The buzz on brittle bones

You can shatter the silent epidemic called osteoporosis. By Dr. Ivan Olegario

With more and more people reaching the ripe old age, diseases such as osteoporosis are becoming increasingly prevalent. Take care of your bone health now before you become another statistic. 

Osteo-what?
Osteoporosis is a condition where the bones become so thin and weak you run the risk of fractures. Bone is a living tissue that grows in a porous, mesh-like structure. Throughout life, the body breaks down old bone and rebuilds new bone in a continuous cycle. You should gain more bones than you lose, but when it is the other way around, you become a candidate for osteoporosis.

Building bones requires several components:

• The minerals, calcium and phosphorus, when combined, form the "cement" of the bone.
• The protein called collagen acts as steel reinforcements to the brittle cement.
• Vitamin D stimulates absorption of calcium.
• Hormones, estrogen in women and testosterone in men, signal special bone cells to build bone.
• Physical activity can also be a stimulus to deposit more cement and reinforcement into the bone.

The major problem with aging-related osteoporosis (found typically among perimenopausal women) is a lack of hormones---the materials are there, but there are no orders to build.

Osteoporosis affects more than half of women and a third of men over 60 years old, as well as a few younger people.

The big deal
Thin bones, per se, do not cause problems. It's when they break that the real trouble begins. Osteoporosis is debilitating as it can lead to fractures in the spine, wrists, hips and other bones. Coughing lightly or lifting a bag of groceries may cause fractures in osteoporotic bones.

A broken wrist can lead to difficulties in dressing, housekeeping, gardening, and doing other activities. Worse, a broken hip or spine can land you in a wheelchair.

Osteoporosis is often called the "silent disease" because you may not know you have thin bones until they break. So the best way to avoid osteoporosis is by preventing bone thinning and fractures.

Bone up early!
To prevent osteoporosis, make sure your bones are thick. And the best time to thicken your bones is during childhood, when bone growth is at its peak. Children, adolescents and adults should heed these tips:

• Take enough calcium from supplements or calcium-rich foods (milk, milk products, green vegetables and fish [sardine] bones).
• Exercise regularly to stimulate bone growth.
• Get adequate sunlight (five to 10 minutes a day), and vitamin D supplements, especially if the child is not a hearty eater.
• Avoid cigarette smoke, caffeine (coffee and colas), and regular heavy alcohol drinking.

Break a leg!
Adults need to go one step further by checking for osteoporosis or osteopenia (early signs of bone thinning), and preventing injuries that can lead to fractures.

To find out if you have osteoporosis, know your bone density through a test called a DEXA scan. Take this scan if you have these risk factors:

• Age 50 years or older
• Thin, petite frame
• Fair skin
• Menopause
• Had surgical removal of ovaries
• Never been pregnant
• Unmeasured daily calcium intake
• Physical inactivity
• Drinking more than four standard alcoholic drinks per day
• Long-term use of steroids (e.g., cortisone, prednisone) or anticonvulsant drugs
• A family history of fractures in elderly relatives

Discuss the results of your scan with your doctor and ask for treatment options. Treatments range from calcium and vitamin D supplementation and hormone replacement therapy, to taking of bisphosphonates and other bone-specific medicines that increase bone density.

To reduce your risk of falls in day-to-day life:

• Plan your activities.
• Avoid straining your back or falling. Wear slip-proof shoes, put slip-proof mats in the bathroom, and hold on handrails.
• Be careful when lifting, bending or reaching.
• Use a cane or walker correctly and consistently, especially if you have poor balance.
• Have your eyesight checked to keep from bumping into things or slipping up. 

From Health Today online; see the source article here.
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Understanding asthma

This common disease can claim lives, so control it as early as possible. By Dr. Sonia J. Silos

A good friend of mine in his mid-30s has had asthma since childhood. He tells me that his attacks since then have been few and far between, but that they come at the most inopportune moments. He says, "It has reminded me of its presence at the worst times: when I am elated, when I exert myself physically or at the tail end of the flu."

Yes, living with asthma is difficult but it doesn't have to be that way. The first step is learning about the disease and how it affects you. This will help you better understand how to treat, manage and, ultimately, control asthma. 

What is asthma?
Asthma is an inflammatory disease of the lungs and its airways. It affects adults and children alike, but asthma in children is different, explains Dr. Agnes Sebastian-Sanchez, pediatric pulmonologist at the Victor R. Potenciano Medical Center and the Healthway Medical Clinics (both in the Philippines). "Children have smaller airways so the symptoms are exaggerated, particularly in younger kids."

Asthma is a chronic condition characterized by acute attacks. These attacks are caused by hyperreactive airways, which produce increased mucus, then subsequently tighten and narrow, causing airway obstruction. All these bring about the common asthma symptoms of coughing, wheezing, and shortness of breath.

But what exactly causes the airways to hyperreact? There are numerous asthma triggers and each individual has his own particular trigger. Once you identify what sets off your asthma attack, you can begin to avoid or limit your exposure to them.

Dr. Rommel Tipones, adult pulmonologist at the National Kidney and Transplant Institute in the Philippines and the Healthway Medical Clinics, shares these handy tools for controlling asthma triggers.

• Quit smoking. Ban smoking inside your home.
• Keep furry pets out of your home.
• Keep doors and windows closed to control the entry of outdoor allergens. Air-conditioning, although expensive, will help.
• Remove stuffed animals, carpeting, curtains, or anything that collects dust, from the bedroom. Cover your mattresses and pillows with airtight covers.
• Get a flu shot each year. These are safe for adults and children over 3.

Drugs defined
Asthma medications can either be inhaled or swallowed (systemic medication). Tipones says inhaled medications are preferred because they deliver the drug direct to the airways, decreasing any side effects that affect the whole body (systemic effects). Medications are classified into relievers, which help stop attacks once they start, and controllers, which help prevent attacks from starting.

Relievers consist of bronchodilators, which keep the airways open, allowing you to breathe during an attack. Inhaled bronchodilators in the proper dose and frequency are very effective. It is the one medication that every asthmatic should have handy wherever he goes. Inhaled bronchodilators are the medication of choice for exercise-induced asthma and are the only medication that those with mild asthma will ever need.

Systemic bronchodilators, although equally effective, have more associated side effects and so are not frequently used. Side effects include a rapid heartbeat, nausea and vomiting, indigestion, dizziness, irritability and difficulty sleeping. When these occur, tell your doctor immediately.

Controllers are anti-inflammatory medications that reduce the swelling of airways and their mucus production. There are different types, including the ever-popular corticosteroids. These are recommended for daily use and are safe and highly effective for long-term therapy. But remember that they have to be used regularly and consistently for maximum effect.

Inhaled corticosteroids are the most frequently used controller medication, but they require spacer devices to avoid side effects such as throat infections. Systemic steroids are only given for severe, uncontrolled asthma. They are extremely effective but can cause serious side effects with prolonged use. Among the many side effects are weight gain, nausea and vomiting, face puffiness and foot swelling, hyperacidity, growth retardation in kids, early cataracts, delayed wound healing and infections.

As such, avoiding their long-term use whenever possible, especially in children, is prudent.

The doctor's role
Your treatment program will usually be individualized because each person's asthma is different. What works for your friend may not work for you. It is the doctor's role to choose the right medication at the right dose for your particular asthma.

After you have been prescribed asthma medicine, see your doctor even when you feel well. Regular checkups can help your doctor ascertain if the medicine is working well for you. "Generally, improvement should be seen within a month of starting treatment," Tipones points out. It is vital for your doctor to know if:

• You are taking more than the usual recommended dose.
• You have symptoms at night and have trouble sleeping.
• Your daytime symptoms are increasing.

These things signal that your treatment program is not working, and a change of medication or additional medicine might be needed.

Asthma and you
Finally, successful asthma management relies heavily on you as the patient. Everyone with asthma has a responsibility to learn everything about the condition.

Know your symptoms and what to do about them. During an attack, knowing the signals that precede it is vital, especially in young children, who usually can't report what they feel. Your job as a parent is to spot those early signs to ward off a severe attack. Be alert for cough especially at night, noisy, irregular breathing, wheezing, flaring nostrils and pursed-lip breathing.

Learn about your medication and how it works. Inhaled bronchodilators relieve symptoms quickly. They take effect within five to 10 minutes, when symptoms should start abating. The earlier treatment is given, the less medicine you'll need to control the attack. It is best to give treatment within five minutes of an attack.

Discover what your triggers are and work hard to avoid or control them.

Complete control of all your triggers is impossible, but you can decrease the frequency and severity of attacks. For instance, those with exercise-induced asthma need not curb their sports activities; they may be advised to take medication instead before engaging in strenuous activity.

Swimming has long been touted as the best exercise for asthmatics. Sebastian-Sanchez says, "Children can benefit from swimming because it teaches proper breathing techniques and there are less environmental triggers associated with it."

Take your med exactly as prescribed, even when you feel well. With controller medicine, the effects are not evident immediately. It takes a few weeks for them to work. For this reason, some people discontinue medication because they deem it unnecessary or see no attack forthcoming.

To control your asthma continuously and permanently, you must adhere to the treatment exactly as the doctor recommends. "Asthma management requires a partnership between the patient, his family and their doctor," Sebastian-Sanchez stresses. Asthma can last a lifetime and can even be life threatening, but if you manage it properly, it is almost always controllable.

From health Today online; see the source article here.
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Pregnancy mistakes even smart women make

Misinformation, no matter how well-meaning, can be dangerous for you and your unborn child. Get your facts straight here. By Dr. Diwata Bose-Altura and Dr. Awi Curameng

With the wealth of medical knowledge that's out there for everyone to access, it's a wonder that people still engage in patently non-healthy behavior. Millions of individuals still smoke cigarettes, for instance, despite overwhelming evidence against their use. Even the more prudent make the occasional health-care "mistake"--over-flossing, for instance (dentists recommend doing so only once every other day), or thinking that only children need vaccination (adults do, too).

Part of the problem is that there is simply too much information coming in--and too fast!--to be absorbed. Many times media reports are either vague or ambiguous at best or, at worst, clash glaringly with conventional medical knowledge.

For most laymen, interpreting medical jargon, research scientists and anyone else who sends out health-related signals is like trying to figure out a Rubik's cube. A pregnant woman cannot escape the confusion and is, perhaps because of situational anxieties, more prone to misinformation than ordinary individuals, especially when every woman in her life--mother, grandmother, sister, aunt, cousin, in-law and friend--is anxious to dispense advice on the healthy, "proper" way of going through pregnancy and labor.

Our advice? Talk to your obstetrician. No issue should be too simple or too complicated to discuss. Ask her all your questions and explore with her all your concerns. You and your doctor are a team. Your goal is to make sure you deliver a healthy baby. The only way that can happen is if you work together and communicate regularly. 

Pregnancy no-no's
For starters, we've listed a few choices and decisions we discourage pregnant women from taking: A healthy pregnancy they surely will not make. Check to see if any of the items apply to you and then go see your doctor so you can both figure out what to do about them.

1. Taking preconception folic acid for granted. Folic acid is essential for the healthy development of baby's nervous system. This occurs during the first 45 days of life, at a time when a woman doesn't even know yet that she's pregnant. If you're planning on having a baby, be sure to take a multivitamin supplement containing folic acid once you begin trying to conceive.

2. Stopping medications for pre-existing diseases. A lot of women think that all prescription drugs are teratogenic (can cause birth deformities), and the reflex is to stop taking them once the stick turns blue. This decision often does more harm than good, especially for women with pre-existing diabetes, seizure disorders or psychiatric illnesses, which have to be kept in check. The best thing to do is to ask the doctor for advice on continuing versus stopping the medication.

3. Thinking that morning sickness is always normal. Nausea and vomiting in pregnancy, which occur in 70 percent to 85 percent of women, are traditional signs of a healthy pregnancy. Severe and persistent vomiting unrelated to other causes and leading to weight loss of at least 5 percent of pre-pregnancy weight, however, is not. It strongly suggests hyperemesis gravidarum, a condition that can lead to dehydration, vitamin and mineral deficiencies, and a low birth weight. The truth is that pregnant women don't have to "grin and bear it." Many medications can help alleviate morning sickness.

4. Not screening for chromosomal abnormalities. A lot of women think that having children with chromosomal abnormalities (e.g., Down's syndrome) occurs only in pregnant women over 45, who carry a one-in-30 risk of having a Down's baby. The truth is, these abnormalities occur sporadically and, while age-related, may still strike the offspring of young women. Screening is widely available, and all women should be aware of this option.

5. Eating for two. Average weight gain during pregnancy should only be about 25 pounds. Putting on a lot more weight will increase your chances of hypertension, gestational diabetes and having a big baby (and a more difficult delivery, of course!).

6. Decreasing activity. Engaging in mild to moderate exercise is still best. It keeps you fit and prepares you for the rigors of delivery. Ask your doctor to prescribe an exercise regimen for you.

7. Suffering through low-back pain. The condition called sacroiliitis is very common in pregnancy due to the laxity of the lower back ligaments and postural changes. Physical therapy and simple exercises can help relieve sacroiliitis.

8. Abstaining from sex. Except in cases of preterm labor (or a history of preterm deliveries) and bleeding due to a diagnosed placental abnormality, it is safe to engage in sexual activity--as long as it's not too acrobatic--at all stages of pregnancy.

9. Missing the blood work. Asian women are particularly predisposed to gestational diabetes, so it's important to be screened for this condition.

10. Shunning pain relief, especially epidural anesthesia, during labor. Evidence has shown that being given an epidural doesn't necessarily lengthen labor, as was previously thought.

11. Thinking that Lamaze will work miracles. The Lamaze technique is not guaranteed to work for everyone, so don't count on pain-free labor.

12. Asking the universe for twins. Multiple pregnancies, compared to ordinary single-baby pregnancies, bring a lot more complications.

13. Asking for a C-section. A C-section will involve more difficult, more painful recuperation than vaginal delivery, believe it or not.

 

14. Asking for perineal repair after delivery to "make the vagina virginal again." Perineal repairs and episiotomies may cause more blood loss during delivery. Discuss your options with your obstetrician.

15. Not taking prenatal vitamins and iron. Iron is the only mineral that must be supplemented in pregnancy, but some women stop taking their iron supplement when they begin to experience side effects like nausea or constipation. A simple solution to the problem is to take the iron pill at bedtime, and increase the fiber in one's diet or take stool softeners.

16. Fretting about breast-feeding. While breast-feeding is best for babies, a woman has the right to decide whether to breast-feed or not. She should not feel guilty if she cannot breast-feed for any reason or produce milk immediately after delivery. It's perfectly normal not to have milk until the third to the fifth day, so giving a temporary bottle at this time will not cause nipple confusion.

From Health Today online; see the source article here.
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