Pharmacy blog, health and medicine news

Fat-free mass. The amount of FFM (which includes all non-fat components such as muscle, organs, bones, blood) is by far the biggest determinant of MR. The higher the FFM, the higher the RMR and total MR. Obese people have higher FFM (mainly muscle) in order to carry around their extra weight. Thus, they also have a higher MR compared to lean people. Skeletal muscle metabolism accounts for approximately 50 per cent of RMR and about 75 per cent of MR when active during exercise. At a given body weight, an individual with a greater proportion of FFM to fat mass (FM) would have a higher metabolic rate.

Fat mass. As body fat levels increase so does RMR. Most of this is due to the increased FFM, but even at the same amounts of FFM, the person with the higher fat mass (FM) has a higher RMR. Similarly, as FM decreases, RMR will decrease and tend to ‘brake’ the reduction in body fat which might otherwise occur.

Age. Recent research estimates that RMR decreases at a rate of approximately 2 per cent per decade between the ages of 20 and 70 years. This reduction is accounted for primarily by decreases in FFM which is mostly due to reduced overall physical activity. However, at the same levels of FFM and FM, older people have a slightly lower RMR.

Gender. For a given body weight, females have a lower RMR than males due to a lower FFM to FM ratio. Females also have a slightly lower RMR than males independently of FFM, FM and age, most probably due to the effects of sex hormones on RMR. Several studies have shown that energy expenditure varies within the female menstrual cycle. During the preovulatory (progesterone) stage, RMR appears to be 6-15 per cent lower than during the pre-menstrual (oestrogen) stage. RMR may also be reduced in women taking progesterone-only oral contraceptives.

Genetics. FFM, FM, sex and age account for about 70-80 per cent of the differences in RMR between people. Other genetic factors account for some of the remaining differences. This suggests that RMR is at least partially genetically determined. These findings are supported by studies involving identical (monozygotic) and non-identical (dizygotic) twins which showed that identical twins are more alike with respect to RMR than non-identical twins.

Sympathetic nervous system (SNS) activity. The SNS is that part of the nervous system involved in generally speeding up the body’s responses, for example through increased heart rate, constriction of blood vessels and release of hormones such as adrenalin. The SNS also stimulates lipolysis resulting in the release of free fatty acids (FFA). The degree of SNS activity may have a small influence on RMR.

Ambient environmental temperature. When the environmental temperature is low, maintenance of normal body temperature at 37°C is an active process requiring extra energy. For this reason more energy needs to be expended in cold conditions than in warm. The cooling process (for example, sweating) is more energy efficient than the heating process (for example, shivering). The use of a sauna bath may result in fluid loss (and therefore weight loss), but not significant fat, or energy loss. Similarly, exercising while rugged up to increase sweating is only likely to have a short term effect on fluid loss and no extra effect on fat loss over and above the exercise. On the other hand exercising in the cool or cold, while only lightly dressed, would require that the body increase its energy use to maintain body temperature. Of course, this needs to be balanced by the injury protection benefits of warming up muscles before exercising.

Physical activity. One question which is often asked is whether physical activity has a carry-over effect on RMR? In the short term immediately after exercise, there is an excess post-exercise oxygen consumption (EPOC) which reflects an ongoing excess metabolic rate. The duration of EPOC is dependent on the duration and intensity of the exercise, but it may last for a few hours. In the longer term, the question of whether fit people have a higher RMR after the EPOC has disappeared (say 24 hours after an exercise bout), is less clear. A recent review of all the major work earned out in this area’ suggests that regular physical activity does have a positive effect on increasing RMR but this is mainly because of the relative increase in FFM in the body. The longer term benefit of regular exercise on metabolism is probably more related to changes in the respiratory exchange ratio (RER) than RMR.

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This is a fairly rare disorder, occurring in perhaps one in 2000. It is an inherited disorder, and symptoms often start soon after birth. The main attributes are a diseased pancreas gland (which sits in the abdomen), chronic chest infections and a high level of solium in the sweat. A persistent early cough is often the first sign. A failure to thrive despite adequate food, diarrhoea and a distended abdomen generally follow.

Treatment

Treatment is usually difficult. Special antibiotics are needed, and the requirements may be ongoing. Specialist care centred in a major hospital which has full facilities is usually necessary. The final outlook is grave, and most patients perish before reaching adult life. Parents are cautioned that, being an inherited disorder, there is a one chance in four that with any subsequent pregnancy another child with the same disease could be born. It is a sad fact of life, but one worth knowing about.

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‘Danny is still wetting the bed at night,’ Sandra said. ‘By now he should have dry nights. I’m worried he may have something wrong with his bladder or kidneys.’

‘There are many variations to what we believe is normal,’ I replied. ‘Most children—in fact, about 90 per cent—manage to learn bladder control between the ages of eighteen months and five years. Very few manage it before they can walk properly, which is usually around the 18-month mark. The rest tend to wet the bed intermittently for a short while, but a few continue for quite a few years. It seems more probable in boys.’

‘That’s my problem,’ Sandra continued. ‘Danny may have several good nights in a row. Then, wow! several really bad ones in quick succession. He simply floods the place.’

‘It’s not unusual,’ I said. ‘And here’s the background to it…

‘It seems that children who continue to bed-wet often have bladders of smaller capacity than those who manage to have dry nights quicker. In fact, besides passing urine in bed during the night, they tend to pass it more frequently during the day. Not that they pass more during a 24-hour period but simply because their bladder is able to accommodate only a smaller volume.

‘The best time to start to teach bladder control is in the 15-24 month age. Training should be gradual and non-coercive, I feel, with tolerance to accidents, which hopefully will gradually lessen. Of course, some parents try to outdo their neighbours and have their child learning “good habits” much too early. They are coercive, and this may often have the reverse effect on the young child, who becomes confused about it all, or builds up resentment, and finally does the exact opposite to what the parents want.’

‘I’ve tried to be very subtle about it all,’ Sandra said. ‘We’ve never made an issue about it. We accept it all and endeavour to encourage Danny all the way. We do make a big thing out of successes and try to play down failures. But, it still goes on…’

‘Very often hidden underlying factors may play a part. Frequently there are emotional situations which may not be apparent to the parent but which are playing a major part in Danny’s outlook and reactions.’

‘I’ve often wondered about this,’ Sandra said. ‘My husband Jim lives a very busy life and has never-ending business commitments. He is frequently called interstate on business matters, and fairly regularly simply vanishes from the home scene, for several days at a time.

‘I wonder if Danny worries about this, whether he feels neglected or harbours resentment. When Jim returns he always makes a big fuss with Danny. Then, bingo! A week later he’s off again on another trip. I’ve sometimes noted—although I haven’t kept accurate records—that the bed-wetting bit is often worse when Jim is away. I have wondered, and so has Jim.’

‘It is quite probable that Danny feels neglect or resentment at being suddenly deprived of his dad, especially as he is made such a fuss of when Dad’s around. It may be his way of telling you he wants more tender, loving care without the sudden breaks.

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Finger and toenails are made from a specialised kind of skin cell. The stratum lucidum, the cell layer which separates the dermis and epidermis layers of the skin, hardens as the fingers and toes of the foetus develop in the womb. Nail cells are living when they have not yet emerged from under the skin but are dead from the ‘moon’ of the nail outwards. Nevertheless, this dead cell material can vary in texture, strength and flexibility depending on the condition of the original living cells, the nail bed, a person’s general health and environmental factors.

While strong and healthy nails in themselves are desirable, weak, splitting, discoloured or ridged nails can tell us much about our nutrition and overall health. For example, white spots can indicate zinc or Vitamin A deficiency. Ridging and brittleness can point to a sluggishness of the thyroid or poor circulation. White pits or grooves can result from anaemia or calcium imbalance, and spooning can indicate low iron levels. These deficiencies can be overcome with dietary adjustment and vitamin or mineral supplements. Some tests have shown that taking gelatin or silicon helps increase the flexibility of the nail.

However, external factors such as detergents, solvents, and, ironically, manicure preparations themselves, are the most common causes of nail defects. Damage to the cuticle when manicuring can lead to a variety of infections. Nail polish removers contain solvents which can seriously dehydrate the nail. Avoid acetone removers or look for a brand which contains moisturising oil. Even polishes can cause acute allergic reactions resulting in inflammation and marking of the nail surface. Fungal infections under the nail occur when the hands are wet too often. To avoid this and limit the damage caused by detergents and high alkaline soaps, protect the hands with gloves when cleaning, washing and gardening. Nail brittleness increases with age.

*16\69\2*

Discomfort in the stomach felt beneath the ribs in the upper part of the abdomen is one of the commonest signs of anxiety. The discomfort—or if it is more severe, the pain—is very similar in nature to the pain of peptic ulcer except that the pain of nervous dyspepsia tends to be associated with emotional stress whereas ulcer pain is more clearly related to food intake. A mild persistent gnawing discomfort in the upper abdomen is often a symptom of chronic anxiety. This is frequently interrupted by intervals of more acute discomfort as the sufferer is subjected to periods of greater stress. Sometimes it is expressed as a feeling of a void or emptiness in the stomach. Other people react with acute upper abdominal discomfort to any sudden anxiety. They describe it by saying, “It gets me in the stomach.” It came quite suddenly, “almost as if someone kicked me there.” Other people experience anxiety as a sensation of “butterflies in the stomach,” or a feeling that “the stomach turns over.”

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Once they’ve tried it, most people agree that if they can lie down and relax completely for twenty minutes to half an hour, they feel very much better in every way: soothed, refreshed and with more energy. But unfortunately most women can’t just take time off to lie down whenever they feel like it. You may be on a bus or a train when your period begins, or out shopping, or at school or college, doing examinations. It’s amazing how exams will trigger a period even when it isn’t due. You might be at home looking after your children, and there’s no way a baby or a toddler will allow you the luxury of an hour in bed. They’re like little weather vanes. If you’re ill or in pain that’s the time they choose to be absolutely diabolical. Perversely, they’re angelic, sunny and a joy to be with when you are on top of the world. So it’s necessary to learn how to relax when you are sitting down, or even standing up.

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Federal law dictates that dates and many other dried fruits must be fumigated with a chemical called methyl bromide before they are shipped across state lines. Thus, almost all of the dates eaten in this country contain a small but often troublesome residue of this chemical.

Many people have noticed that dates and figs are laxatives and even eat them for this purpose. However, in my experience, it is not mainly the fruit itself which exerts this laxative effect but the chemical contamination. Unsprayed figs or dates can usually be eaten with impunity, even in one- or two-pound lots, without causing any laxative action at all. An exception would be a person who is allergic, or sensitive, to dates or figs per se and reacts by getting an upset stomach.

The same problem can be observed with nuts, dried peas, beans, and lentils, all of which are heavily fumigated. Many people believe that they simply cannot eat these foods without having a reaction, but when they try “organic” varieties of the same foods, or nuts in the shell, they do not have the reactions.

Health-conscious people often try to protect themselves by buying unsulfured dried fruit. Such apricots, pears, peaches, and so forth may indeed be unsulfured, but they are generally not uncontaminated. Most of the so-called “health food” dried fruit has been sprayed and fumigated and will often cause the same problems (or chemically susceptible people as the commercial variety.

In the early 1960s, I conducted a test among my patients to determine the possible effects of chemical contamination of wheat and com—the two leading causes of food allergy. Both foods were avoided for five days prior to the test feedings. Patients were then given commercially available wheat and corn, and reactions to these were compared to those to cereal grains from a farm on which no commercial fertilizers and sprays had been used for thirty years. Although the frequency of food allergy to wheat and corn is approximately the same, more persons reacted to commercial corn products than to commercial wheat products. This difference may have been due to the fact that corn is often soaked in sulfur dioxide for several days in order to separate different parts of the kernel. Most manufactured corn products start from such chemically contaminated sources.

A similar problem is posed by bleaching agents used to whiten flour. It is difficult to separate the contribution of the bleach in white bread from the host of other chemicals which go into the loaf.

*15\110\2*

Coughing is a valuable defense mechanism of the body. It is the body’s way of removing any foreign material that enters the respiratory tree (the organs used for breathing). The respiratory tree includes the throat, larynx, trachea, bronchial tubes, and lungs. Coughing is not a disease itself. It is an automatic reflex that is set off by any foreign matter that enters the respiratory tree or by any irritation of the lining of the tree.

In most cases, coughing helps remove unwanted materials from the body, although sometimes coughing does not succeed. The only harm in a cough is that it may keep a person from sleeping, or it may cause sore muscles and exhaustion if the cough is hard and frequent. Coughing may also lead to vomiting.

A cough is only as serious as the disease or condition that causes it. As with a fever, a child with a cough is no less ill if you lessen or stop the cough. A child with a mild illness and a cough is still only mildly ill. To correct the cough, cure the disease.

Signs and symptoms

Coughing is itself a symptom of a disease or of an irritating substance in the respiratory tree. Most coughs are caused by viruses (common colds, croup and bronchitis). Some are caused by bacteria (sinusitis, epiglottitis, bacterial pneumonia, whooping cough). Other coughs are caused by allergies (asthma) or by inhaling irritating particles from the air.

Home care

Since coughing is only one symptom of an illness, you must treat the whole illness – not just the cough. When the illness is cured, coughing and other symptoms will be relieved. There are, however, steps you can take to help relieve coughing.

Give the child plenty of liquids. Use a vaporizer or humidifier to add moisture to the air. Cough medicines are sometimes useful. There are, however, different types of cough medicines, which are used for different types of coughs or for different types of illness.

Cough suppressants are used to reduce the frequency of the cough by suppressing the cough reflex; they may contain a narcotic (codeine, dihydrocodeinone, or hydromorphine) or a non-narcotic (dextromethorphan or benzonatate). Consult your doctor before using a narcotic cough suppressant.

Cough looseners are used to loosen a tight cough; they contain an expectorant (glyceryl-guaiacolate, guaifenesin, ammonium chloride, or antimony potassium tartate), which may help the person cough mucus out of the lungs.

Cough tighteners are used to dry up a loose cough; they contain a decongestant (ephedrine, pseudoephedrine, phenylpropanolamine, or homatropine).

Anti-allergy drugs are used to fight the allergy causing the cough; they contain ephedrine or an antihistamine. Some cough medicines contain a combination of ingredients and are intended to serve more than one purpose at the same time. Many different combinations of drugs are on the market in liquid form or as tablets or capsules. Before purchasing a cough medicine for home use, consult your doctor about the type of cough medicine (if any) that should be used.

Remember also that sometimes it is better not to try to suppress the cough. In some illnesses (especially asthma and pneumonia), coughing helps the child get rid of excess mucus in the lungs or air passages.

Precautions

• Do not give cough medicine to a child with croup.

• Do not give cough medicine to a child with any breathing difficulty unless you know you are treating asthma, and then give only anti-asthma drugs.

• Do not give cough medicine to a child who may have inhaled a foreign body.

Medical treatment

Your doctor will concentrate on treating the condition causing the cough, not on the cough itself. Narcotic cough medicines and some with antihistamines require a doctor’s prescription.

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Men don’t stretch. And for good reason: They hate it.

“Stretching’s just not fun,” says Janet Sobel, a physical therapist and clinical specialist at National Rehab Hospital/Suburban Regional Rehab in Chevy Chase, Maryland. “The results aren’t visible. No muscles bulge. And you don’t look cool doing it.”

But stretching is a joint-saver, according to Sobel, as well as a circulation-promoter, a performance-enhancer, and an injury-preventer. All of those things are important for disease prevention. “Stretching doesn’t directly decrease the likelihood of disease,” Sobel says. “But by enabling you to exercise without injury, it enables you to do what you need to do to minimize your disease risk.”

Here’s how to ride the stretch limousine to better health.

Stretch daily (or almost). “Stretching should be like brushing your teeth,” says Barbara Sanders, Ph.D., chairman of the physical therapy department at Southwest Texas State University in San Marcos. “It should be part of your daily routine.” Since we’re talking about only a few minutes to do a handful of stretches that require no equipment, you’ll probably find seven days a week doable and even enjoyable. But five is an acceptable minimum, Sobel says. “You’re not going to see results if you do it every other day,” she says. “But if you do it five days a week, it will pay off.”

Hold the stretch, but not your breath. To get the big benefits, you should hold each stretch for 20 to 30 seconds and repeat two or three times, Sobel says. And hold it still – no bouncing. At first you’ll notice a temptation to hold your breath as you hold the stretch. Resist it. “Breathing is very important,” Sobel says. “If you don’t breathe, you’re going to tighten up and it will hurt. That’s counterproductive.”

Stretch for as long as it takes. And that’s not very long. The only requirement is to work all the major body areas. “A basic stretch routine will be six to eight stretches,” Sobel says. Three repetitions of six stretches at 20 seconds each is six minutes. You spend more time than that looking for your bathrobe in the morning.

Just do what you can. What’s the most annoying moment in those stretching classes at your health club? How about when the instructor tells you not to worry if you can’t go “all the way” in some stretch that looks like it was invented by one of those contortionists in Chinese circuses? All the way? You can’t even begin it.

Don’t even try, Sobel advises. “Get as close as you can until you feel a comfortable pull, but not pain,” she says. “Be attentive to your body’s signals. Each person has his own genetic design, and you want to achieve your own potential, not someone else’s. Ultimately, you’ll get there.”

*47/36/5*

As you are unlikely to be in hospital for longer than a few days, there are very few things you will need. The following list may be helpful.

1    Nightclothes. Loose, comfortable nightclothes are best. You will be given a hospital shift to wear during the operation itself.

2     Slippers.

3     Dressing gown.

4     Towel and washing things.

5     Money. A small amount of money may be useful for newspapers and the telephone. Large sums of money, wallets and handbags should not be taken into hospital as these may have to be kept in an unlocked cabinet by your bed. If you do have to take any valuables or large sums of money into hospital, you should give them to the nurse in charge of your ward when you are admitted. You will be given a receipt listing each item and should keep this safe so that you can collect your possessions when you are discharged. However, hospital authorities strongly discourage people from bringing anything of great value with them unless absolutely necessary.

6     Boob, magazines, puzzles, knitting. There will inevitably be periods of waiting between visits from medical staff before your operation, and you may want something to occupy you during this time. Apart from reading, it may also be possible to write letters or do some types of business work if your stay in hospital is longer than overnight.

7     Clothes to wear to go home. Following a mastectomy operation to remove a breast, you should be fitted with a soft, temporary prosthesis before you go home. The breast care nurse or ward sister will put this inside your bra as an interim measure until a permanent prosthesis can be fitted, some 6 to 8 weeks after the operation when the wound has completely healed. For this reason, you should take into hospital with you a well-fitting, comfortable bra which is not wired or low cut, preferably made of Lycra or elastic to provide support, and in good condition. You may also be asked to take a tight-fitting T-shirt or similar garment to wear while the nurse is matching the shape of the prosthesis to that of your other breast. You will probably prefer a loose shirt or sweater to go home in.

8     Drugs you are already taking. Once your admission has been arranged, your GP will have been asked to fill in a form stating all the drugs you are taking and their doses. You may also be asked to take your drugs with you when you go into hospital so that their dosages can be checked and so that you can continue to be given any which are necessary. All your drugs will be kept for you during your stay as you must only take those which are given to you by medical staff. If you are asked to take your own drugs into hospital, these should be returned to you before you leave.

9     Admission letter. An admission letter will have been sent to you from the hospital, and you should take this with you when you are admitted for your operation.

Jewellery

Whenever possible, all jewellery should be left at home. Although wedding rings may be worn during an operation, there is a risk that any jewellery you take off before surgery may be lost or stolen. If you have to take any jewellery into hospital, it should be given to the ward sister for safe keeping.

Wedding rings, or any other rings which are very precious to you or which cannot be removed, will be covered with adhesive tape before your operation as metal can cause electrical burns or electric shocks during the process of electrocautery which is used to control bleeding during surgery. In electrocautery an electric current heats the tip of an instrument which then shrivels and seals the little blood vessels and stops them bleeding.

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