April 2009

More on Swine Flu

Yesterday, the CDC announced that the number of people with swine flu in the U.S. reached 64, with 5 people needing hospitalization. The acting director of the CDC stated that he is very concerned about the evolving epidemic. Rather than use this space to update you with numbers of new cases each day, I will again summarize what you can and should do.

1) The symptoms of swine flu are exactly like other influenza illnesses – fever, cough, lack of appetite, fatigue; the incubation period, or that period of time between when you are exposed and when you will have symptoms is between 2 and 7 days. Some people do not get symptoms or get sick at all even after being exposed.

2) If you get these symptoms, stay home. If you begin to feel very ill – especially if you are having trouble breathing, have a high fever that will not come down even with Tylenol, or cannot take in fluids by mouth – call your doctor to be seen. Trying to avoid the emergency room – especially if your symptoms are mild – is a good idea to limit your and other people’s exposure, BUT if you can’t breathe, call 911.

3) The swine flu virus is thought to be spread person to person by the coughing or sneezing of infected people. Therefore, always cover your mouth  with a tissue, your hand or even your forearm when you cough or sneeze. Throw the tissue away immediatlely.

4)Wash your hands (and arms if used to cover a cough) with soap and water frequently. Alcohol based hand cleansers are also good.

5) Stay home if you are not feeling well; limit contact with others.

6) The CDC recommends that you avoid nonessential travel to Mexico.

7)If your immune system is suppressed -for instance if you have active cancer, are taking chemotherapy or radiation therapy, have AIDS or HIV with a low CD4 count, are on steroids chronically, or have had an organ transplant – you are more susceptible to getting sick. Check with you doctor about having a medication to prevent swine flu illness in the event you are exposed. Try to avoid being in crowded places.

8)There are two medications available which are effective against the swine flu virus: Relenza and Tamiflu. These can be taken to prevent illness after you’ve been exposed but before you get sick. They can also be taken once you develop symptoms but must be taken within the first 48 hours after your symptoms start in order to be effective. When taken after symptoms have begun, the medications can shorten the duration of the illness, and make the symptoms milder.

9) Don’t panic. Follow the above recommendations. The CDC updates the information on the Swine flu epidemic regularly. Stay informed by regularly visiting http://www.cdc.gov/swineflu/.

Update on Swine Flu Alert

The World Health Organization (WHO) raised the pandemic alert level for the swine flu epidemic to Phase 4, which means that the virus is getting better and better at spreading among humans in at least one country. This was done yesterday because of the steadily increasing number of people in Mexico suspected of being infected with the swine flu virus, now up to nearly 2000 there, and with the number deaths there up to 149. In addition, the number of cases in the U.S. doubled when – through further testing yesterday – officials found more infected people at a school in New York City in which the original cases were found; the total number of cases in the U.S. now stands at 48, with only one person needing hospitalization and no deaths.

What does this mean? The WHO has 6 phases of alert that can be used during an epidemic, phase 6 meaning that there is a full blown pandemic with outbreaks in at least 2 countries in the entire world. Being at Level 4 worldwide means that preventative measures are rapidly being put in place. In this country, it is now advised that no one travels to Mexico unless it is absolutely essential; checking people for infection at the borders is now in effect as well. You can find out more at: http://www.msnbc.msn.com/id/30398682/

If you, or someone you know, is having flu-like symptoms, such as fever and a new cough, you should get checked out by your healthcare provider. It is generally advised that you not go to an emergency room (unless you are seriously ill) for this because of the risk of the virus spreading to uninfected people (and your risk of catching it from someone else). In addition, re-read the recommendations for preventing its spread on the CDC page about the swine flu epidemic at the link given in yesterday’s blog. That page will be continually updated.

Swine flu:U.S. Health Officials Have Declared a National Health Emergency

In case you haven’t heard or read the news, U.S. health officials declared a national public health emergency regarding Swine flu yesterday. This action was taken because of the discovery of 20 people with documented Swine flu infection in the United States; these cases were found in the following states: New York, California,Kansas, Ohio, and Texas. All twenty of the patients recovered. Suspected cases have been recently found in Mexico,where 1600 cases were reported, with 100 deaths. Six cases have been found in Canada. Infection with the swine flu virus is known to spread from person to person.

What does the declaration of a national public health emergency mean for you and yours? Should you panic? No. Right now, whether this virus causes mostly mild or serious infections is not known for sure. Although there is a fear that infection with this virus will lead to an epidemic globally, the good news is that it is still early for this possibility. By declaring a national health emergency, health officials are raising awareness of this infection and its potential to spread quickly, which will hopefully lead to proper actions by all of us (see below for more on this), and thus, is a step in the prevention of its spread.  

For everything you need to know about this, go to the page that the Centers for Disease Control and Prevention (CDC) has set up; especially read the section on the steps you can take to avoid, or lessen your risk of, becoming infected with this virus. 


April is IBS Awareness Month:What You Need to Know – Part II

Because any part of the GI track can contract in an unpredictable manner in people with IBS, the regularity of bowel movements is disrupted, resulting in diarrhea or constipation, or an unpredictable combination of the two. In addition, abdominal pain can occur due to the extra contractions, or spasms.  These spasms can occur not only in the lower part of the GI track, the bowel, but also in the upper part, the esophagus. Spasms of the esophagus can cause chest pain, which can be severe and mimic a heart attack.  Any of these symptoms can be quite mild, or very severe. In fact, some people with IBS have such severe symptoms that it can disrupt their daily lives.

How is IBS diagnosed? This can be a problem because there are other diseases that can cause the exact same symptoms. For instance, you can get a viral or bacterial infection of your bowel that causes diarrhea and abdominal cramping.When these symptoms are due to an infection, however, they usually do not last long, and generally do not recur as does IBS.

Also you can get similar symptoms with a group of diseases known as Inflammatory Bowel Disease (IBD), which includes Crohn’s disease and Ulcerative Colitis. Some of the differences between IBD and IBS (besides that one letter at the end!) are:

·        IBD results in inflammation of the GI track which is thought to be due to one’s body attacking itself, the bowel in this case ; therefore, IBD is thought to be an autoimmune disease. IBS does not cause inflammation and is not autoimmune in nature.

·        IBD can lead to long term complications including bowel obstruction and cancer; IBS does not lead to either.

·        People with IBD can have recurrent episodes that may include high fever, dehydration, and loss of appetite requiring hospitalization; IBS does not include symptoms other than those of the GI tract

·        IBD may lead to surgery of the bowel; IBS does not require surgery.

As you can see, the diagnosis of IBS can be tricky, and should be done in consultation with your clinician. If your bowels become irregular for more than a couple of weeks, or if you develop abdominal pain seemingly out of nowhere that recurs or persists, don’t try to make your own diagnosis.  And never treat yourself without seeing your clinician first.

Although the symptoms of IBS can get severe, most can be controlled with medications. In addition, there are many lifestyle changes you can make that will lessen the effects IBS has on your daily life. In other words, you can definitely manage this disease.

If you haven’t, please read the section in our book on IBS to learn more. (Sorry for that shameless plug!) In that chapter, you’ll read some actual cases histories of patients with IBS, including yours truly.  Also for more information, go to: www.aboutibs.org

April is Irritable Bowel Syndrome (IBS) Awareness Month: What You Need to Know – Part I

April, like March, is another one of those months during which there are many diseases highlighted. Almost too many – not easy to keep up with all of these!

If you’ve read our book, then you know that we devote a lot of space to the topic of Irritable Bowel Syndrome (IBS). Why? Because one of our goals in our book is to discuss those diseases that are common in women our age. IBS is one of these.

What exactly is IBS? It is commonly thought of as a motility disorder, or a malfunction of the movement (contractions) of the entire GI tract. The purpose of these contractions is to keep food moving down the entire GI tract so that parts of it can be absorbed and used by the body, and the rest can be expelled through a bowel movement. IBS results in the loss of the GI track’s ability to regulate its own contractions.

IBS has also been called “spastic colon,” “spastic colitis,” and “nervous stomach.” But, nerves or stress do not cause IBS. The cause is unknown. There is no cure, but there are medications available to help control the symptoms.

IBS is quite common. It affects between 10- 15% of the US population, or between 25 and 45 million people. Women are affected more commonly than men are; it can affect all age groups.

In Part II, we’ll talk about how you can tell if you have IBS.

More on Parkinson’s Disease:New Research

A research scientist from Louisiana State University has found that consuming fish oil or omega-3 fatty acid can potentially help prevent diseases such as Parkinson’s disease, Retinitis Pigmentosa and Huntington’s disease. We know that there are genetic abnormalities that occur to cause these diseases.What fish oil does is prevent the misfolding of these abnormal genes that cause the diseases to manifest symptoms. (http://www.physorg.com/news159366745.html)

There have been previous studies in mice that had the gene for Parkinson’s disease and that were given fish oil in their diets, and it was found that they were less likely to develop the disease.This new study now suggests how this might be done.

We already know that fish oil is good for the brain, joints, and heart. Now this gives us another good reason to make sure that we have adequate amounts in our diet, particularly if there is a family history of one of the diseases mentioned above.If you are concerned about the mercury content of fish, then take fish oil supplements that you know are mercury free. If you already have a disease such as Parkinson’s disease, you might want to have a discussion with your doctor concerning fish oil and the possibility that it may be beneficial to a family member, and perhaps to you.

April is Parkinson’s Disease Awareness Month:What You Need to Know

Parkinson’s is a disease of the nervous system which affects our movements. Michael J. Fox, the popular actor, was diagnosed with this disease in 1991, at the young age of 30, and has helped tremendously to raise awareness by telling the world about his diagnosis, and then by setting up his foundation to raise money for research to find a cure.

In people with this disease, the brain cells that produce a chemical, known as dopamine, malfunction and eventually die. This results in decreased amounts of dopamine in the brain. Since dopamine is a neurotransmitter, or messenger, to the part of the brain controlling movement and coordination, less of this chemical means a slower delivery of those messages from the brain telling the body when and how to move. The person affected will have difficulty starting and controlling her/his movements.

The cause of Parkinson’s is unknown. Although Mr. Fox developed the disease at a young age, that is not as common as developing when we are older. The risk of developing this disease increases as we age; it affects 1-2% of Americans over the age of 60. It may run in families, although people without a family history get it as well. This is an active area of research, and recent studies suggest that exposure to pesticides may play a role. Approximately 1.5 million people in the US have Parkinson’s, and 600,000 new cases are diagnosed each year.

Early in the disease there may be no symptoms. Once symptoms appear,the most common include an uncontrollable tremor, or shaking, of the hands, while at rest; slowed and difficult movement; impaired posture and balance; and rigid, or stiff, muscles. The disease is chronic and the symptoms continually worsen. There currently is no cure, although there are medications that can help in the control of the symptoms.

What can you do? Let others know the importance of this disease. Or, join the 15th Annual Parkinson’s Unity Walk in New York City on Saturday, April 25! Learn more about the disease and the ongoing research to find a cure at one of the following sites:       http://www.michaeljfox.org/index.cfm   OR  http://www.pdf.org


April is Stress Awareness Month:Are the Effects of Chronic Stress on Your Body All in Your Mind?

Have you ever believed that your mental functioning was “off” during a long period of time when you were under a lot of stress? Did you think it was all in your head, so to speak? Or, that it wasn’t real, but just in your imagination? Think again.

A recent study in the Proceedings of the National Academy of Sciences (2009 Jan 20; 106:912.) followed twenty healthy medical students for the month before and the month after their important exams, and compared them with twenty matched control students who were not taking exams or under stress. That the students preparing for exams were indeed under stress was confirmed by using a standard scale of measurement.  

After four weeks of stress, impairment was shown by MRI scan, and by testing, in the section of the brain known as the prefrontal cortex.  The specific function that was found to be impaired was that of “attention”, or the ability to prioritize mental tasks, to focus on them, and to shift the focus as the need arises. This impairment was not seen in the students who were not under stress.

Four weeks after the stress ended, the students were tested again. Those who had been under stress were no longer different from those who had not. This shows that brain function can change, and then change again. And shows that stress-induced changes are reversible.

This study confirms what we’ve thought for years: that chronic stress can indeed affect the brain so that it does not function as well as usual. And this research leads to the conclusion that we need to be on the lookout for stress-induced changes in our bodies, and that we need to de-stress in order to keep ourselves functioning well.

So, the next time you are under stress for a longer period of time than just a few days, and think that your mental functioning is not quite up to par, remember this study. It’s not all in your head (imagination)! Learn ways to de-stress. (See the prior blog)

April is Stress Awareness Month:Cognitive Behavioral Therapy May Be What You Need To De-Stress

Spring is here and stress is in the air. There are worries over the economy, unemployment, and the state of healthcare (among other things). There are ways that each of us deals with stress -both consciously and unconsciously. Some people get sick (not a great solution);others overeat; still others drink too much alcohol. But many people have learned to work it out in a healthy way using things like exercise, meditation, yoga, and talk therapy such as cognitive behavioral therapy (CBT).

CBT is a process that looks at a person’s beliefs, and helps to change negative thought patterns.It is like teaching people to look at the cup as half full, rather than half empty.A recent study has found that ten sessions of CBT significantly improved worry in older individuals with generalized anxiety disorder.CBT has also recently been shown to have an impact on depression and health outcomes in those who have undergone cardiac bypass surgery.

If you are stressed out, you are not alone.We suggest that you look to healthy ways to deal with stress and worry.If you feel you need help and would benefit from talking to someone, you might want to find a therapist who does CBT.And of course, you can always exercise too! Are you sick of hearing that from us yet?!

I’m Tired. Not Just a Little Tired – I’m Really Tired. How About You?

How many times have you thought this over the years. And now that you’re older, and hopefully taking a bit – or a lot- of time out for yourself, are you still feeling that way? Should you be? Is it normal? How do you know when the fatigue is simply from doing too much and when it indicates a serious illness?

This is a question that comes up a lot in both our practices, especially from women. And though you’d think that women younger than us would have less of a problem with fatigue, and that we midlife women are entitled to be chronically tired, that isn’t the case. To illustrate this, I’m sure you know of one (or many) women in midlife and older who have so much energy that they almost never need to rest. I certainly know women like this in their 70s, 80s and even 90s. So, by that fact alone – ie, that there are some women who never slow down no matter their age – we know that humans are not necessarily programmed to lose energy and be more easily tired as we age.

In fact, what it boils down to is what is normal for you, and whether or not there has been a change in your fatigue levels over a short period of time. (This is true of virtually any symptom that you get too.) To know if your fatigue is abnormal and indicative of an underlying illness, such as thyroid dysfunction or anemia or a low-grade infection, ask yourself these questions:

Am I needing more sleep on a regular basis than I ever did in the past?

Do I never feel rested or energized no matter how much sleep/rest I get?

Do I feel incapacitated by the fatigue?

Am I having to change my exercise routine because I now get tired doing the same amount that I’ve done for ages?

Does any exercise, or any physical activity, make the fatigue symptoms immediately worse?

Am I taking more “time outs” or rest periods during my day, and not able to keep up my usual schedule?

Am I getting less done because of my increased need to sleep or rest?

Am I turning down activities in the evenings that I used to do regularly because of  fatigue?

Am I drinking more caffeinated fluids or taking “pep” pills just to get through the day?

Is there an element of physical fatigue to how I feel, or is that I “just don’t feel like getting up and going”, but feel physically ok?

Once you’ve asked yourself these questions, take a look at your daily calendar for this month and compare it to the past several months. Are there many less activities planned?

Most illnesses that start with fatigue do so over a fairly long period of time; that is, weeks to months rather than days to weeks.  If you notice that you are unusually tired for longer than a month or two, you should see your primary healthcare practitioner. One very common cause of fatigue is depression, for which there are  good treatments available. 

If the incapacitating fatigue goes on for 6 months or longer, with no other illness being found as an explanation for it, you may have Chronic Fatigue Syndrome, or CFS (sometimes also known as Chronic Fatigue and Immune Dysfunction Syndrome). This is an illness that has a very specific definition; the diagnosis of CFS cannot be made unless your symptoms meet that definition.  For more information on CFS, visit here: http://www.cdc.gov/CFS/

In my experience, most women who are unusually fatigued do not have CFS, but rather another illness or explanation for their symptoms. Most of the time, this symptom is correctable. The important point is that you recognize what amount of fatigue is abnormal for you, and take action to get medical help for it. Remember that the earlier an illness is diagnosed, the quicker and more easily it can be treated. Don’t ignore fatigue, or think “it goes with the territory” of aging. It doesn’t.


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