General Health Topics

Infertility Treatment: 7 Tips to Manage Stress

2009-07-13T23:37:00.000-07:00

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Jay W. Marks, MD

Infertility treatment can be physically uncomfortable, time-consuming, exhausting, and costly — all without a guarantee of success. The infertility experience for many can range from multiple diagnostic procedures through progressively more aggressive treatment options, all of which impose demands upon the emotional and physical self. It's no wonder that many women experience severe stress, depression, or anxiety during treatment for infertility.

It is possible although difficult to relieve some of the stress and pressure of infertility treatment. Some tried-and-true stress control suggestions from former infertility patients and counselors include the following:

Accept that you are experiencing a time of heightened stress and don't try to downplay or deny its effects. You may find that you need to cut back on some or all of your nonessential obligations or activities for a while. Give yourself permission to say 'no' to nonessential commitments and demands on your time.
Don't suffer alone. Confide in a trusted friend, loved one, or support group. Social support networks can tremendously reduce feelings of stress and emotional pain. Many infertility clinics also offer support groups and/or counseling services. If you're trying to conceive as a couple, accept that your partner may also feel stress, depression, or anxiety and may not be able to provide all the emotional support you require right now.

Join RESOLVE, the National Infertility Association. You should be able to find a local chapter in your area. Individual chapters sponsor support groups, newsletters, and seminars and lectures on treatment options. Both health care providers and patients make up the membership of this valuable organizational resource.
Empower yourself with knowledge about the procedures and treatments you may need. After researching on the Web, write down a list of questions to take with you to your next appointment if you feel there are issues you'd like to clarify.
Decide in advance with whom you want to share your experience, and plan some strategies for avoiding inappropriate questions and unwanted advice from colleagues and acquaintances.

Discuss the possibility of treatment breaks with your doctor, if you feel that you need "time off" from the experience. Some people prefer to be treated every other month or every few menstrual cycles, while others are stressed by the waiting periods. Work with your doctor to find a treatment schedule that is comfortable for you.

Know that it's common for women in the midst of treatment to experience feelings of depression or sadness, and sometimes these feelings are strongest when participating in baby or child centered functions. Don't feel guilty if you want to pass up the baby shower or child's birthday party you're invited to. Taking care of yourself and your emotional needs is the top priority now.

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NIAID study finds higher dose of flu vaccine improves response in elderly

2009-07-05T05:12:00.000-07:00

There may be a simple way to provide elderly Americans with extra protection against the annual flu virus: give them a higher dose of seasonal flu vaccine.
This idea is suggested by the results of a newly reported clinical trial supported by the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health (NIH).

The trial, described in the latest issue of the Archives of Internal Medicine, was conducted by a team of researchers from Baylor College of Medicine in Houston, TX, and sanofi pasteur, the vaccines business of the sanofi-aventis Group in Paris. Led by Dr. Wendy Keitel, M.D., the team conducted the trial at the Baylor Vaccine and Treatment Evaluation Unit, which is one of a network of NIAID-supported sites at university research hospitals across the United States that conduct Phase I and II clinical trials to test and evaluate candidate vaccines for infectious diseases.

NIH Director Elias A. Zerhouni, M.D., notes, "The study results reported by Dr. Keitel and her colleagues are important because they suggest that a higher dose of seasonal influenza vaccine can safely and significantly increase the immune responses of older people."

"Elderly Americans are among the most vulnerable to serious complications of influenza because they generally have more underlying diseases and weaker immune systems than younger people," says NIAID Director Anthony S. Fauci, M.D. "These findings are an important first step in developing new strategies to better protect the elderly against influenza-associated hospitalizations and mortality."

"If you look at people who are dying and going into the hospital during an outbreak of seasonal influenza," says Dr. Keitel, "the majority of those people are older individuals."

Influenza accounts for some 36,000 deaths and more than 200,000 hospitalizations every year in the United States. It is among America's most lethal killers simply because the virus infects so many people--some 5 to 20 percent of the U.S. population every year.

In other influenza vaccine studies, higher antibody levels resulted in better protection against infection. Conversely, decreased antibody production in the elderly can leave them more susceptible to infection and the severe complications of influenza. Helping elderly people increase antibody production should help them fight off influenza infections, and this is exactly what Dr. Keitel and her colleagues set out to test when they began the clinical trial. They hypothesized that elderly people could be given higher doses of vaccine safely and that these higher doses would increase the antibody response and confer increased protection without increasing side effects.

In the study, the investigators randomly assigned 202 adults 65 years of age or older into four equal-sized groups: those receiving the normal dose of vaccine (15 micrograms); twice the normal dose (30 micrograms); four times the normal dose (60 micrograms); or a placebo. The average age of the volunteers was 72.4 years. All study participants were followed for a month post-vaccination to look for any vaccine-related side effects and to collect blood to evaluate antibody responses.

Dr. Keitel and her colleagues found that participants in the high-dose group (60 micrograms) had 44 to 79 percent higher levels of antibody than did those who received the normal dose of vaccine. Higher doses also increased the number of elderly volunteers achieving levels of antibody that have been associated with protection against influenza. Moreover, the vaccine was well-tolerated at all dosage levels. Although the higher doses of vaccine caused more mild side effects at the injection site, there were no significant differences in systemic symptoms such as fever or body aches among the groups.

The successful achievement of higher levels of antibodies in this study suggests that larger doses of vaccine may be a safe and viable way of enhancing protection against influenza among elderly persons. These promising results provide a basis for further evaluation of enhanced potency vaccines in the elderly, says Dr. Keitel.

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New cause of sexual dysfunction in women revealed

2009-07-02T22:17:00.000-07:00

Researchers at Yale School of Medicine and the Albert Einstein College of Medicine have found that female sexual dysfunction (FSD) affects 48.2 percent of women in a new study and that these women had decreased sensation in the clitoris, which increased the risk of sexual dysfunction.
"There is a paucity of data available on FSD and this study brings attention to the possibility of a neurological cause for the dysfunction," said lead author Kathleen Connell, M.D., assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine.

Connell said previous epidemiological studies have shown that about 10 million women between the ages of 50 and 74 report abnormal sexual complaints, including decreased desire, inability to reach orgasm and increased pain with intercourse. In contrast to data on men, Connell said clinical trials evaluating the physiologic mechanisms responsible for sexual function in women are few, despite reports of other investigators, which suggest that sexual dysfunctions may be more common in women than men.

"The sexual response is complex and involves interaction between the nervous system, the vascular system and the musculoskeletal system," said Connell. "Alterations in any of these systems could potentially cause FSD."

The trial was conducted while Connell was at the Albert Einstein College of Medicine. The team studied the pudenal nerve, which provides nerve fibers to the pelvic floor muscles and is also responsible for sensation in the genital region. They evaluated the role of genital neurological integrity and sexual function in 56 women. They used a validated screening questionnaire to identify women between ages 18 and 68 with FSD and tested vibratory and pressure sensation in the genital region.

The team found that almost half of the women studied reported sexual dysfunction. Of the women with FSD, 23.2 percent had more than one form of sexual dysfunction. Those with sexual dysfunction had decreased sensation in the clitoris compared to asymptomatic women.

###
Other authors on the study included Marsha K. Guess, M.D., Julie La Combe, M.D., Andrea Wang, M.D., Kenneth Powers, M.D., George Lazarou, M.D. and Magdy Mikhail, M.D.

Men's Health Watch: Allergic Rhinitis: Your Nose Knows

2009-06-29T23:38:00.001-07:00

It's easy to dismiss hay fever as a minor nuisance.

But call it by its proper name, allergic rhinitis, and you'll be on the way to recognizing it as a legitimate medical problem.

Add the fact that it affects about one of every five Americans and drains the economy of about $2 billion a year, and you'll see that it's an important problem indeed.

Fortunately, it's also a problem that responds very well to treatment.

If a man thinks about his nose at all, he's likely to think of it as a simple organ of smell. It's true, of course, that the nose is responsible for the sense of smell, but smell means much more than the ability to enjoy pleasing scents. Because smell contributes importantly to taste, it plays a central role in maintaining good nutrition. Smell can also warn us of dangers ranging from toxic fumes and smoky fires to spoiled food.

Allergic rhinitis can blunt the sense of smell, and it can also interfere with the other important functions of the nose. When your nasal passages are functioning normally, about five to eight quarts of air pass through them each minute. Your nose has the job of conditioning that air before it reaches the sensitive tissue of your lungs. Your nose adds moisture, but to do that, it must produce large amounts of mucus. It also warms the air, with help from a large network of blood vessels. Finally, the nose traps small particles, keeping them out of the lungs.

If you have allergies and your nose traps pollen or other particles to which you are sensitive, an inflammatory process starts right in your nose. Immune system mast cells in the nasal tissue release chemicals such as histamine and leukotrienes. Blood vessels swell, causing nasal congestion, and mucus production soars, creating a runny nose. Just like that, you've developed some of the symptoms of allergic rhinitis — and some of your nose's normal functions have been compromised.

Allergic rhinitis is the most common.

Seasonal allergic rhinitis comes and goes as various plants come into bloom. If your symptoms occur in the spring, you are probably allergic to tree pollen; in the summer, grass and weed pollens are the likely culprits; in the late summer and fall, ragweed is the most likely cause.

But if your symptoms occur year-round (perennial allergic rhinitis), you are probably allergic to indoor allergens such as dust mites, mold, or animal dander.

Rhinitis can also occur without allergies.

Examples include viral rhinitis (the common cold); drug-induced rhinitis (possible culprits include Viagra and the other ED pills, the alpha blockers used for benign prostatic hyperplasia, the ACE inhibitors and beta blockers used for hypertension, and aspirin and nonsteroidal anti-inflammatory drugs); and hormonal rhinitis (including the "pregnant nose" experienced by some women).

In some people, exercise, eating, and exposure to cold or dry air, air pollutants, or strong smells can trigger rhinitis. Inflammation is absent in nonallergic rhinitis, and the symptoms are limited to a runny, stuffy nose.

A final category of rhinitis can be particularly tricky. It's rhinitis medicamentosa, irritation of the nasal membranes caused by overuse of decongestant nasal sprays such as phenylephrine and oxymetazoline that some people use for quick relief of allergic rhinitis.

Nearly everyone with allergic rhinitis complains of a stuffy, runny nose. Sneezing is nearly as common, and a postnasal drip can trigger coughing. Typical symptoms extend beyond the nose to include an itchy or sore throat and itchy, burning, watery eyes that may look red due to allergic conjunctivitis.

Between 20% and 40% of patients with allergic rhinitis also have asthma. Other allergy-related disorders such as eczema may also be present. Some patients have nasal polyps, a deviated nasal septum, or sinusitis.

Most people with allergic rhinitis can diagnose the problem themselves simply by recognizing typical symptoms. In complicated cases, an ENT (ear, nose, and throat) specialist can check for polyps and other nasal abnormalities. If it is important to identify specific allergic triggers, allergists can perform skin tests; the so-called RAST blood test can also help pin down the culprits.

Three strategies are available: avoiding triggers, using medications to reduce symptoms, and getting immunotherapy ("allergy shots").

Avoiding triggers. Here are the steps to take for seasonal rhinitis:

Limit your outdoor activities when pollen counts are high. Ragweed counts usually peak in early midday, grass pollen in late afternoon and early evening. If you have to do yard work during pollen season, wear an N95 mask. Shower, wash your hair, and change your clothes afterwards.

Keep your windows and doors closed as much as possible during pollen season.

Use air conditioners instead of fans, which bring in outside air. Drive with your windows and vents closed and your air conditioner on.

For year-round allergic rhinitis:

If you have a dog or cat that triggers symptoms, have it bathed weekly and do your best to keep it off furniture and out of the bedroom.

Put pillows, box springs, and mattresses in sealed plastic covers (allergen encasements) to keep out dust mites. Wash bedding in hot water (above 120° F) to kill dust mites.

Remove carpets from your bedroom.

Use a dehumidifier to keep relative humidity below 40%.

Medication. Many treatments are available. Here's a quick summary of the major types.

Antihistamine tablets will help most patients. For the majority of people, one of the newer, less sedating preparations will be best. Some are available over the counter, such as loratadine (Alavert, Claritin, generic) and cetirizine (Zyrtec), while others such as fexofenadine (Allegra, generic) and desloratadine (Clarinex) require a prescription. High doses can produce sleepiness and dry mouth; men with benign prostatic hyperplasia (BPH) may have difficulty urinating.

Nasal steroid sprays are very effective but usually take several days to kick in. Like the oral antihistamines, these prescription drugs can relieve eye symptoms as well as nose symptoms. Examples include beclomethasone (Beconase AQ) and triamcinolone (Nasacort AQ). Side effects may include nasal irritation and headaches; long-term use may slow growth in children.

Antihistamine nasal sprays are as effective as oral antihistamines. Azelastine (Astelin) and olopatadine (Patanase) are available by prescription; some patients experience a bitter taste or drowsiness.

Leukotriene blockers, such as the oral prescription drug montelukast (Singulair), relieve most symptoms of allergic rhinitis. Side effects may include headache and, perhaps, personality changes.

Decongestants are available without prescription as tablets (pseudoephedrine, phenylephrine) or nasal sprays (phenylephrine, oxymetazoline) and can relieve nasal congestion but have little effect on other allergic rhinitis symptoms. Side effects may include nervousness, racing heart, elevated blood pressure, and insomnia. Men with BPH may have difficulty urinating. Decongestants should not be relied on for primary treatment but can be combined with a first-line drug for temporary use. You should not use a decongestant nasal spray for more than a few days.

Other medications include an anticholinergic nasal spray called ipratropium (Atrovent), which is effective only for runny noses; an intranasal mast cell stabilizer (Cromolyn) and various anti-allergic eye drops can be used to treat eye symptoms. In rare cases, patients with severe rhinitis may need a short course of oral steroids.

Immunotherapy, or "allergy shots," can help achieve long-term control of allergic rhinitis. The regimen usually involves skin testing to identify the responsible allergens followed by weekly injections of gradually increasing doses of the allergen, and then maintenance injections every two to six weeks for several years. Most doctors reserve immunotherapy for patients who do not respond well to medication.

For many men, allergic rhinitis is a temporary seasonal woe, but for others, it's a year-round hassle. And for some, it can be linked to asthma, sinusitis, or other more serious problems. Because allergic rhinitis is so very common, it also adds up to an expensive proposition for American society.

If you are one of the unlucky many with allergies, you'll have to learn to deal with the problem.

Avoid exposure to things that trigger symptoms.

Experiment with medications to control symptoms; nonsedating antihistamines, antihistamine nasal sprays, and steroid nasal sprays are among the first-line treatments. Some men may prefer one of the many other drugs that are available, and others need combination therapy.

Immunotherapy is available for particularly difficult cases.

The many options for treating allergic rhinitis can be confusing at first, but if you take the time to nose around, you'll find a way to keep your nose working smoothly — without running!

Men's Health Watch: Allergic Rhinitis: Your Nose Knows

2009-06-29T23:38:00.000-07:00

Genetic Screening for Prostate Cancer

2009-06-29T02:20:00.000-07:00

Genes regulate the growth, multiplication, and death of all human cells. Cancer develops when cell growth escapes from the normal control that holds it in check.

In a fundamental sense, then, all cancers depend on genetic abnormalities.

In some cases, abnormal genes are passed down from parent to child.

In others, problems develop after birth as a result of environmental influences, including nutritional imbalances and exposure to tobacco, radiation, and toxins.

If genes are responsible for cancer, then therapies that target genetic abnormalities should be beneficial.

That possibility lies in the future, but we are already at the point where genetic testing can predict the risk of certain cancers. The breast cancer genes BRCA1 and BRCA2 are the best-known examples.

Prostate cancer is the most common internal malignancy in American men and the second leading cause of cancer death among males in the United States. Some men inherit an increased risk of prostate cancer. Men with fathers or brothers who've had prostate cancer are 1.5 to three times more likely to get the disease than men with no family history; if multiple relatives have been diagnosed before age 55, a man's risk rises even further. But most cases of prostate cancer occur in men without a family history of the disease; that's because anytime after birth, males can develop the genetic abnormalities that drive the disease later in life.

The first prostate cancer gene was identified by a team of scientists in the United States and Sweden in 1996. The gene was aptly named hereditary prostate cancer 1, or HPC1. It was an exciting discovery, but HPC1 accounts for just a tiny fraction of all prostate cancers.

Since the late 1990s, genetic research has exploded. Numerous prostate cancer genes have been proposed; many have been confirmed, but some have not stood up to additional research. And even when particular genes have been implicated, their exact functions and roles in cancer have not been determined.

New techniques allow scientists to scan the entire human genome, the sum total of all the genetic material in human cells, for abnormalities. In brief, the idea is to recruit patients with a particular disease, scan their genes for polymorphisms, and compare the results with the genetic profiles of people who do not have the disease in question. Polymorphisms are naturally occurring variations in gene structure; it's normal to find some, but if the number is large, the statisticians weigh in to determine if the abnormalities occur often enough to suggest a link to the disease that's being investigated.

Staggering scientific advances have taken this research to a new level. In addition to looking for abnormal genes, researchers can now investigate the individual chemicals, called nucleotides, that come together to form DNA. So instead of studying "just" 20,000 to 25,000 genes, scientists can now investigate hundreds of thousands of individual nucleotides.

Abnormalities of individual nucleotides are known to the pros as single nucleotide polymorphisms, or SNPs. It's very sophisticated, complex research that usually depends on large teams of scientists from around the world. Few men will try to grapple with the details, but most will be interested to learn that many SNPs have been linked to prostate cancer. And even if you're not interested now, you may be later. That's because you could soon be invited to pay for a genetic test that screens for prostate cancer SNPs.

To review the pros and cons of genetic screening, let's focus on one of the most widely publicized studies of prostate cancer.

Scientists in the United States and Sweden compared the genetic profiles of 2,893 prostate cancer patients and 1,781 men who were free of the disease.

They identified five individual SNPs that were linked to an increased risk of prostate cancer. Individually, the increased risk was modest; men with just one SNP were from 1.22 to 1.53 times more likely to develop prostate cancer than men who had none of the five SNPs. But men with four or five of the SNPs were 4.47 times more likely to get prostate cancer. And men who also had a family history of prostate cancer were a whopping 9.46 times more likely to develop the disease.

That's a substantial risk indeed — but it doesn't necessarily mean the test is right for you

One caution is based on the possibility of false-negative and false-positive results. Only 5.4% of the men with prostate cancer but no family history of the disease had four or five abnormal SNPs. That means the test failed to predict almost 95% of the cancers in these men. On the other hand, 2.2% of the men without cancer had four or five SNPs; they would worry about an increased risk when none was present.

Worry itself is another issue. Men with abnormal genetic scans might face years of anxiety. And privacy is also a concern since a positive test might affect insurance or even employment.

But the most important caution of all relates to the natural history of prostate cancer itself.

Many prostate cancers are slow growing and indolent, even harmless, while some are aggressive, even lethal. This genetic test is not able to tell the good actors from the bad. Since positive genetic tests are likely to lead to aggressive prostate cancer screening with prostate-specific antigen (PSA) tests and prostate biopsies, it would lead to treatment (and side effects) that might never have been necessary. And there's a final hooker: even if the chain of events leads to early diagnosis, doctors don't know if that will lead to a better outcome.

Genetic screening for prostate cancer is still experimental; it has not been approved by the FDA, and it's not available commercially.

But if (or when) it's ready for prime time, the decision about testing will be up to you.

Men with strong family histories of prostate cancer might choose genetic testing and aggressive prostate cancer screening, while men at average risk might decide to hold off.

And all men will want to pay close attention to new research that may help answer some of these crucial but vexing questions.

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Recession's Impact on Women's Health

2009-06-29T02:17:00.000-07:00

By Deborah Kotz
Sure, we're worried about the economy, but just how much of an impact is it having on women's health?

Actually, quite a lot, according to some new polls. One -- a Gallup survey of 1,031 women ages 18 to 44 conducted for the American College of Obstetricians and Gynecologists -- suggests that a growing number of us are putting off having babies and have become more careful about taking our birth control pills.

One in five women says she's more worried today about having an unintended pregnancy than she was a year ago; a full 17 percent of married women say they've put off plans to have a baby as a result of the economy.

More worrisome, the survey also showed that 1 in 7 women has postponed her annual ob-gyn checkup because of economic woes, which means a lot of women aren't getting Pap smears or breast exams.

I'm guessing many of them lost their health insurance along with their employment, and I can't help but wonder what impact this will have in terms of missed early detection of cervical cancers and breast cancers in addition to other health troubles. In fact, 15 percent of women also reported that they've cut back on medications because of their cost, which means they're playing a game of russian roulette with their health.

The economy has also taken a toll on our mental health, according to a survey released last week by the American Psychiatric Association. More than half of us nationwide have experienced a mental-health downturn along with the economic one. And those of us living in hard-hit areas like Clinton County, Ohio -- which has a 10.5 percent unemployment rate -- are faring worse. Nearly two thirds of women living there reported that they're experiencing chronic frustration, anxiety, irritability, depression, anger, and/or other signs of severe emotional stress. "I'm not surprised by these findings," says APA President Nada Stotland. "We thought it was important to corroborate what we thought was going on--that people living in places with high unemployment would be more likely to be suffering emotionally."

On the bright side, it's somewhat easier to cope when everyone around you is suffering.

"We do much better when our friends are in the same boat," says Stotland. "We tend to be more upset by discrepancies in wealth than actually being poor." It's also easier for people to provide support for one another when there's an equal sharing of burdens as opposed to feelings of guilt that can crop up when one friend has troubles and another is fine.

"The person without money troubles feels guilty and embarrassed for being unaffected by the recession," says Stotland, whereas the financially strapped friend feels guilty for venting or asking for a loan.

Fortunately, women in the APA survey reported that they were turning to healthful stress-relieving approaches to deal with the economic pressures.

More than three quarters of them said they were participating in more positive activities than they were six months ago. Those included spending time with family and friends, praying or attending religious services, exercising, and listening to music.

(The survey didn't ask about negative activities like overindulging in alcohol or food.)

Deborah Kotz, U.S. News & World Report

(c) 2009 U.S. News & World Report DISTRIBUTED BY TRIBUNE MEDIA SERVICES, INC

Ten Commandments of Cancer Prevention

2009-06-27T23:55:00.000-07:00

About one of every three Americans will develop some form of malignancy during his or her lifetime. This year alone, about 1,437,000 new cases will be diagnosed, and more than 565,000 people will die of the disease.
Cancer is the second leading cause of death in America, and as deaths from heart disease decline, it's poised to assume the dubious distinction of becoming our leading killer.
Despite these grim statistics, doctors have made great progress in understanding the biology of cancer cells, and they have already been able to improve the diagnosis and treatment of cancer.

But instead of just waiting for new breakthroughs, you can do a lot to protect yourself right now

Get regular check-ups, including the screening tests that can help detect cancer before it causes any symptoms. For men between 15 and 35, that means a periodic doctor's testicular exam along with regular self-exams. All men older than 50 should have regular screening for colon cancer, and they should make an informed decision about testing for prostate cancer.
Men with risk factors should begin both processes even earlier, and every man should routinely inspect himself for signs of melanomas and other skin cancers.
Screening tests can help detect malignancies in their earliest stages, but you should always be alert for symptoms of the disease.

The American Cancer Society developed this simple reminder years ago

C: Change in bowel or bladder habits
A: A sore that does not heal
U: Unusual bleeding or discharge
T: Thickening or lump in the breast or elsewhere
I: Indigestion or difficulty in swallowing
O: Obvious change in a wart or mole
N: Nagging cough or hoarseness

It's a rough guide at best.

The vast majority of such symptoms are caused by nonmalignant disorders, and cancers can produce symptoms that don't show up on the list, such as unexplained weight loss or fatigue. But it is a useful reminder to listen to your body and report sounds of distress to your doctor.
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Early diagnosis is important, but can you go one better? Can you reduce your risk of getting cancer in the first place?

It sounds too good to be true, but it's not.

Scientists at the Harvard School of Public Health estimate that up to 75% of American cancer deaths can be prevented; the table below summarizes their research on the causes of cancer in the United States.

The American Cancer Society is only slightly less optimistic about prevention, estimating that about 60% of America's cancer deaths can be avoided.
And a 2005 study argues that over 2.4 million of the world's 7 million annual cancer deaths can be blamed on nine potentially correctable risk factors.

Risk factor
Percentage ofCancer Deaths
Smoking and tobacco use
30
Obesity and diet (red meat vs. fruits and vegetables)
30
Lack of exercise
5
Carcinogens in the workplace
5
Viruses (hepatitis, human papillomavirus)
5
Family history of cancer
5
Body size (taller, bigger people get more cancer)
5
Women's reproductive factors (late or no childbearing, late menopause, early periods)
3
Excessive alcohol consumption
3
Poverty (aside from bad diet)
3
Environmental pollution
2
Excessive exposure to sun
2
Medical procedures, drugs
1
Salt, food additives, contaminants
1Source: "Harvard Report on Cancer Prevention, Vol. I: Causes of Human Cancer" (1996), Vol. 7, pp. 53–55.

You don't have to be an international scientist to understand how you can try to protect yourself and your family. The 10 commandments of cancer prevention are:

1. Avoid tobacco

Avoid tobacco in all its forms, including exposure to secondhand smoke.

2. Eat properly

Reduce your consumption of saturated fat and red meat, which appears to increase the risk of colon and prostate cancers. Limit your intake of charbroiled foods (especially meat), and avoid deep-fried foods. Increase your consumption of fruits, vegetables, and whole grains.
Although other reports are mixed, two large 2003 studies found that high-fiber diets may reduce the risk of colon cancer. And don't forget to eat fish two to three times a week; you'll get protection from heart disease, and you may reduce your risk of prostate cancer.

3. Exercise regularly

Physical activity has been linked to a reduced risk of colon cancer, and it may even help prevent prostate cancer. Exercise also appears to reduce a woman's risk of breast and possibly reproductive cancers. Exercise will help protect you even if you don't lose weight.

4. Stay lean

Obesity increases the risk of many forms of cancer. Calories count; if you need to slim down, take in fewer calories and burn more with exercise.

5. If you choose to drink, limit yourself to one to two drinks a day

Excess alcohol increases the risk of cancers of the mouth, larynx (voice box), esophagus (food pipe), liver, and colon; it also increases a woman's risk of breast cancer. Smoking further increases the risk of many alcohol-induced malignancies.

6. Avoid unnecessary exposure to radiation

Get medical imaging studies only when you need them. Check your home for residential radon, which increases the risk of lung cancer. Protect yourself from ultraviolet radiation in sunlight, which increases the risk of melanomas and other skin cancers. But don't worry about electromagnetic radiation from high-voltage power lines or radiofrequency radiation from microwaves and cell phones. They do not cause cancer.

7. Avoid exposure to industrial and environmental toxins

Avoid exposure to industrial and environmental toxins such as asbestos fibers, benzene, aromatic amines, and polychlorinated biphenyls (PCBs).

8. Avoid infections that contribute to cancer, including hepatitis viruses, HIV, and the human papillomavirus

Many are transmitted sexually or through contaminated needles.

9. Consider taking low-dose aspirin

Men who take aspirin or other nonsteroidal anti-inflammatory drugs appear to have a lower risk of colon cancer and possibly prostate cancer. It's an unproven benefit, and aspirin can produce gastric bleeding and other side effects, even in low doses. On the plus side, though, low-dose aspirin does protect men from heart attacks and the most common type of stroke; men at the highest risk reap the greatest benefits.

10. Get enough vitamin D

Many experts now recommend 800 to 1,000 IU a day, a goal that's nearly impossible to attain without taking a supplement.

Although protection is far from proven, evidence suggests that vitamin D may help reduce the risk of prostate cancer, colon cancer, and other malignancies.

But don't count on other supplements. Careful studies show that selenium, vitamins C and E, beta carotene, folic acid, and multivitamins are not protective, and that some may do more harm than good.

These lifestyle changes will yield another cancer-preventing benefit: if you stay healthy, you won't need cancer treatments (chemotherapy, radiotherapy, drugs that suppress the immune system) that have the ironic side effect of increasing the risk of additional cancers.
As always, prevention is the best medicine.

Stroke: 7 Signs You Could Be at Risk of a Brain Attack

2009-06-26T00:38:00.000-07:00

Sarah Baldauf
Stroke can hit like a deadly lightning bolt.
And if the victim survives, the aftermath can be debilitating -- affecting functioning from movement to speech.
While stroke is the third-leading cause of death and the leading cause of adult disability in the United States, it trails behind other major diseases in awareness and recognition of symptoms.
Being informed, however, can protect you from suffering either an ischemic stroke, caused by a blood clot and the most common form of stroke, or the less common hemorrhagic stroke, caused by bleeding in the brain.
Know the factors that may be putting you at risk:
1. Uncontrolled high blood pressure
As for all cardiovascular disease, high blood pressure is a major risk factor for stroke. The American Heart Association estimates that only 45 percent of people with high blood pressure actually have it under control. Female stroke victims, in particular, tend to have uncontrolled blood pressure, and in general, women who suffer have strokes don't seem to be treated as aggressively as men. High blood pressure doesn't have any outward telltale signs, so getting it measured by your healthcare provider is essential to learning if you should make lifestyle changes or take medications to bring it down.
2. Smoking
Puffing on cigarettes is associated with a host of ills. An increased risk of stroke is one of them. When compared to nonsmokers, smokers have double the risk of ischemic stroke. Heavy smokers face an even greater risk: A study of women ages 15 to 49 in an August issue of the journal Stroke found stroke risk was proportional to the number of cigarettes smoked per day. The women who smoked two or more packs a day had nine times the risk of stroke of a nonsmoker.
A study published in Neurology in January found that smokers with a family history of brain aneurysm, abnormal bulging of an artery in the brain, are six times as likely to have a subarachnoid hemorrhage stroke, which is caused by a bleed between the brain and the tissue that covers it. These types of stroke are deadly nearly 40 percent of the time.
3. Family history of stroke
Having a relative who has suffered a stroke increases your chances of having one. Scientists recently moved closer to finding a basis for this genetic component of stroke. In the New England Journal of Medicine in April, researchers identified a chromosomal region and two genetic variants that appear to be associated with ischemic stroke. The researchers are not yet sure what mutation is responsible, but they've determined that having one of these gene variants increases the likelihood of having any type of stroke by 30 percent and of suffering ischemic stroke by 33 percent.
4. Migraines
This severe type of headache may be associated with an increased risk of suffering an ischemic stroke, though the biological reason for this link is still unclear. (One theory is that a common heart defect is behind both some strokes and many migraines.) And some research has also suggested that people who have migraines with aura, or visual disturbances, have a higher risk of stroke than people who have migraines without this symptom.
Additionally, the American College of Obstetricians and Gynecologists recommends that women who experience migraines and are taking birth control pills find another method of contraception. Research has suggested the combination may double or triple the likelihood of stroke. There may be other cardiovascular risks for women over 35 who take the pill as well.
5. "Ministroke"
Transient ischemic attacks, or TIAs, as ministrokes are formally known, can look and feel just like a full-blown stroke, but the symptoms are fleeting. Because the signs are typically short-lived and painless, lasting from one to five minutes, people often don't seek medical attention. But up to 17 percent of people who have a ministroke will have an actual stroke within 90 days, according to the American Heart Association. Because risk for a stroke is highest within the first 30 days, it is essential to quickly diagnose the TIA and work with a doctor to mitigate your stroke risk.
6. History of stroke
Not surprisingly, once you've suffered one, you're primed for another--unless you work with your doctors to reduce your risk factors. But efforts to prevent having a second stroke are lacking, suggests a March study published in Stroke. Lifestyle changes known to reduce the risk of a second attack, such as getting regular exercise, were reported by only 57 percent of the people who'd had a stroke.
Other preventive measures include quitting smoking (66 percent of study subjects reported getting counseling to help them do so), taking aspirin regularly (77 percent), taking medication to control high blood pressure (91 percent), making diet changes if high blood pressure is an issue (62 percent got such dietary counseling), at least annual average blood sugar testing if diabetic (89 percent), getting the flu vaccine (52 percent), and getting the pneumococcal vaccine (53 percent). Some experts have suggested that vaccination against common infections may reduce the risk of stroke; flu epidemics have been associated with higher rates of stroke-related hospitalizations.

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7. Too much homocysteine
High blood levels of this amino acid are associated with cardiovascular troubles, including stroke. Genetics and diet each play a role in generating homocysteine.
For example, having high levels of dietary nutrients folic acid and vitamins B6 and B12 is associated with lower levels of homocysteine in the blood.
While it's not yet clear if acting to lower homocysteine will reduce the risk of stroke or heart attacks, the American Heart Association recommends that high-risk patients get hearty amounts of folic acid, B6, and B12 through green leafy vegetables and fortified grains and cereals.

© 2009 U.S. News & World Report DISTRIBUTED BY TRIBUNE MEDIA SERVICES, INC

Energy Drinks Can Have a Variety of Adverse Effects on the Body

2009-06-26T00:20:00.000-07:00

DEAR MAYO CLINIC:
My grandson has several energy drinks a day. Is this bad for his health?
ANSWER:
It certainly could be.
Energy drinks come in a variety of formulations but most contain lots of caffeine and sugar -- and possibly herbal stimulants and a supplementary amino acid known as taurine.
However, it can be difficult to determine what's in them or how much.
Having an occasional energy drink isn't necessarily bad, especially those that contain about the same amount of caffeine as a cup or two of coffee and a similar amount of sugar as a can of soda. But many energy drinks contain much higher amounts of caffeine and other substances.
High amounts of caffeine and sugar -- and whatever herbal stimulants may be added -- can have a variety of adverse effects.
They may cause a markedly faster heartbeat, irritability, nervousness, impaired sleep and nausea. In addition, the acids and sugars in these drinks promote tooth decay, and the sugar contains a lot of extra calories and little other nutritional value.
By itself, massive amounts of caffeine can increase your blood pressure and sometimes impair blood flow to your heart. It may trigger abnormal heart rhythms, which can be life-threatening in some people. Increased risk of a potential heart problem rises when energy drinks are consumed along with alcohol, when you're dehydrated, or when consumed quickly before a sporting event. Serious medical problems, including fainting or even a heart attack can occur due to consumption of energy drinks in these situations.
It's important to educate your grandson about the potential hazards of energy drinks. Perhaps you can encourage him to read the labels to determine the contents and amounts of caffeine and other ingredients. It may be helpful to remind your grandson that the best route to a healthy, energetic life is to get adequate sleep, exercise regularly and to eat a healthy diet.
-- Martha Grogan, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

READERS:
Have you heard the term "hospitalist" but are not sure what it means?
A hospitalist is a physician whose primary professional focus is the care of hospitalized patients. Most hospitalists are board-certified internal medicine physicians, although some are pediatricians and family practice physicians. What brings them under the same umbrella is that they work exclusively in the hospital and have dedicated their careers to the care of hospitalized patients.
Hospitalists are an important part of the care team because the hospital (inpatient) setting often creates different patient-care situations than those in the clinic (outpatient) setting. Working day in and day out within the fast-paced, often intense, hospital environment, hospitalists gain unique expertise and experience that benefits patients when they are in the hospital.
Hospitalists partner with primary care physicians to care for patients when they require hospitalization and work to ensure smooth transfer of care between inpatient and outpatient settings. Hospitalists meet with some patients before surgery for preoperative evaluations and follow up with them afterward for postoperative care.
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Hospitalists work closely with surgeons and other specialty and sub-specialty physicians.
They also coordinate communication with referring physicians to assure continuity of care before, during and after a patient's hospital stay.
In some cases, hospitalists may work with patients preparing to move from the hospital to a nursing home or an assisted-care facility, to help smooth the transition from one care environment to another.
Hospitalists are well positioned to be leaders in quality improvement and patient safety initiatives. The overall goal of a hospitalist is to work collaboratively as part of the health care team to ensure that patients receive high-quality care in the hospital.
-- Alina Popa, M.D., Hospital Internal Medicine, Mayo Clinic, Rochester, Minn.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care.
To submit a question, write to: medicaledge@mayo.edu, or Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.
(c) 2009 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED DISTRIBUTED BY TRIBUNE MEDIA SERVICES, INC.

Kick the Caffeine Habit and Kick Up Your Energy Level

2009-06-26T00:00:00.000-07:00

Caroline MacDougall
It's the common complaint you hear uttered by friends, family and co-workers throughout the day: "I just can't get going without my cup of coffee!"

Although we hope to boost our energy levels when reaching for a cup of coffee, in truth we're actually inducing a state of stress. Caffeine drives the adrenal glands to produce stress hormones that can remain in the bloodstream up to 18 hours after consumption.

These hormones produce the "fight or flight" response that nature designed to help save our lives when every bit of energy is required to survive an impending disaster, such as an attack by an enemy.

In today's world, where we're more often sitting at a desk, driving, or eating a meal, caffeine can put us into a chronic state of stress with no way to burn off the extra fuel and hormones.
Caffeine-induced stress can produce mood swings and insomnia, increase muscle tension, impair digestion and nutrition, restrict blood circulation to the brain, elevate blood pressure, create blood sugar swings, and accelerate the heart rate. Yet the lines at the local coffee bar still stretch out the door with people desperate for their next caffeine "fix."
In addition, while your adrenal glands are busy pumping out cortisol to send energy to the muscles and divert energy from the digestive and immune systems, there's a very important hormone they aren't making: DHEA. It turns out that the adrenals have to reduce their production of the most important anti-aging hormone your body requires for youth and longevity in order to produce the stress hormones that ultimately weaken your immune system and impair your health.

DHEA is the mother hormone for all the sex hormones, such as estrogen and testosterone, and it also increases your brain's seratonin levels naturally. So if you've been feeling down in the dumps and your lover no longer interests you, check out how much caffeine you're consuming daily in that coffee mug of yours!

It turns out that a "cup" of coffee is not your normal 8-ounce cup, but a mere 5-ounce cup.
So when you read that a couple of cups of coffee a day shouldn't be any problem to your health, think of one 10-ounce mug. When you add to that the statistics for caffeine content in a cup of coffee brewed at popular coffee bars, you'll find out that you can expect up to 300 mg in that 10-ounce serving, not the 150 mg you might find in a cup of coffee from your own coffeemaker.
Decaf coffee drinkers who think they've switched to a healthier choice will be surprised to find out that a Stanford University study showed that decaf coffee raises the cholesterol higher and faster than regular coffee. A cup of decaf coffee still contains around 7 mg of caffeine. Plus, the beans chosen for decaf coffee have a higher acidic content than regular coffee to compensate for flavor loss during the decaffeination process.

You may be wondering what alternatives exist.

Stephen Cherniske, M.S., author of "Caffeine Blues" (Warner 1998), recommends switching to caffeine-free herbal coffee over a 2-week period. Herbal coffee, made from carob, chicory, barley, dates, figs and almonds can be brewed right in your coffee maker.
It's not as hard as you might think to ease yourself off of caffeine. If you use a 2-week weaning program, by slowly reducing the amount of caffeine you consume daily, you can avoid withdrawal headaches and help your adrenal glands recover. You may be surprised to find in two to three months that you feel better than you've felt since you were a kid and once again have an abundance of energy and enthusiasm for life!

KICK THE CAFFEINE HABIT

Caffeine withdrawal headaches can be incapacitating. Often they're accompanied by fatigue as your body starts to recuperate from its former caffeine-driven pace. Caffeine constricts blood vessels in the brain and decreases circulation. When caffeine is not present, the sudden increased circulation causes headaches.

To slowly wean yourself off of caffeine, start by making a pot of coffee by mixing 3/4 of your normal coffee with 1/4 caffeine-free herbal coffee. Gradually reduce the percentage of your coffee in each pot until you're drinking 100 percent herbal coffee. You should be able to avoid the headaches and also gradually adjust your body to less reliance on stimulants.
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Try these herbal tonics to help rebuild adrenal health and detoxify the body (speak to a holistic practitioner for dosages and directions on how to use them):

- Siberian Ginseng (Eleutherococcus senticosus) - Panax Ginseng (Panax ginseng or quinquefolius) - Licorice (Glycyrrhiza glabra) - Astragalus (Astragalus membranaceus) - Ashwaganda (Withania somnifera)) - Milk thistle (Silybum marianum)
Some serious coffee drinkers experience "brain fog" in the first month or so after quitting caffeine. Good nutrition along with a bio-energetic supplement, coupled with some herbal extracts including gotu kola and gingko biloba can help you clear that "fog" and restore your normal brain clarity.

(c) 2009, NATURALLY SAVVY DISTRIBUTED BY TRIBUNE MEDIA SERVICES, INC.

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Laptops can affect fertility in males, US researchers warn

2009-06-25T00:37:00.000-07:00

US fertility experts warned teenage boys and young men to consider limiting the time that they use laptop computers positioned on their laps, as long-term use may affect their fertility.
The increasing popularity of laptop computers (LC), coupled with existing evidence that elevated scrotal temperature can result in sperm damage, prompted researchers from the State University of New York at Stony Brook to undertake the first study into the effect of heat from LC on scrotal temperature.

The findings are reported in Europe's leading reproductive medicine journal Human Reproduction. They show that using an LC on the lap increased the left scrotal temperature by a median 2.6�C and the right by a median 2.8�C. Several previous studies have shown that increases in testicular or scrotal temperatures of between 1�C and 2.9�C are associated with a sustained and considerable negative effect on spermatogenesis and fertility.
Lead researcher Dr Yefim Sheynkin, Associate Professor of Urology and Director, Male Infertility and Microsurgery at the University, said: "By 2005, there will be 60 million laptop computers in use in the USA and a predicted 150 million worldwide. Continued improvements in power, size and price of LC have favored their increased use in younger people and laptop sales now exceed those of desktop computers."

With the exception of an anecdotal report of genital burns, the effect of portable computers on scrotal temperature when they are used on the lap was not known, he said.
"Laptops can reach internal operating temperatures of over 70�C. They are frequently positioned close to the scrotum, and as well as being capable of producing direct local heat, they require the user to sit with his thighs close together to balance the machine, which traps the scrotum between the thighs."

The researchers worked with 29 healthy volunteers aged 21 to 35, measuring scrotal temperatures with and without laptops. Two one-hour sessions of scrotal temperature measurements were performed on different days in the same room with a median room temperature of 22.28�C. The men were dressed in the same casual clothing for each session and sessions with and without LC were conducted at the same time of the day. Body temperature was taken by mouth beforehand and each volunteer spent 15 minutes standing in the room to adjust to room temperature before being seated. A non-working LC was placed on the lap so that the volunteer could adopt the right position to balance the laptop, then removed, and the seating position held for one hour, with scrotal temperature being measured every three minutes. The same procedure was repeated for one hour, with the same baselines controls, but this time with a working laptop. The temperature of the bottom surface of the LC was also measured at intervals.

"We found that scrotal temperatures rose by 2.1�C when the men sat with their thighs together, which is necessary to keep LC on the lap. But, the rise was significantly higher when the LC were used � 2.8�C on the right side and 2.6�C on the left," said Dr Sheynkin. " It shows that scrotal hyperthermia is produced by both special body posture and local heating effect of LC."
The median surface temperature of Pentium 4 computers used increased from nearly 31�C at the start of the experiment to nearly 40�C after one hour.

Dr Sheynkin said: "The body needs to maintain a proper testicular temperature for normal sperm production and development (spermatogenesis). Portable computers in a laptop position produce scrotal hyperthermia by both the direct heating effect of the computer and the sitting position necessary to balance the computer. The magnitude of scrotal hyperthermia associated with abnormal spermatogenesis is unclear. But, previous studies suggest that 1�C above the baseline is the possible minimal thermal gradient capable of inhibiting spermatogenesis and sperm concentration may be decreased by 40% per 1�C increment of median daytime scrotal temperature.

"We don't know the exact frequency and time of heat exposure capable of producing reversible or irreversible changes in spermatogenesis. Studies have shown significant but reversible changes after short-term heating. However, LC produce significant repetitive transient scrotal hyperthermia for years, and insufficient recovery time between heat exposures may cause irreversible or partially reversible changes in male reproductive function."

"Portable computers in a laptop position produce scrotal hyperthermia by both the direct heating effect of the computer and the sitting position necessary to balance the computer."

Dr Sheynkin said his team now planned further studies to evaluate the heating effect of LC on testicular function and sperm parameters. For now, he did not know an exact time for safe use. However, their study showed that within the first 15 minutes of use scrotal temperatures increased by 1�C, so it did not take long to reach a point that may affect testicular function. Also, frequent use may cause intermittent temperature rises, which could significantly increase a single heating effect.

"Until further studies provide more information on this type of thermal exposure", he said, "teenage boys and young men may consider limiting their use of LC on their laps, as long-term use may have a detrimental effect on their reproductive health."

Dr Sheynkin added that two LC brands were tested randomly to avoid criticism that brands may differ. "All laptop computers generate significant heat due to the increasing power requirements of computer chips. New laptops with higher power requirements may produce even more heat. So far, computer fans and 'heat sinks' are not sufficient. It's possible that external protective devices could somewhat help, but it is essential to confirm their protective effect in a clinical study to prevent commercial advertising and use of inefficient and useless products."

Sources: European Society for Human Reproduction and Embryology
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Obese women at greater risk of having big babies, new research finds

2009-06-24T06:01:00.000-07:00

ST. LOUIS -- Doctors should advise overweight moms considering another pregnancy to take off extra weight first because they are at greater risk of having big babies, a new Saint Louis University study finds.
Researchers found that moms who don't lose the weight they gained during the first pregnancy and continue to gain after their first child is born are at risk of having bigger babies than mothers who do not gain weight between pregnancies. A patient's prepregnancy weight remained the strongest predictor for the birth of a large infant in the next pregnancy.
"Our advice to moms is to take off the weight they gained during one pregnancy and not to gain weight between pregnancies," said Robert Blaskiewicz, M.D., professor of obstetrics, gynecology and women's health at Saint Louis University.
Large babies can be more difficult and take longer to deliver than normal weight babies because they are too big to fit easily through the birth canal. Large birth weight also might lead to a cesarean delivery.
"The ideal is to have their weight as close to normal as possible. Weight gain between pregnancies doubles the risk of having a 'large for gestational age' baby."
Dr. Blaskiewicz presented the research, which was conducted in conjunction with the Saint Louis University School of Public Health, at the May meeting of the American College of Obstetricians and Gynecologists.
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A broken bank balance can break you your heart too

2009-06-20T06:01:00.000-07:00

Patients who have trouble paying their medical bills do significantly worse in the year after heart attacks the patients under less financial pressure, a new study finds. In the study, which appeared last week in the journal of the American Medical Association, the researchers surveyed almost 2,500 patients when they were hospitalized for heart attacks. Although most of the patients were insured, the researchers found that almost one in five reported that financial barriers had led them to avoid health care over the previous year. More than one in 10 said they had not been able to afford some medications. Dr. Harian M. Krumholz of Yale and his co-authors found that a year after the heart attacks; there were 12 per cent more cases. of angina among the patients who had reported financial barriers.

Diabetes and Kidney Disease

2009-06-16T00:14:00.000-07:00

Diabetes is the number one cause of Kidney failure. Almost a third of people with diabetes develop kidney disease (also called diabetic nephropathy).

People with diabetes and kidney disease do worse overall than people with kidney disease, alone. This is because people with diabetes tend to have other long-standing medical conditions, like high blood pressure, high cholesterol and blood vessel disease (atherosclerosis). People with diabetes also tend to have other kidney related problems, such as bladder infections, and never damage to the bladder.

Kidney disease in type 1 diabetes is slightly different than in type 2 diabetes. In type 1 disease, kidney disease begins acutely and may start at an early or young age. Overt disease, when present, is obvious after about 15 years of having type 1 diabetes.

In type 2 diabetes, many petients have kidney disease at the onest, when they are diagnosed with diabetes. Because type 2 diabetes is frequently found in the middle or older aged person with other chronic medical conditions, kidney disease may have been caused by other conditions.

What are the symptoms of kidney Disease?
Although there are often no symptoms with early kidney damage, they may include:
Ø Swelling of the hands, feet and face.
Ø Weight gain.
Ø Itching (end atage kidney disease) and extremely dry skin.
Ø Drowsiness (end atage kidney disease).
Ø Blood in the urine (rare).
Ø Abnormalities in the hearts’ regular rhythm, because of increased potassium in the blood.
Ø Muscle twitching.

As kidney damage progresses, your kidneys cannot remove the waste from your blood. The waste then builds up in your body and can reach poisonous levels, a candition known as uraemia. People with uraemia are often confused or comatose. Uraemia is worsened by high blood pressure.

How is kidney disease Diagnosed?
The disease is detected by finding protein in the urine. That’s why you should have your urine tested every year.

How is kidney Disease Treated?
Lowering blood pressure and maintaining blood glucose control are absolutely necessary to slow the progression of kidney problems. Some medicines called angiotensin converting enzyme (ACE) inhibitors can help slow down the progression of kidney damage. Although ACE inhibitors--in cluding Altace, Lotensin and Capoten--are usually used to treat high blood pressure and other medical problems, they are prevent complications, even if their blood pressure is normal.

If a person has side effects from taking ACE inhibitors, another class of drugs called angiotensin receptor blockers can be given instead.

If not treated, the kidneys will continue to fail and larger amounts of proteins can be detected in the urine. Advanced kidney failure requires treatment with dialysis or a kidney transplant.
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The pill does not boost breast cancer death risk

2009-06-15T01:50:00.000-07:00

Survival is no better or no worse among breast cancer patients who have used the birth control pill, according to a report in the journal Obstetrics and Gynecology. The findings are broadly reassuring, Dr. Herbert R Peterson of the University of North Carolina at Chapel Hill said. There just does not appear to be any concern about woman using the pill at younger ages from the standpoint of breast cancer. The researchers found no increased risk of death associated with the use of the pill, duration of use, or any specific oral contraceptive formulation. Women currently taking oral contraceptives were actually at 100% lower risk of dying from the disease, but this finding may have been due to chance.

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How to Give Her the Most Spectacular Foot Massage Ever

2009-06-15T01:40:00.000-07:00

Master this toe-curling, step process and she’ ll be yours forever.
1. Make her a Thai footbath. Slice up half a lime and put in a bowl of warm water. Rest her feet in the water while you rub the bottoms of them with the other half of the lime, using it as a scrubber. The acid helps extract toxins, and the warm water will soften her feet and help her relax.
2. Take a hand towel and soak it in the footbath. Hold the towel above her knee, and, without letting it touch her leg, let the water drip down her calf and foot. Pat dry after one of you gets bored.
3. Gently holding her feet, rotate her ankles clockwise and then counterclockwise. Rotate each toe the same way, pulling gently on each.
4. After applying lotion, take one foot in both hands and walk your thumbs back and forth over the soles of her feet. Push deep with your thumbs, working the pressure points.
5. Directly beneath the ball of her foot, move your thumbs, in semicircles, working back and forth horizontally.
6. Starting with your thumbs on opposite sides of her sole, slide them toward each other and to the opposite side of her foot. Move slightly down and bring them back. Continue until you reach her heel.
7. Interlace your fingers, resting them on the top of her foot with your thumbs on her sole. Slide your hands up and down over the whole foot, applying pressure with your thumbs.
8. Place your fingertips in the channels between each metatarsal (those are the long bones on the top of the foot), gently sliding all four fingers up and down between them.
9. Starting at the outside of her ankle, find where the muscle meets the bone. Glide your thumb along this line all the way up her shin, applying slight pressure.

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