switching contraceptive doses. Basically you are at slightly higher risk for pregnancy no matter what you do. Keep in mind one of the things we have mentioned before, i.e., that the biggest risk for pregnancy from pill failure is starting the pills LATE after you have been off of them for 7 days. If you are very good about prompt starting of a new pill pack or patch, you may be a lower risk than the general population on which this study is based. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Massages to relieve muscle tension ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did you know there a quite a few different types of massages? Different massage types vary in how the hands are used in the massaging stroke and the amount of pressure applied to the different muscles or parts of the body. Types of massages Swedish - long smooth hand strokes and kneading movements along the skin Deep - slow heavy strokes on deep muscle tissue Sports - specific muscle directed massage both deep and superficial Craniosacral - focuses on the muscles and ligaments of the head, neck and spine Neuromuscular - concentrates on painful or trigger point areas of specific muscles Rolfing - significant pressure on connective tissue throughout the body using the hands, knuckles and elbows Massages are not only for spa treatments but medically they can relieve stress and muscle tension, relieve anxiety, lessen muscle pain and even stimulate the immune system. They can be safely performed by licensed health professionals such as a massage therapist, physical therapist or occupational therapist. If you have a massage, be sure to let the therapist know if you have any skin burns or wounds, or have had a recent heart attack, cancer, arthritis flare, unhealed fracture or bone thinning (osteoporosis). You do not want to have a serious complication of massage such as internal bleeding, nerve damage or temporary paralysis which can rarely happen with an untrained massage therapist. Massages to relieve muscle tension ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Too many fluids ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "The traditional advice to treat a cold with bedrest and plenty of fluids may be at least half wrong. Recently investigators have found cases in medical reports in which excessive fluid intake in people with upper respiratory tract infections has produced a dangerous lowering of body salts (hyponatremia). This could possibly result in congestive heart failure, pneumonia and even death." - FRJ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Little Known Illnesses HAIRPIECE SWIMPLEX Rash caused by wearing a toupee in a pool. HERPES CINEPLEX Rash caused by movie tickets priced at $9.50. VISACARDITIS The heart-stopping sensation brought on by exceeding your credit limit. OREOPOROSIS Disorder caused by too many cookies, not enough milk. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
********** Health Newsletter *********** March 21, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Hypertension drug therapy 2. Is routine use of antibacterial soap helpful? 3. Reader submitted Q&A - Hypothyroidism control 4. Melatonin hormone declines with age 5. Health tip to share - IUCD for heavy bleeding 6. Humor is healthy The next newsletter will be in two weeks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Hypertension drug therapy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If a person with high blood pressure is treated correctly, physicians and friends have high expectations that future strokes and heart attacks will be prevented. In practice, those events are often not prevented because hypertensive individuals either do not regularly take their recommended medicines or they are not prescribed the best regimen to control the blood pressure. In the U.S. only about 30% of hypertensive individuals have the blood pressure controlled at 140/90 or less. In Europe the number is about 10%. The latter issue, that of prescribing the best anti-hypertensive treatments possible, has been the subject of several guidelines from the U.S., Europe and now from the British Hypertensive Society. Most of the recommendations in the consensus guidelines are very similar although there are some differences of emphasis. Most importantly, different classes of antihypertensive drugs seem to have better results and less complications in different age and ethnic groups. The recommendations of the British Hypertensive Society are to initially start non black patients under the age of 55 on either an ACE inhibitor or a beta-blocker. Black men and women or non black individuals over the age of 55 should be started on either a calcium channel blocker or a diuretic. The combination of a beta blocker and a diuretic is avoided because it may be associated with a higher incidence of diabetes. If initial single drug therapy is not successful in keeping the blood pressure below 150/90 (yes 150/90), then other combinations can be tried. The preferable combinations would be an ACE inhibitor plus a calcium channel blocker or a diuretic. As combination therapies are tried, the important concept is to avoid using a beta blocker with a diuretic if possible. Hypertension drug therapy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Is routine use of antibacterial soap helpful? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ There is a plethora of cleaning products available in stores that advertise antibacterial components. The antibacterial additives are expected by buyers to reduce the incidence of infectious diseases in a household. Unfortunately many infectious diseases are viral in origin and one would not expect antibacterial soaps to substantially reduce those infections. A study was carried out in inner city New York households in which half the households were given unlabeled, antibacterial cleaning, laundry, and hand washing products. The other half were given the same products but without antibacterial chemicals. After almost a year of follow up, the number of respiratory, fever, vomiting and diarrhea symptoms were recorded in each group. There were no statistical differences between those using antibacterial cleaning products and those not. This would imply that at least for most infections, routine use of antibacterial cleansing products is not worth any price difference. There may be a place for them if people are involved in a lot of food preparation but even that still has to be proven. Is routine use of antibacterial soap helpful?