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Should Heart Failure Patients Avoid Exercise?
Tweet Share on Facebook February 4, 2010 Comment (3)I've heard that it's not a good idea to exercise if you have heart failure. Is that true?
Regular brisk exercise is a key component of managing heart failure. We recommend that people get a good-quality pedometer and try to achieve 10,000 steps of walking (roughly 4 miles) each and every day. This will improve their quality of life and help to optimize their blood pressure, glucose, and lipid values. There are increasing data that regular brisk exercise significantly reduces cardiovascular morbidity and mortality in people with normal and reduced heart muscle function. -
Help! What Can I Do for My Vertigo?
Tweet Share on Facebook February 2, 2010 Comment (3)I've been suffering from vertigo for the past three or four years. Lately, ear pain, dizziness, light sensitivity, and headache have become a regular occurrence. What should I do?
If your vertigo is becoming increasingly frequent and severe, you should definitely see an ear, nose, and throat specialist to look for wax, infections, or tumors that could be seen in the external or middle ear. A formal audiogram should be obtained, and even if you do not have more hearing loss in that ear than your other ear, I would recommend an MRI of the brain (with and without gadolinium contrast) with special sections of the internal acoustic canals to look for a benign and typically slow-growing tumor known as a vestibular schwannoma, popularly called an acoustic neuroma. Meclizine (Antivert) is an antihistamine medicine that can lessen vertigo symptoms, but it can also make one more drowsy and fuzzy-headed. This is also true for baclofen and diazepam. Until your evaluation is complete, it would be prudent to go on a low-salt diet and to drive defensively and be cautious about biking and other activities that might put you at risk for injury should you suddenly experience neurologic symptoms.
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What's the Story About Gastrointestinal Problems in Kids With Autism?
Tweet Share on Facebook January 29, 2010 Comment (14)What's the story about gastrointestinal problems in children with autism? I'm wondering about the recent news showing little evidence that special diets do any good.
Families of children with autism face many challenges day in and day out. One of the toughest problems is trying to figure out how to make their children comfortable when they have the inevitable ups and downs of childhood. Recent studies show that children with autism are at no higher risk of having gastrointestinal problems than are children without autism. But that means they also have no fewer GI upsets. And when they are having stomach aches or are refusing to eat, it can be really tough for them and their parents. I asked William Barbaresi, director of the Developmental Medicine Center at Children's Hospital in Boston and associate professor of pediatrics at Harvard Medical School, to comment on the question of how parents can best comfort their children with autism when they have GI disturbances. Here is his answer: -
The Skinny On Salt. How Much Is Too Much?
Tweet Share on Facebook January 27, 2010 Comment (2)I've heard that if Americans cut back on salt intake, even just a little, we'd be a lot less at risk for heart attacks and stroke. What amount should I consume each day? Also, where might salt lurk that I'm not aware of?
Sodium, usually in the form of common table salt, is an essential nutrient, but like most essential nutrients, too much can be a problem. Studies over the past decade have shown unequivocally that reductions in sodium will benefit almost everyone in the United States by lowering their blood pressure, even if they do not technically have hypertension. Because reductions in blood pressure reduce the risk of heart disease and stroke, it is estimated that many tens of thousands of deaths could be prevented each year if we were to reduce our average intake from about 3,500 mg per day to the recommended upper limit of 2,300 mg per day for adults. This would mean reducing intake from about 1 1/2 teaspoons per day to 1 teaspoon per day. For those with hypertension, adults over 40, and African-Americans, the recommended upper limit is 1,500 mg per day, or about two thirds of a teaspoon. -
Are Mercury Dental Fillings Safe?
Tweet Share on Facebook January 20, 2010 Comment (37)My daughter is concerned that mercury from fillings slowly leaks into the body, possibly causing autoimmune problems and cancers. She also fears that removing them may pose even greater health dangers. Is she right?
Mercury can pose a serious risk to our health, and your daughter is right to ask questions such as this. Fortunately, though, Man Wai Ng has offered the following information, which should ease her concerns and provide her with current information about the very low risk of health effects of mercury from dental amalgam. Ng is the chief of pediatric dentistry at Children's Hospital Boston. -
I’m a Cancer Patient. Should I Ask About PARP Inhibitors?
Tweet Share on Facebook January 19, 2010 Comment (4)
PARP stands for poly ADP-ribose polymerase, an enzyme found in the nucleus of cells that is responsible for repairing damage to DNA. While repairing DNA is critical to preventing the genetic mutations that give rise to cancer, many treatments for cancer actually aim to damage the DNA of the cancer cell. Many chemotherapy drugs used today directly or indirectly work by damaging DNA and do this more potently in cancer cells than in normal cells.PARP inhibitors work by inactivating the PARP enzyme. There are at least eight PARP inhibitors in development, but none are yet approved by the Food and Drug Administration. PARP inhibitors have been of particular interest for patients who have a cancer that is associated with a BRCA mutation, such as those with familial breast or ovarian cancer. The BRCA proteins, important in one DNA repair pathway, are inactive in these BRCA-associated cancers. When a second DNA repair pathway is inactivated using a PARP inhibitor, BRCA-associated cancers show response rates that are significant and sometimes higher than would be expected with other available treatments.
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Can I Stop Taking Vytorin Without Bad Side Effects?
Tweet Share on Facebook January 14, 2010 Comment (3)Is there a way to stop taking Vytorin without bad side effects? I would like to get off the drug but am worried.
There's no evidence that switching to another regimen is going to cause you harm. Many physicians have successfully switched their patients from Vytorin to other cholesterol-lowering drugs.Vytorin is a combination of ezetimibe (Zetia) and a statin, simvastatin (Zocor). It's a very controversial drug. The reason it's controversial isn't about safety but about efficacy. Although Vytorin has been out there for a while, evidence hasn't really developed to show that it's better than a statin alone; clinical studies have not demonstrated a greater reduction in the risk of heart attack or stroke with Vytorin compared with a statin alone. Therefore, many physicians prescribe Zocor alone as an alternative to Vytorin.
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What’s the Biggest Mistake People Make When Starting a Fitness Program?
Tweet Share on Facebook January 12, 2010 Comment (4)
Starting too fast. It may have taken you 20 years to lose your conditioning, and yet you want to take 20 days to get it back. That approach can be dangerous, particularly for those 40 and older, and may result in major medical problems, both musculoskeletal and cardiovascular. Remember, the older you are, the faster you will lose your fitness and the longer it will take you to get back into shape. In younger people, under 40, it is just the reverse. -
Does Being Vegetarian Mean Healthful Eating?
Tweet Share on Facebook January 11, 2010 Comment (11)No. A vegetarian diet can be very healthy, but don't forget that the all-American vegetarian diet is Coke, pizza, and ice cream. Also, many people in the world eat a poverty vegetarian diet that is mostly starch and salt—clearly not healthy.A desirable vegetarian diet would consist of healthy carbohydrates, fats, and protein packages, along with plenty of vegetables and fruits. Healthy carbohydrates mean whole grains and few refined starches and sugars. Healthy fats include almost all of the vegetable oils that have not been partially hydrogenated (meaning they won't contain trans fats); palm oil and coconut oil in modest amounts are also OK. Of course, the protein package most distinguishes vegetarian diets, and not including red meat will make the diet healthier as this is related to higher risks of heart disease, diabetes, and probably some cancers. Alternative vegetarian sources of protein would include a combination of nuts, beans, and soy products; these are not only lower in saturated fat and don't contain cholesterol, but they also are great sources of micronutrients, healthy fats, and fiber.
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Is There a Definitive Test for Lyme Disease?
Tweet Share on Facebook January 7, 2010 Comment (40)The most sensitive test for Lyme disease is the Western blot, which looks at three IgM antibodies and 9 IgG antibodies to antigens found on the Borrelia bacteria that cause Lyme disease. Two or three positive IgM bands suggest an acute infection, and five or more of the IgG bands suggest an infection at an indeterminate time in the past. It takes several weeks from the time when an infected tick releases the infection into your body for you to begin mounting an antibody response, so a test would be negative at an early stage. Our current blood tests for Lyme disease are 90 percent accurate, and we know that a significant percentage of patients not only lack the bull's-eye rash initially described but lack a rash of any sort.Some Lyme disease experts recommend treating with doxycycline for three days after removing an embedded tick since this will substantially decrease the likelihood that one would develop Lyme disease even if the tick were carrying the organism. In the Washington area, we have experienced warmer winters and a substantial increase in the deer population, and we diagnose Lyme disease even in the winter months. Some physicians who say they specialize in the treatment of Lyme disease will treat patients with three antibiotics, including intravenous ceftriaxone, for several months even though studies published from academic centers have failed to show that superaggressive treatment improves outcomes.
