Children May Outgrow Migraines

A majority of adolescents with migraines either stop having headaches or develop less-severe ones as they reach adulthood, new research shows.

Of the 55 children studied, 40% had remission by their early 20s, while 20% shifted to less troubling tension-type headaches, according to the report, published in the Oct. 24 issue of Neurology.

However, adolescents whose parents or siblings have migraines may be less likely to outgrow their own.

That's especially true of adolescents initially diagnosed as having migraines without aura -- a form in which the migraines are not accompanied by sensory disturbances such as flashing lights, strange odors, or sounds, according to the research.

On balance, it is good news for children and teens who have migraines, says Rosolino Camarda, MD, of the University of Palermo in Italy, one of the study's researchers. It means most of them won't have to cope with disabling headaches as adults, Camarda says.

Researchers Studied Entire Town

In 1989, Camarda's team screened all primary school students aged 11-14 in the town of Monreale, Italy. They identified 80 adolescents as having probable migraine.

Because some studies have suggested the International Headache Society's criteria are too restrictive for patients under age 15, the researchers not only included adolescents diagnosed with migraine without aura, but also those said to have migrainous disorder or non-classifiable headache.

In 1999, they re-evaluated 55 cases -- 30 women and 25 men who were then aged 21-24. Of these, 28 had initially been diagnosed as having migraine without aura, 14 with migrainous disorder, and 13 with non-classifiable headache.

"Our study shows that over a 10-year period, migraine headaches starting in adolescence have a favorable long-term prognosis," Camarda tells WebMD. "About 40% of our subjects experienced remission, and 20% of them transformed to tension-type headache, which is a less distressing headache."

Remission Depends of the Patient

Remission Depends of the Patient

Although most patients improved, about 40% still had persistent headaches.

This included 15 subjects diagnosed with migraine without aura, two with aura, five with migrainous disorder, and one with non-classifiable headache.

The study showed migraine was most likely to persist in adolescents initially diagnosed with migraine without aura and least likely to persist in those initially diagnosed with migrainous disorder or non-classifiable headache.

It also showed a family history of migraine was a strong risk factor for migraine persistence. Adolescents who had parents or siblings with migraine were seven times as likely to still have migraine 10 years later as those whose first-degree relatives were migraine-free.

"Our data suggest that migraine without aura is probably genetically determined," Camarda says.

Public Health Implications

Because migraine without aura is far more common in young adults than migraine with aura, it is an "enormous public health problem," Camarda says.

"Our data have important implications for prevention," Camarda says.

The researcher suggests that aggressive medical treatment of children and teens who have migraine without aura, especially those with a family history of migraine, might lead to eventual remission or to transformation into a less-severe tension-type headache.

Unlike some previous studies, the new one did not confirm that migraine is more likely to persist in girls than boys, although it did show a trend in that direction.

Because the study included only 55 subjects, the association between gender and migraine persistence was probably underestimated, Camarda says.

Larger studies are needed to answer lingering questions about the natural history of migraine, say Camarda and colleagues.

Long Term Prognosis Unclear

"Even if migraine remits, it can reoccur later in life," says Stephen Silberstein, MD, of Thomas Jefferson University in Philadelphia, who was not connected with the new study.

Silberstein says the Italian study "partly replicates" a 1997 Swedish study of 73 children with migraine followed for 40 years.

That study showed that 23% of the children -- boys more often than girls -- were migraine-free by age 25, he says. But it also showed more than half still had migraine attacks at 50.

Contradicting the Italian researchers, Silberstein says he doubts migraine transforms into tension-type headache. "I believe they are just milder attacks of migraine," he tells WebMD.

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Drug-Slang Quiz Helps Parents Help Kids

Use of terms like 'fry stick' or 'schwagg' are clues youngsters are in trouble, experts say

If you're a parent, you might want to brush up on your drug slang to stay alert to possible drug use by your children, suggest addiction experts at the Menninger Clinic in Houston.

Slang terms for drugs constantly change and evolve, the researchers said. For example, while marijuana is still called weed or pot by some, it's also referred to by newer terms such as chronic or schwagg. Heroin is still be called smack but, depending on the type of heroin, it may also be called black tar or brown sugar.

Then there are terms such as Special K and biscuits. Special K refers to ketamine, a powerful hallucinogenic drug similar to LSD and PCP. A biscuit (or tab) is a hit of the "club drug" Ecstasy.

In order to test your knowledge of drug slang, here's a quiz created by the Menninger Clinic experts:

1. K-Hole is slang for: a) a type of ketamine; b) periods of ketamine-induced confusion.

2. The painkiller Oxycontin is also called: a) oxies; b) cotton.

3. Rophies is the nickname for: a) Rohypnol, the date rape drug; b) the rush you feel after using cocaine.

4. Fry sticks are: a) the act of injecting yourself with speed; b) marijuana cigarettes dipped in formaldehyde and sometimes laced with PCP.

5. Inhaling a small amount of cocaine is called a: a) bump; b) blip.

6. Combining the prescription drug Viagra with Ecstasy is called: a) 24-7 heaven; b) sextasy.

7. "Amped out" is: a) fatigue after using amphetamine; b)using the maximum amount of steroids your body can take.

8. Working Man's Cocaine is: a) crack cocaine; b) methamphetamine.

9. A marijuana cigarette rolled with cocaine is called a: a) primo; b) speedy.

10. "Juice" is the slang term for: a) steroids; b) PCP.

Here are the answers: 1 (b), 2 (b), 3 (a), 4 (b), 5 (a), 6 (b), 7 (a), 8 (b), 9 (a), 10 (both a or b).

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High Blood Pressure, the Insidious Killer

Jay B Stockman

Next time you are with a group of 3 friends, take a good look around; one of you will have high blood pressure. The sad part is, since there are no symptoms, you may not even be aware of it. Untreated high blood pressure can lead to heart attack, congestive heart failure, stroke, or kidney failure. Various risk factors contribute to this disease that are both under our control, and out of our control. The only way to determine if you have high blood pressure is to have your blood pressure checked. The insidious nature of this disease makes it a true Silent Killer.

The brain requires unobstructed blood flow to nourish its many functions. Very high, sustained blood pressure will eventually cause blood vessels to weaken. Over time these weaken vessels can break, and blood will leak into the brain. The area of the brain that is being fed by these broken vessels start to die, and this will cause a stroke. Additionally, if a blot clot blocks a narrowed artery, blood ceases to flow and a stroke will occur. Symptoms of a stroke include sudden numbness or weakness of the face, arm or leg, especially on one side of the body, confusion, trouble speaking, or seeing, sudden severe headache. If you or someone with you has one or more of these signs, don't delay, call 911.

Like the brain, the heart requires blood to bring oxygen, and nutrients to its muscle tissue. The narrowing of the arteries due to blockage can cause high blood pressure. If this blockage occurs in the arteries of the heart, coronary arteries, heart muscle damage can occur, resulting in a heart attack. Some heart attacks are sudden and intense, however most heart attacks start slowly with mild pain and discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Shortness of breath may occur, as well as nausea, or lightheadedness. It is vital to get help immediately if any of these symptoms occur.

Adopting a healthy lifestyle including healthy eating habits, reducing salt in the diet, maintaining a healthy weight, limiting alcohol consumption, being physically active, and quitting smoking is an effective step in preventing and controlling high blood pressure.
The kidneys act as filters to rid the body of all waste products. Eventually, high blood pressure can thicken, then narrow the blood vessels of the kidneys. The kidneys becomes less efficient, filtering less fluid, and waste builds up in the blood. Over time, the kidneys may fail altogether. When this happens, medical treatment such as dialysis, or a kidney transplant may be needed.

The best way to find out if you have high blood pressure is by having your blood pressure checked regularly. Generally speaking, doctors will diagnose a person with high blood pressure on the basis of two or more readings, taken on different occasions. A consistent blood pressure reading of 140/90 mmHg or higher is considered high blood pressure, or hypertensive. It is vital to take steps to keep your blood pressure under control. The treatment goal is blood pressure below 140/90 and lower for people with other conditions, such as diabetes and kidney disease.

Adopting a healthy lifestyle including healthy eating habits, reducing salt in the diet, maintaining a healthy weight, limiting alcohol consumption, being physically active, and quitting smoking is an effective step in preventing and controlling high blood pressure. If lifestyle improvements alone are not sufficient in keeping pressure controlled, it may be necessary to add blood pressure medications. There are several options that physicians have at their disposal, and each option should be discussed, as to their side effects and efficacy.

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Weather and joint pain: Any connection?

Is there any truth to the common belief that cold, damp weather worsens arthritis pain?

Answer:

Many studies have explored the relationship between joint pain and weather changes, such as barometric pressure, temperature and humidity. Although both anecdotal and scientific evidence suggest that a connection exists, it has not been proven.

Your joints are lined with a membrane (synovium) that secretes a lubricating fluid (synovial fluid). In arthritis, particularly inflammatory types such as rheumatoid arthritis, the amount of fluid increases. Theoretically, changes in barometric pressure could affect the fluid in joints if, for example, a chemical in the joint increased — causing inflammation — when pressure rose and fell. But there's no conclusive evidence that supports this theory.

One recent study suggests that changes in barometric pressure and cooler temperatures are associated with joint pain. Still, other studies have found no connection or contradictory results — some people have increased pain with low barometric pressure and others have increased pain with high pressure. The reason for these discrepancies isn't clear.

Researchers have also studied the effect of weather changes, such as temperature and humidity, on pain in people with rheumatoid arthritis, osteoarthritis and lower back pain. But results so far are inconclusive.

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Testosterone Tumbling in American Males

The testosterone-fueled American male may be losing his punch.

Over the past two decades, levels of the sex hormone in U.S. men have been falling steadily, a new study finds.

For example, average total testosterone levels in men aged 65 to 69 fell from 503 nanograms/decileter (ng/dL) in 1988 to 423 ng/dL in 2003.

The reasons for this trend are unclear, said researchers at the New England Research Institutes in Waterdown, Mass. They noted that neither aging nor certain other health factors, such as smoking or obesity, can fully explain the decline.

"Male serum testosterone levels appear to vary by generation, even after age is taken into account," study lead author Thomas G. Travison said in a prepared statement.

Testosterone is the primary male sex hormone and plays an important role in maintaining bone and muscle mass. Low testosterone levels have been linked to health problems, including lowered libido and diabetes.

It's normal for men's testosterone levels to peak in their late 20s and then start to gradually decline, experts say. But this study found that overall testosterone levels are lower than they were 20 years ago.

"In 1988, men who were 50 years and older had higher serum testosterone concentrations than did comparable 50-year-old men in 1996. This suggests that some factor other than age may be contributing to the observed declines in testosterone over time," Travison said.

He and his colleagues analyzed blood samples -- along with health and other information -- from about 1,500 men in the greater Boston area who took part in the Massachusetts Male Aging Study. That study collected data in 1987-89, 1995-97, and 2002-04.

"This analysis deals with men who were born between 1915 and 1945, but our baseline data were not obtained until the late 1980s, when the elder subjects were about 70 years old, and the youngest about 45," Travison said.

"Events occurring in earlier decades could certainly help explain our results, if their effects persisted into recent years," he noted.

The findings were published in the Journal of Clinical Endocrinology and Metabolism.

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Cancer Drug Studied in Children with Rare Form of Leukemia

Martin Champagne, MD, FRCP(C)

STI-571, also known as Gleevec, was approved for the treatment of chronic myeloid leukemia, or CML, one of the four main types of leukemia. It has also achieved remarkable clinical trial results in the treatment of a rare intestinal tumor called gastrointestinal stromal tumor, or GIST.

Researchers are also beginning to look at the effects of this new drug on children with CML, and in phase I clinical trials, the drug is showing promising results. Dr. Martin Champagne, a medical oncologist at St. Justine Hospital in Montreal, Canada, is the principal researcher of the current study investigating the use of Gleevec in children with CML. Below, he discusses these promising results and the special considerations involved in testing new drug treatments on children.

Q: Could you summarize the results of the trial?
The trial is a phase I trial, which means that we're looking at the dose-limiting toxicities and the maximum tolerated dose in children with the Philadelphia chromosome-positive leukemia, which is the defining characteristic of this particular type of rare leukemia. We were also looking at the way that their bodies were handling the drug. We have found that the drug is fairly well tolerated in the children tested.

The levels that we achieved in the patients were at levels where we would expect to see anti-leukemic activity based on preclinical models.

Q: So is it common for drugs to be tested separately for children and adults?
Yes. Children are not young adults. You can't figure out how the body will handle the drug just by making a sample rule of three and dividing by body weight. So we have to do specific studies to find out how they will handle and tolerate the drug - which is different in most studies than in adults.

Q: What kind of side effects have you seen in the study?
The most common toxicities that we found were minor nausea and vomiting. We also had some toxicity related to what we call the hematological parameters, which is a little bit of anemia, and decrease of white blood cells, which is no surprise in patients with leukemia at the start.

Q: How safe is this drug in children?
Although we did escalate the drug by different levels, and we increased the drug at a fairly high amount of total dose, we did not encounter significant toxicity of one organ or one function of the body that will prevent using the drug in children at the set dose. So, actually the drug was well tolerated for most of the kids.

Q: And when will the trial be completed?
The trial is still underway. We're looking for more patients so that we can test the drug at two levels, to find out if the preliminary information we got is consistent.

Q: This drug has been tested for safety in children, but what about efficacy?
We have no data yet that I can comment on. But we hope at least from our preclinical model that it will work, because the Philadelphia chromosome, which is the defining feature in these types of leukemia, is not different in the pediatric patients than it is in the adults. But we have to figure that out. We just don't know yet.

Q: Do you foresee any future implications for the use of Gleevec in children with leukemia?
There will be many challenges, because these particular types of leukemia are different in children than they are in adults. We'll ask medical oncologists to figure out what the best timing and schedule would be for giving the drug to children. We'll have to look at how we can incorporate the drug with chemotherapy trials, to see if we can build better results by using combination therapies.

Q: Do you believe that this drug could be a cure for leukemia in children as well as adults?
I hope for some kids it will be the solution. But you have to keep in mind that these types of leukemia are rare in children. They represent only about 2 to 3 percent of the most common type of leukemia, which is the acute lymphoblastic leukemia. So the major proportion of patients will have to rely still on other therapeutics to achieve a cure.

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Colon Cancer and IBD: Understanding the Link

Colon cancer, the third most common type of cancer in the United States, is a serious health threat for men and women over 50. However, if you are of the one million Americans living with an inflammatory bowel disease (IBD), you face a higher risk for colon cancer than the average person.

IBD, which includes Crohn's disease and ulcerative colitis, is a disorder of the gastrointestinal tract. Inflammation can occur anywhere along the gut, but it typically affects the lining of the colon when the intestinal wall becomes irritated and sometimes ulcerated. People with this condition experience cramps, bloating and a wide range of bowel problems. There is, of yet, no known cause or cure for IBD but many patients achieve some improvement in their condition with medication or dietary changes. No one knows why IBD ups the risk of this cancer, but it is believed to be a function of chronic inflammation.

Still, it is important that those living with IBD understand their risk for colon cancer and regularly monitor their health. Steven Itzkowitz, MD, a professor of medicine, and Thomas Ullman, MD, an assistant professor of medicine, both from the Mt. Sinai School of Medicine in New York City, explain the prevalence of colon cancer and medical options available to people with IBD.

How high is the risk of colon cancer for people with IBD?
THOMAS ULLMAN, MD: You are at increased risk of developing colon cancer if you have long-standing and extensive ulcerative colitis or long-standing and extensive Crohn's colitis.

STEVEN ITZKOWITZ, MD: After having colitis for about eight years, a person's risk of colon cancer starts to go up by about a half a percent to 1 percent each year. IBD is thought to be the third-highest risk factor for colon cancer, after two hereditary syndromes: familial polyposis and Lynch syndrome.

How is colon cancer screened in patients with IBD?
STEVEN ITZKOWITZ, MD: Once you've had your colitis for about eight years, even if you have relatively few symptoms, you should be going for regular colonoscopies about every one to two years; some people say every one to three years. The colonoscopy itself turns out to be quite well tolerated. We have very good anesthetics now where people literally wake up and say, "When are we going to get started?"

How is colon cancer diagnosed in patients with IBD?
STEVEN ITZKOWITZ, MD: With patients who have inflammatory bowel disease, we may find polyps or raised growths during the colonoscopy, but there can also be precancerous or sometimes even cancerous changes that are flat and almost invisible. So we do multiple biopsies, sampling the tissue throughout the colon to try to detect these areas that are otherwise invisible.

THOMAS ULLMAN, MD: The samples are examined [under a microscope] by the pathologist to see what the cells look like and to determine the presence or absence of dysplasia, which are precancerous changes in the colon.

How are precancerous changes and colon cancers treated in people with IBD?
STEVEN ITZKOWITZ, MD: Dysplasia has different gradations: low-grade dysplasia and high-grade dysplasia. If an expert pathologist tells you have a high-grade dysplasia, there's a 45 to 65 percent likelihood that there is already cancer in the colon or will be in the near future. If you only remove a part of the colon that you think has the area of cancer, there is a very high likelihood that cancer will crop up in the future. So, most physicians would recommend that the whole colon should be removed. With low-grade dysplasia, there is a little bit more controversy. But, because of our inability to see all cancers before they become problematic in people with IBD, many doctors will recommend that you consider removing the colon.

That's why the stakes are a little bit higher for people with IBD. The surgery for colon cancer or dysplasia in inflammatory bowel disease means taking out the entire colon and rectum, whereas, in the general population, if you found a cancer or a precancerous polyp, you only have to remove that one little segment of the colon that's affected.

What surgical options are available?
STEVEN ITZKOWITZ, MD: New surgical techniques, available in the last decade, are more conducive to an active lifestyle. If we have to remove the colon and the rectum, we can create an internal pouch out of the end of the small intestine and bring that down to the muscles at the lower sphincter. The person can still be able to [go to the bathroom] normally.

Occasionally, people will need an end ileostomy, where the colon and the rectum are removed and the end of the intestine is brought out through the skin to an external appliance. Sometimes that's a better operation.

Can colon cancer be prevented in people with IBD?

STEVEN ITZKOWITZ, MD: With IBD patients, there are a few different compounds that may lower the risk of colorectal cancer. The one that has been proven to be the most efficacious is ursodeoxycholic acid (USRO), or Actigall. [This drug may prevent cancer by reducing levels of a carcinogenic substance called deoxycolate and bile acid in the colon.] So far, this has only been looked at in the high-risk group of IBD patients who also have primary sclerosing cholangitis, an inflammation of the bile ducts in the liver. In this small group of people, about 5 to 10 percent who take USRO seem to have a lower rate of cancer and dysplasia.

If you look at all IBD patients, not just the sclerosing cholangitis group, there seems to also be some evidence that the 5-aminosalicylate compounds (otherwise known as mesalamine) reduce the risk of colon cancer and dysplasia.

Then, there's folic acid, a safe, inexpensive vitamin. We don't have good scientific proof that it lowers colon cancer or dysplasia risk, but there's some circumstantial evidence that it may work in IBD, and there's pretty good evidence in the non-IBD population, that it seems to lower the risk of colon cancer.

We have to just remind our patients that even if they take these medicines, they still need to come for regular colonoscopy.

What is your colon cancer screening advice for people with IBD?

THOMAS ULLMAN, MD: We actually do a very good job of preventing cancer in ulcerative colitis and in Crohn's colitis. So the first thing that I would tell patients is, "Don't worry early on in the course of disease." Build a strong alliance with your gastroenterologist and then when the time comes—after eight years—do yourself the favor and have your annual colonoscopy.

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Lowering Your Risk of Colon Cancer

Karen Barrow

Colon cancer is the third most common cancer in the United States, and well over 100,000 people will be diagnosed with the disease this year alone. And while it is the second and third leading cause of cancer death in women and men, respectively, more and more people are being successfully treated and cured of colon cancer because of improved screening methods that can detect the cancer in its earliest stages.

“One of the most powerful weapons in preventing colorectal cancer is regular colorectal cancer screening or testing,” writes the American Cancer Society (ACS) on its website. Since it takes 10 to 15 years for an abnormal cell to develop into colorectal cancer, regular screenings can help identify and remove abnormal cells before they ever cause a problem.

The ACS recommends that those at relatively low risk for developing colorectal cancer should begin having routine colonoscopies every ten years beginning at age 50. If you have a family history of the disease, or other risk factors that increase your risk of the disease, you may need to begin regular screenings earlier at more frequent intervals.

But preventing abnormal cells from growing altogether is ideal, and while the exact cause of colon cancer is unknown, there are things you can do to lower you risk of colorectal cancer.

Measuring Your Risk
There are two types of risk factors for colorectal cancer: those you can change and those you can’t. These “uncontrollable” factors include:

• Age. Inevitably, as you grow older, your risk of colon cancer rises considerably. Yes, it is possible for a young man or woman to get colon cancer, but their risk is considerably lower than someone over the age of 50.
• Family History. If you have a first-degree relative (mother, father, sister or brother) who has had colorectal cancer or adenamotous polyps (a precursor of colorectal cancer) before the age of 60, you are considered to be at an increased risk of developing the disease. Your doctor will likely recommend that you begin colorectal cancer screening before the age of 50, sometimes as early as age 40.
• Personal History. If you have any history of colorectal cancer or colorectal polyps, your risk for colorectal cancer is increased.
• Other Diseases that Increase Risk. It you have chronic inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, you are at an increased risk for developing colon cancer. The ACS recommends that you begin getting regular colonoscopies 8 to 12 years after you were first diagnosed with inflammatory bowel disease. Additionally, people with diabetes have up to a 40 percent greater chance of being diagnosed with colon cancer.
• Ethnic Background. Jewish men and women of Eastern European descent have been found to have a higher rate of colorectal cancer due to a genetic mutation common in this group. Additionally, there is some evidence that African Americans are at an increased risk for colorectal cancer, but researchers are unsure as to why this is.

If you do have one or more of these uncontrollable risk factors, it is important that you inform your doctor. Based on what you tell him or her, your doctor may recommend that you begin regular colorectal screenings earlier and/or more frequently.

Keep in mind, though, that there are risks factors that are in your power to change. These include:

• Diet. A diet high in fat, particularly animal fats, has been found to increase your risk of colorectal cancer. To lower your risk, the ACS recommends substituting plant-based foods for animal products whenever possible. Also, be sure to have five servings of fruits and vegetables each day and several servings of food from other plant sources, such as grains, rice, pasta or cereal. “Many fruits and vegetables contain substances that interfere with the process of cancer formation,” writes the ACS.
• Exercise. Those who are not active are at a greater risk of developing colorectal cancer. Aim to do at least 20 minutes of exercise a day. It will both lower your risk of colorectal cancer and other diseases, as well as increase your overall fitness.
• Weight. Obesity is linked to a higher risk of death from colorectal cancer. If you are overweight, be sure to speak with you doctor about healthy plans to help you shed the excess pounds.
• Smoking. Smoking doesn’t just hurt your lungs; it is estimated that smoking causes 12 percent of all fatal colorectal cancers. Chemicals in cigarettes and cigars are swallowed and absorbed into the bloodstream, increasing your risk of various types of cancer.
• Alcohol intake. Heavy alcohol consumption has been linked to an increased risk of colorectal cancer. Be sure to limit alcohol intake to lower this risk.

So, no matter what your risk is, by changing your diet, exercising, maintaining a healthy weight and limiting alcohol intake and smoking, you do have to power to lower your chance of developing colorectal cancer.

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Cell Phones and Sperm

Christine Gorman

Here’s why I’m not worried about a recent report that cell phone use has been associated with low sperm count in men. A) I am a woman. B) I just spent a half hour on the phone with the first author of the report and he’s been fielding calls non-stop for the past two days on, you guessed it, a cell phone.

“I’m not giving up my cell phone,” says Ashok Agarwal, a reproductive biologist at the Cleveland Clinic in Cleveland, Ohio. Indeed, he’s probably going to have to get a new one since his cell phone stopped working this morning and he had to borrow someone else’s to talk to all the journalists from around the world who are calling him up. “Our study is not the final word,” Agarwal says. “But we were able to demonstrate some interesting findings.”

More specifically, Agarwal and his colleagues surveyed 364 men who were being evaluated at an infertility clinic in Mumbai, India. The researchers determined that those men who used their cell phones the most—four hours or more a day—had the lowest average sperm counts. A closer look also showed that fewer of the sperm were good swimmers and more of them appeared abnormal when compared to the sperm of the men who never used a cell phone.

But just because the scientists found a statistical association between heavy cell phone use and damaged sperm doesn’t necessarily mean anything. Heavy cell phone use may actually be a marker for something else that is known to affect sperm count—like sitting for long stretches or being overweight. Maybe people who use their cell phones a lot tend to be more stressed out than those who don’t.

The results, which were presented at a poster sessison of the annual meeting of the American Society for Reproductive Medicine in New Orleans, are intriguing enough, however, that they’re worth pursuing. In the next few months, Agarwal hopes to sign up a couple hundred men at the Cleveland Clinic for further study.

In the meantime, says Dr. Peter Schlegel, a urologist and board member of the American Society for Reproductive Medicine, there’s no need to throw your cell phone away. (I also talked to him on his cell phone.) “I won’t be recommending a change of behavior for my patients,” Schlegel says. But any men who are really, really worried and want to play it absolutely safe, he notes, could just stop carrying their cell phones on their belt or in a pocket.

There are plenty of other reasons to spend less time on a cell phone, especially if you’re trying to have a baby.

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Indian men don't play safe in sex

Kavita Bajeli-Datt

New Delhi - Lack of information about safe sex have made most Indian heterosexual males who visit sex workers seeking anal sex believe ignorantly that they would not catch HIV/AIDS.

This pattern of behaviour among Indian males came out in a nationwide survey conducted by Naz Foundation Internationalis, an Indian NGO based in Britain that specializes in sexual and reproductive health of homosexuals and their partners in South Asia.

The survey was conducted to find out understanding, risks and behaviours prevailing in the country, especially among gays, he said adding that sex education was absent among majority of the people covered in the survey.

"The survey was conducted in 56 cities. We surveyed sex workers, who told us that their client demand anal sex. Most men think that it is a safe way of not contracting HIV/AIDS. But they don't know that it is ten times more dangerous and risky," Arif Jafar, the foundation Executive Director said.

"The issue is not just restricted to homosexual men. Many men, who are heterosexuals, sometimes prefer to have sex with men when they are travelling. But they do not consider sex with other men risky," said Jafar.

"Knowledge of male and female bodies, of reproduction, of the sex organs was almost non-existent. This led to a variety of myths, beliefs and practices, which were accepted as true and helpful," he said.

"Condom use was determined primarily in terms of access, knowledge, shame, and sickness. With the condom equated with disease prevention, many participants either felt stigmatized through condom usage, or felt that their was no need to use condoms because either they or their sex partners were not sick," he said.

"Sexual health information and services are primarily focused on so-called heterosexual behaviour and ignore the significant levels of anal sex, irrespective of the gender of the sexual partner.

"Formative research is urgently needed to understand how to design appropriate sexual health interventions regarding male to male sexual behaviour and men having sex with men," he said.

The survey, conducted in Varanasi, Allahabad, Jaunpur, Kanpur, Ghaziabad, Agra, Tuticorin, Thirunalveli, Hubli, Bijapur, Bellary, Nalgonda, Kakinada and Hardoi, showed that most men are ignorant about safe practices because the government has not been able to come out with messages and advertisements which give a clear picture.

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STROKE - Causes, incidence, risk factors and prevention

Chitra R. Uppaluri, M.D

A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a "brain attack."

Alternative Names

Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage
Causes, incidence, and risk factors

Every 45 seconds, someone in the United States has a stroke. A stroke can happen when:

* A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke.
* A blood vessel breaks open, causing blood to leak into the brain. This is a hemmorhagic stroke.

If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.

ISCHEMIC STROKE

This is the most common type of stroke. Usually this type of stroke results from clogged arteries, a condition called atherosclerosis. (See stroke secondary to atherosclerosis.) Fatty deposits and blood platelets collect on the wall of the arteries, forming a sticky substance called plaque. Over time, the plaque builds up. Often, the plaque causes the blood to flow abnormally, which can cause the blood to clot. There are two types of clots:

* A clot that stays in place in the brain is called a cerebral thrombus.
* A clot that breaks loose and moves through the bloodstream to the brain is called an cerebral embolism.

Another important cause of cerebral embolisms is a type of arrhythmia called atrial fibrillation. Other causes of ischemic stroke include endocarditis and the use of a mechanical heart valve. A clot can form on the artificial valve, break off, and travel to the brain. For this reason, those with mechanical heart valves must take blood thinners.

HEMORRHAGIC STROKE

A second major cause of stroke is bleeding in the brain hemorrhagic stroke. This can occur when small blood vessels in the brain become weak and burst. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood after the blood vessel ruptures damages brain cells.

STROKE RISKS

High blood pressure is the number one reason that you might have a stroke. The risk of stroke is also increased by age, family history of stroke, smoking, diabetes, high cholesterol, and heart disease.

Certain medications increase the chances of clot formation, and therefore your chances for a stroke. Birth control pills can cause blood clots, especially in woman who smoke and who are older than 35.

Men have more strokes than women. But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy.

Cocaine use, alcohol abuse, head injury, and bleeding disorders increase the risk of bleeding into the brain.

See also:

* Stroke secondary to carotid dissection (bleeding from the carotid arteries)
* Stroke secondary to carotid stenosis (narrowing of the carotid arteries)
* Stroke secondary to cocaine use
* Stroke secondary to FMD (fibromuscular dysplasia)
* Stroke secondary to syphilis
* Hemorrhagic stroke
* Arteriovenous malformation (AVM)

Symptoms

The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke.

Usually, a SUDDEN development of one or more of the following indicates a stroke:

* Weakness or paralysis of an arm, leg, side of the face, or any part of the body
* Numbness, tingling, decreased sensation
* Vision changes
* Slurred speech, inability to speak or understand speech, difficulty reading or writing
* Swallowing difficulties or drooling
* Loss of memory
* Vertigo (spinning sensation)
* Loss of balance or coordination
* Personality changes
* Mood changes (depression, apathy)
* Drowsiness, lethargy, or loss of consciousness
* Uncontrollable eye movements or eyelid drooping

If one or more of these symptoms is present for less than 24 hours, it may be a transient ischemic attack (TIA). A TIA is a temporary loss of brain function and a warning sign for a possible future stroke.
Signs and tests

In diagnosing a stroke, knowing how the symptoms developed is important. The symptoms may be severe at the beginning of the stroke, or they may progress or fluctuate for the first day or two (stroke in evolution). Once there is no further deterioration, the stroke is considered completed.

During the exam, your doctor will look for specific neurologic, motor, and sensory deficits. These often correspond closely to the location of the injury in the brain. An examination may show changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes. A "bruit" (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck. There may be signs of atrial fibrillation.

Tests are performed to determine the type, location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms. These tests include:

* Head CT or head MRI -- used to determine if the stroke was caused by bleeding (hemorrhage) or other lesions and to define the location and extent of the stroke.
* ECG (electrocardiogram) -- used to diagnose underlying heart disorders.
* Echocardiogram -- used if the cause may be an embolus (blood clot) from the heart.
* Carotid duplex (a type of ultrasound) -- used if the cause may be carotid artery stenosis (narrowing of the major blood vessels supplying blood to the brain).
* Heart monitor -- worn while in the hospital or as an outpatient to determine if a heart arrhythmia (like atrial fibrillation) may be responsible for your stroke.
* Cerebral (head) angiography -- may be done so that the doctor can identify the blood vessel responsible for the stroke. Mainly used if surgery is being considered.
* Blood work may be done to exclude immune conditions or abnormal clotting of the blood that can lead to clot formation.

Treatment

A stroke is a medical emergency. Physicians have begun to call it a "brain attack" to stress that getting treatment immediately can save lives and reduce disability. Treatment varies, depending on the severity and cause of the stroke. For virtually all strokes, hospitalization is required, possibly including intensive care and life support.

The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began.

IMMEDIATE TREATMENT

Thrombolytic medicine, like tPA, breaks up blood clots and can restore blood flow to the damaged area. People who receive this medicine are more likely to have less long-term impairment. However, there are strict criteria for who can receive thrombolytics. The most important is that the person be evaluated and treated by a specialized stroke team within 3 hours of when the symptoms start. If the stroke is caused by bleeding rather than clotting, this treatment can make the damage worse -- so care is needed to diagnose the cause before giving treatment.

In other circumstances, blood thinners such as heparin and coumadin are used to treat strokes. Aspirin and other anti-platelet agents may be used as well.

Other medications may be needed to control associated symptoms. Analgesics (pain killers) may be needed to control severe headache. Anti-hypertensive medication may be needed to control high blood pressure.

Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. The nutrients and fluids may be given through an intravenous tube (IV) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels.

Life support and coma treatment are performed as needed.

LONG-TERM TREATMENT

The goal of long-term treatment is to recover as much function as possible and prevent future strokes. Depending on the symptoms, rehabilitation includes speech therapy, occupational therapy, and physical therapy. The recovery time differs from person to person.

Certain therapies, such as repositioning and range-of-motion exercises, are intended to prevent complications related to stroke, like infections and bed sores. People should stay active within their physical limitations. Sometimes, urinary catheterization or bladder/bowel control programs may be necessary to control incontinence.

The person's safety must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show indifference or lack of judgment, which increases the need for safety precautions. For these people, friends and family members should repeatedly reinforce important information, like name, age, date, time, and where they live, to help the person stay oriented.

Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.

In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.

Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors.

Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.

Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke.

Carotid endarterectomy (removal of plaque from the carotid arteries) may help prevent new strokes from occurring in people with large blockage in these important blood vessels.
Support Groups

Additional support and resources are available from the American Stroke Association. The toll-free phone line for stroke survivors and caregivers is 1-888-4STROKE.
Expectations (prognosis)

The long-term outcome from a stroke depends on the extent of damage to the brain, the presence of any associated medical problems, and the likelihood of recurring strokes.

Of those who survive a stroke, many have long-term disabilities, but about 10% of those who have had a stroke recover most or all function. Fifty percent are able to be at home with medical assistance while 40% become residents of a long-term care facility like a nursing home.
Complications

* Problems due to loss of mobility (joint contractures, pressure sores)
* Permanent loss of movement or sensation of a part of the body
* Bone fractures
* Muscle spasticity
* Permanent loss of brain functions
* Reduced communication or social interaction
* Reduced ability to function or care for self
* Decreased life span
* Side effects of medications
* Aspiration
* Malnutrition

Calling your health care provider

Call your local emergency number (such as 911) if someone has symptoms of a stroke. Stroke requires immediate treatment!
Prevention

To help prevent a stroke:

* Get screened for high blood pressure at least every two years, especially if you have a family history of high blood pressure.
* Have your cholesterol checked.
* Treat high blood pressure, diabetes, high cholesterol, and heart disease if present.
* Follow a low-fat diet.
* Quit smoking.
* Exercise regularly.
* Lose weight if you are overweight.
* Avoid excessive alcohol use (no more than 1 to 2 drinks per day).

If you have had a TIA or stroke in the past, or you currently have a heart arrhythmia (like atrial fibrillation), mechanical heart valve, congestive heart failure, or risk factors for stroke, your doctor may have you take aspirin or other blood thinners. Make sure you follow your doctor's instructions and take the medication.

To prevent bleeding strokes, take steps to avoid falls and injuries.

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What You Must Know about Menopause

Melanie N. Smith, M.D., Ph.D

Menopause is the transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether.
Alternative Names

Perimenopause; Postmenopause
Causes, incidence, and risk factors

Menopause is a natural event that normally occurs between the ages of 45 and 55.

Once menopause is complete (called postmenopause), you can no longer become pregnant.

The symptoms of menopause are caused by changes in estrogen and progesterone levels. As the ovaries become less functional, they produce less of these hormones and the body responds accordingly. The specific symptoms you experience and how significant (mild, moderate, or severe) varies from woman to woman.

In some women, menstrual flow comes to a sudden halt. More commonly, it tapers off. During this time, your menstrual periods generally become either more closely or more widely spaced. This irregularity may last for 1 to 3 years before menstruation finally ends completely.

A gradual decrease of estrogen generally allows your body to slowly adjust to the hormonal changes. When estrogen drops suddenly, as is seen when the ovaries are removed surgically (called surgical menopause), symptoms can be more severe.
Symptoms

The potential symptoms include:

* Hot flashes and skin flushing
* Night sweats
* Insomnia
* Mood swings including irritability, depression, and anxiety
* Irregular menstrual periods
* Spotting of blood in between periods
* Vaginal dryness and painful sexual intercourse
* Decreased sex drive
* Vaginal infections
* Urinary tract infections

In addition, the long-term effects of menopause include:

* Bone loss and eventual osteoporosis
* Changes in cholesterol levels and greater risk of heart disease

Signs and tests

Blood and urine tests can be used to measure hormone levels that may indicate when a woman is close to menopause or has already gone through menopause. Examples of these tests include:

* Estradiol
* FSH
* LH

A pelvic exam may indicate changes in the vaginal lining caused by changes in estrogen levels. A bone density test may be performed to screen for low bone density levels seen with osteoporosis.
Treatment

Menopause is a natural process. It does not require treatment unless the symptoms, such as hot flashes or vaginal dryness, are particularly bothersome.

One big decision you may face is whether or not to take hormones to relieve your symptoms. Discuss this thoroughly with your doctor, weighing your risks against any possible benefits. Pay careful attention to the many options currently available to you that do not involve taking hormones.

If you have a uterus and decide to take estrogen, you must also take progesterone to prevent endometrial cancer (cancer of the lining of the uterus). If you do not have a uterus, progesterone is not necessary.

HORMONE REPLACEMENT THERAPY

For years, hormone replacement therapy (HRT) was the main treatment for menopause symptoms. Many physicians believed that HRT was not only good for reducing menopausal symptoms, but also reduced the risk of heart disease and bone fractures from osteoporosis. However, the results of a major study -- called the Women's Health Initiative -- has led physicians to revise their recommendations.

In fact, this important study was stopped early because the health risks outweighed the health benefits. Women taking the hormones did see some benefits. But they greatly increased their risk for breast cancer, heart attacks, strokes, and blood clots.

If your symptoms are severe, you may still want to consider HRT for short-term use (2-4 years) to reduce vaginal dryness, hot flashes, and other symptoms.

To reduce the risks of estrogen replacement therapy and still gain the benefits of the treatment, your doctor may recommend:

* Using estrogen/progesterone regimens that do not contain the form of progesterone used in the study.
* Using a lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream rather than a pill).
* Having frequent and regular pelvic exams and Pap smears to detect problems as early as possible.
* Having frequent and regular physical exams, including breast exams and mammograms.

ALTERNATIVES TO HRT

The good news is that you can take many steps to reduce your symptoms without taking hormones:

* Dress lightly and in layers
* Avoid caffeine, alcohol, and spicy foods
* Practice slow, deep breathing whenever a hot flash starts to come on (try taking six breaths per minute)
* See an acupuncturist
* Use relaxation techniques like yoga, tai chi, or meditation
* Eat soy foods
* Remain sexually active to preserve elasticity of your vagina
* Perform Kegel exercises daily to strengthen the muscles of your vagina and pelvis
* Use water-based lubricants during sexual intercourse

There are also some medications available to help with mood swings, hot flashes, and other symptoms. These include low doses of antidepressants such as paroxetine (Paxil), venlafaxine (Effexor), and fluoxetine (Prozac), or clonidine, which is normally used to control high blood pressure.
Complications

Estrogen is responsible for the buildup of the lining of the uterine cavity. During the reproductive years, this buildup occurs and then is shed (menstruation). This usually happens about a once a month.

The menopausal decrease in estrogen prevents this buildup from occurring. However, hormones produced by the adrenal glands are converted to estrogen, and sometimes this will cause postmenopausal bleeding.

This is often nothing to worry about, but because postmenopausal bleeding may also be an early indication of other problems, including cancer, a physician should always check any postmenopausal bleeding.

Decreased estrogen levels are also associated with an increased risk of developing osteoporosis and possibly an increased risk of cardiovascular disease.
Calling your health care provider

Call your health care provider if:

* You are spotting blood between periods
* You have had 12 consecutive months with no period and suddenly vaginal bleeding begins again

Prevention

Menopause is a natural and expected part of a woman's development and does not need to be prevented. However, there are ways to reduce or eliminate some of the symptoms that accompany menopause. You can also reduce your risk of long-term problems like osteoporosis and heart disease.

* DO NOT smoke -- cigarette use can cause early menopause
* Exercise regularly to strengthen your bones, including activity that works with the resistance of gravity
* Take calcium and vitamin D
* Eat a low-fat diet
* If you show early signs of bone loss, talk to your doctor about medications that can help stop further weakening
* Control your blood pressure, cholesterol, and other risk factors for heart disease

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Headache or Migraine ???

Kevin Sheth

A migraine is a type of primary headache that some people get repeatedly over time. Migraines are different from other headaches because they occur with symptoms such as nausea, vomiting, or sensitivity to light. In most people, a throbbing pain is felt only on one side of the head.

Migraines are classified as either "with aura" or "without aura." An aura is a group of neurological symptoms, usually vision disturbances that serve as warning sign. Patients who get auras typically see a flash of brightly colored or blinking lights shortly before the headache pain begins. However, most people with migraines do not have such warning signs. See also:

* Migraine without aura (no warning symptoms)
* Migraine with aura (visual disturbances before the headache starts)
* Mixed tension migraine (features of both migraines and tension headache)

Alternative Names

Headache - migraine
Causes, incidence, and risk factors

A lot of people get migraines -- about 11 out of 100. The headaches tend to start between the ages of 10 and 46 and may run in families. Migraines occur more often in women than men. Pregnancy may reduce the number of migraines attacks. At least 60 percent of women with a history of migraines have fewer such headaches during the last two trimesters of pregnancy.

Until the 1980s, scientists believed that migraines were due to changes in blood vessels within the brain. Today, most believe the attack actually begins in the brain itself, and involves various nerve pathways and chemicals inthe brain. A migraine attack can be triggered by stress, food, environmental changes, or some other factor. However, the exact chain of events remains unclear.

Migraine attacks may be triggered by:

* Allergic reactions
* Bright lights, loud noises, and certain odors or perfumes
* Physical or emotional stress
* Changes in sleep patterns
* Smoking or exposure to smoke
* Skipping meals
* Alcohol or caffeine
* Menstrual cycle fluctuations, birth control pills
* Tension headaches
* Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
* Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods

Symptoms

Migraine headaches, which can be dull or severe, usually:

* Feel throbbing, pounding, or pulsating
* Are worse on one side of the head
* Last 6 to 48 hours

Symptoms accompanying migraines include:

* Nausea and vomiting
* Sensitivity to light or sound
* Loss of appetite
* Fatigue
* Numbness, tingling, or weakness

Warning signs (auras) that can precede a migraine include seeing stars or zigzag lines, tunnel vision, or a temporary blind spot.

Symptoms that may linger even after the migraine has gone away include:

* Feeling mentally dull, like your thinking is not clear or sharp
* Increased need for sleep
* Neck pain

Signs and tests

Migraine headache may be diagnosed by your doctor based on your symptoms, history of migraines in the family, and your response to treatment. Your doctor will take a detailed history to make sure that your headaches are not due to tension, sinus inflammation, or a more serious underlying brain disorder. During the physical exam, your doctor will probably not find anything wrong with you.

Sometimes an MRI or CT scan is obtained to rule out other causes of headache like sinus inflammation or a brain mass. In the case of a complicated migraine, an EEG may be needed to exclude seizures. Rarely, a lumbar puncture (spinal tap) might be performed.
Treatment

There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or altering triggers. When you do get migraine symptoms, try to treat them right away. The headache may be less severe.

A good way to identify triggers is to keep a headache diary. See headache.

When migraine symptoms begin:

* Rest in a quiet, darkened room
* Drink fluids to avoid dehydration (especially if you have vomited)
* Try placing a cool cloth on your head

Over-the-counter pain medications like acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. (Be aware, however, that chronic usage of such pain medications may result in rebound headaches.) If these don't help, ask your doctor about prescription medications.

Your doctor will select from several different types of medications, including:

* Ergots like dihydroergotamine or ergotamine with caffeine (Cafergot)
* Triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), frovatriptan (Frova), and zolmitriptan (Zomig); these are available as a tablet, nasal spray, or self-administered injection
* Isometheptene (Midrin)
* Stronger pain relievers (narcotics)

Many of the prescription medications for migraines narrow your blood vessels. Therefore, these drugs should not be used if you have heart disease, unless specifically instructed by your doctor.

If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.
Support Groups

American Council for Headache Education - www.achenet.org

The National Migraine Association -www.migraine.org

National Headache Foundation - www.headaches.org
Expectations (prognosis)

Every person responds differently to treatment. Some people have rare headaches that require little to no treatment. Others require the use of several medications or even occasional hospitalization.
Complications

Migraine headaches generally represent no significant threat to your overall health. However, they can be chronic, recurrent, frustrating, and they may interfere with your day-to-day life.

Stroke is an extremely rare complication from severe migraines. This risk may be due to prolonged narrowing of the blood vessels, limiting blood flow to parts of the brain for an extended period of time.
Calling your health care provider

Call 911 if:

* You have unusual symptoms not experienced with a migraine before, like speech or vision problems, loss of balance, or difficulty moving a limb
* You are experiencing "the worst headache of your life"

Call your doctor immediately if:

* Your headache pattern or intensity is different
* Your headache gets worse when you lie down

Also, call your doctor if:

* Previously effective treatments no longer help
* Side effects from medication occurs (irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, extreme thirst, or others)
* You are likely to become pregnant -- some medications should not be taken when pregnant

Prevention

* Avoid smoking, caffeine, and alcohol
* Exercise regularly
* Get enough sleep each night
* Learn to relax and reduce stress -- try progressive muscle relaxation (contracting and releasing muscles throughout your body), meditation, biofeedback, or joining a support group

If you get at least three headaches per month, your doctor may prescribe medication for you to prevent recurrent migraines.

Such prescription drugs include:

* Beta-blockers such as propranolol (Inderal)
* Anti-depressants, including tricyclics like amitriptyline (Elavil) or selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac, Sarafem), paroxetine (Paxil), or sertraline (Zoloft)
* Anti-convulsants such as valproic acid (Depacon, Depakene), divalproex sodium (Depakoate), or topiramate (Topamax)
* Calcium channel blockers such as verapamil

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Pregnancy - identifying fertile days

Peter Chen

Many couples spend so much time preventing an unplanned pregnancy that they assume that when they are ready for a family all they have to do is stop using birth control. Getting pregnant is not always that fast -- it can take up to a year or longer -- nor is it automatic.

Many couples today plan intercourse around days 11-14 of the woman's 28-day cycle. If a woman has irregular cycles and is not sure when she ovulates, she can buy an ovulation predictor kit at a pharmacy. These kits test LH (leutenizing hormone) in the urine and are very accurate.

If you are willing to take some extra steps, you can monitor two body functions to pinpoint your most fertile times, maximizing your chances of getting pregnant: changes in body temperature and the consistency of your cervical fluid.

This article explains how to monitor your cervical fluid and temperature, identify the changes, and learn what they mean. It may sound like a hassle, but the process is really pretty easy.

Evaluating Your Cervical Fluid

Cervical fluid plays critical roles in getting pregnant -- it protects the sperm and helps it move through the cervix toward the uterus and fallopian tubes. Like practically everything else involved with the menstrual cycle, cervical fluid changes in preparation for ovulation. You will notice clear differences in how it looks and feels over the course of the cycle.

At the beginning of your cycle, you probably will not notice any cervical fluid at all. Then it may become sticky or gummy, and then creamy and white. Finally, as ovulation approaches, it becomes more clear and stretchy, almost like egg whites. Your cervical fluid actually gives you advance notice that you are about to ovulate.

Cervical fluid can usually be felt inside the lower end of the vagina, especially on fertile days. Check cervical fluid more than once a day if possible, such as every time you use the bathroom.

Rub your fingers together to evaluate the consistency of the fluid, then refer to the stages listed below. More than one adjective is used because the conditions differ slightly among women:

* Menstrual period occurring (no cervical fluid is present)
* Vagina is dry (no cervical fluid is present)
* Sticky/rubbery fluid
* Wet/creamy/white fluid -- FERTILE
* Slippery/stretchy/clear "egg white" fluid -- VERY FERTILE
* Dry (no cervical fluid)

The cervical fluid will be slippery and stretchy on your most fertile days.

Taking Your Basal Temperature

Take your temperature in the morning before you get out of bed. Try not to move too much, as activity can raise your body temperature slightly. Use a glass basal thermometer or a digital thermometer so that you can get accuracy to the tenth of a degree. Keep the thermometer in your mouth for 5 minutes. If your temperature is between two marks, record the lower number.

Try to take your temperature at the same time every day, if possible. If using a mercury thermometer, shake it down when you are done so that you do not have to shake it in the morning and thus risk raising your temperature from the movement.

After you ovulate, your body temperature will rise and stay at an elevated level for the rest of your ovulation cycle. At the end of your cycle, it falls again. Create a chart and write down your temperature everyday. From one day to the next, your temperature will zigzag a little. These small temperature changes will seem random at first -- ignore them.

Also, ignore the occasional "fluke" temperature that is obviously way out of alignment with the others -- this can happen for any number of reasons (like stress) and is not important to finding the pattern. If you look at a complete cycle, you will probably notice a point at which the temperatures become higher than they were in the first part of your cycle. More specifically, the rise is when your temperature increases 0.2 degrees above the previous six days.

The limitation with monitoring your temperature is that by the time you are certain that you have ovulated, it is usually too late to become pregnant! You can still try to get pregnant the morning your temperature rises, but chances are slimmer. The egg is probably gone by that point.

However, temperature is still a very useful indicator of fertility. For one thing, after several cycles you may be able to see a predictable pattern and get a sense for your most fertile days. More reliably, the rise lets you know when trying to get pregnant becomes less likely. And lastly, temperature is an excellent indicator of whether you are pregnant. If your temperature does not go down at the end of the cycle, you probably succeeded and are pregnant!

NOTE: There are other factors you can use to help you track your fertility even more precisely (like the position of your cervix and how open it is). Also, there is a great deal of variety in how different women experience their fertility tracking signs. For a more in-depth explanation, there are a numbers of good reference books available.

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Obese post-menopausal women prone to breast cancer: studies

Virginie Montet

Obese post-menopausal women are more susceptible to breast cancer, and those who continue to gain weight after 50 are more likely to die from the disease, according to research presented at an obesity conference.

"There is an overwhelming number of studies that show a link between obesity and breast cancer," Cheryl Rock of the University of California, San Diego said at the annual conference of the North American Association for the Study of Obesity (NAASO).

Marilie Gammon of the University of North Carolina warned that after menopause, obese women have a 75 percent greater chance of developing breast cancer.

She also said that women should be made aware that if they continue to add pounds past the half-century mark, they are raising their chances of death.

"We have to let them know that if you continue to gain weight after the age of 50 and contracted breast cancer, you are more likely to die," Gammon said.

A person is considered obese when his or her body mass index is 30 or above.

The BMI is a measure of body fat calculated by dividing weight by height squared, with a rating between 18.5 and 24.9 considered normal for adults.

Studies show that women who gain nearly 45 pounds (20 kilos) after the age of 18 are twice as likely to develop breast cancer after menopause than those who maintain a stable weight.

For a long time, it was commonly thought that excess weight protected a woman from breast cancer, but recent studies have indicated otherwise.

"A lot of women say, 'Who cares? I'm already overweight.' But it's bad. You are more likely to die if you are diagnosed with breast cancer," Gammon said, citing in particular a study by Page Abrahamson of the University of North Carolina, published this month.

On the bright side, recent studies also have shown that women who engage in some physical activity, even modest, at the first sign of the deadly disease have a better survival rate.

"The message is that you have to maintain some physical activity," Gammon said.

"Breast cancer is a good motivator for women," she said. "They fear it. They know what it's like to fight against it more than colon cancer or renal cell cancer," which is also linked to obesity.

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A Bizarre Study Suggests That Watching TV Causes Autism

CLAUDIA WALLIS

Childhood vaccines, toxins, genes and now television watching? The alarming rise in autism rates is one of the biggest mysteries of modern medicine, but it's irresponsible to blame one factor without hard scientific proof.

Strange things happen when you apply the statistical methods of economics to medical science. You might say you get dismal science, but that's a bit glib. You certainly get some strange claims-like the contention of three economists that autism may be caused by watching too much television at a tender age. It gets stranger still when you look at the data upon which this argument is based. The as yet unpublished Cornell University study, which will be presented Friday at a health economics conference in Cambridge, Mass., is constructed from an analysis of reported autism cases, cable TV subscription data and weather reports. Yes, weather reports. And yet, it all makes some kind of sense in the realm of statistics. And it makes sense to author Gregg Easterbrook, who stirred the blogosphere this week with an article about the study on Slate, provocatively (and perhaps irresponsibly) titled "TV Really Might Cause Autism."

The alarming rise in autism rates in the U.S. and some other developed nations is one of the most anguishing mysteries of modern medicine-and source of much desperate speculation by parents. In 1970, its incidence was thought to be just 1 in 2,500; today about 1 in 170 kids born in the U.S. fall somewhere on the autism spectrum (which includes Asperger's Syndrome), according to the Centers for Disease Control and Prevention. Some of the spike can be reasonably attributed to a new, broader definition of the disorder, better detection, mandatory reporting by schools and greater awareness of autism among doctors, parents and educators. Still, there's a nagging sense among many experts that some mysterious X-factor or factors in the environment tip genetically susceptible kids into autism, though efforts to pin it on childhood vaccines, mercury or other toxins haven't panned out. Genes alone can't explain it; the identicial twin of a child with autism has only a 70% to 90% chance of being similarly afflicted.

Enter Michael Waldman, of Cornell's Johnson Graduate School of Management. He got to thinking that TV watching-already vaguely associated with ADHD-just might be factor X. That there was no medical research to support the idea didn't faze him. "I decided the only way it will get done is if I do it," he says. Waldman and fellow economists Sean Nicholson of Cornell and Nodir Adilov of Indiana University-Purdue, were also undeterred by the fact that there are no reliable large-scale data on the viewing habits of kids ages 1 to 3- the period when symptoms of autism are typically identified. They turned instead to what most scientists would consider wildly indirect measures: cable subscription data (reasoning that as more houses were wired for cable, more young kids were watching) and rainfall patterns (other research has correlated TV viewing with rainy weather).

Lo and behold, Waldman and colleagues found that reported autism cases within certain counties in California and Pennsylvania rose at rates that closely tracked cable subscriptions, rising fastest in counties with fastest growing cable. The same was true of autism and rainfall patterns in California, Pennsylvania and Washington state. Their oddly definitive conclusions: "Approximately 17% of the growth in autism in California and Pennsylvania during the 1970s and 1980s was due to the growth of cable television," and "just under 40% of autism diagnoses in the three states studied is the result of television watching due to precipitation."

Result of? Due to? How can these researchers suggest causality when no actual TV watching was ever measured? "The standard interpretation of this type of analysis is that this is cause and effect," Waldman insists, adding that the 67-page study has been read by "half-a-dozen topnotch health economists."

Could there be something to this strange piece of statistical derring- do? It's not impossible, but it would take a lot more research to tease out its true significance. Meanwhile, it's hard to say just what these correlations measure. "You have to be very definitive about what you are looking at," says Vanderbilt University geneticist Pat Levitt. "How do you know, for instance, that it's not mold or mildew in the counties that have a lot of rain?" How do you know, for that matter, that as counties get more cable access, they don't also get more pediatricians scanning for autism? Easterbrook, though intrigued by the study, concedes that it could be indoor air quality rather than television that has a bearing on the development of autism. On a more biological level there's this problem, says Drexel Univeristy epidemiologist Craig Newschaffer: "They ignore the reasonable body of evidence that suggest that the pathologic process behind autism probably starts in utero"-i.e., long before a baby is born.

The week also brought a more definitive, though less splashy finding on the causes of autism, published in the Proceedings of the National Academy of Science. A team led by Levitt found that a fairly common gene variation-one that's present in 47% of the population-is associated with an increased risk of autism. People with two copies of the gene have twice the average risk of autism; those with one copy face a slightly increased risk. The gene is intriguing because it codes for a protein that's active not only in the brain-the organ most affected by autism-but also in the immune system and the gastrointestinal tract, two systems that function poorly in many people with autism. Levitt estimates that anywhere from five to 20 genes may underlie the vulnerability to autism. There are probably many routes to the disorder, involving diverse combinations of genes and noxious environmental influences. Could Teletubbies be one of them? Conceivably, but more likely the trouble starts way before TV watching begins.

With reporting by Alice Park/New York

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New Polio Case in Kenya Jeopardizes Eradication

ELIANE ENGELER

The case, Kenya's first in 22 years, was imported from Somalia and marks a resurgence in East Africa brought on in part by anti-western policies set by Islamic clerics.

Kenya has reported its first polio case in 22 years with the infection of a 3-year-old Somali refugee girl marking a new setback in the global effort to eradicate the crippling disease, officials said Tuesday.

The case brings to 26 the number of countries in Africa, Asia and the Middle East that have been reinfected since a 2003 vaccine boycott by hard-line Nigerian Islamic clerics who claimed that the polio vaccine was part of a U.S.-led plot to render Nigerian Muslims infertile or infect them with AIDS.

World Health Organization spokeswoman Fadela Chaib said the Somali girl found infected in Kenya had a polio strain from Somalia, which has been re-infected with the virus since 2005 after it had been polio-free for three years. The virus had been imported to Somalia from Nigeria, she said. Ethiopia, which also borders on Kenya, was reinfected with the polio virus in 2004 and is currently reporting 37 cases, Chaib said.

The girl who developed the symptoms on Sept. 17 was in a refugee camp in the Dadaab area of northeastern Kenya, which recently has seen an upsurge in arrivals of Somalis fleeing violent clashes between pro-government militia and Islamic forces in southern and central Somalia. More than 34,000 Somali refugees have arrived in Kenya since the beginning of the year, said Jennifer Pagonis from the U.N. High Commissioner for Refugees.

There are currently 215 reported cases in 14 out of 19 regions in Somalia. The chaotic nation has no effective central government and little medical infrastructure. The "outbreak in Somalia and Ethiopia is widespread among the ethnic Somali population," said Chaib, adding that this had "put Kenya at high risk."

The infected girl reportedly had been vaccinated, but it is "rather common" that a vaccinated child still can get infected until immunization is completed, said Chaib. "Several vaccination rounds are necessary to really ensure optimal vaccination for children." The last polio vaccination in Kenya took place Sept. 9-12, Chaib said.

Health officials are investigating the case and preparing for additional immunization rounds, which aim at reaching all unvaccinated Kenyan and refugee children under the age of 5 in the northeastern part of the country, she said. The next round is supposed take place Nov. 3-7 and the second Dec. 1-5 and be coordinated with Somalia and Ethiopia, she added. WHO and other organizations had to give up on their 2005 deadline to eradicate the disease. The campaigners said last week that it is still possible to rid the world of polio, but that it will take at least another year.

Polio is spread when unvaccinated people — mostly children under 5 — come into contact with the feces of those with the virus, often through water. The virus attacks the central nervous system, causing paralysis, muscular atrophy and deformation and, in some cases, death.

The United Nations on Tuesday appealed for $35 million to provide food aid and other relief operations over the next six months for Somali refugees in Kenya. UNHCR finds it is difficult to keep up with the influx of refugees, Pagonis said. "We fear this figure could climb to 80,000 by the end of the year," she said,

The number of Somalis fleeing to Kenya started increasing after a radical Islamic militia began seizing control of their country. "In the past two weeks the arrival rate reached 1,000 a day on several occasions and 2,000 a day on Oct. 4 and 5," Pagonis said. The three Somali refugee camps in Dadaab, 50 miles from the Somali border, are home to about 160,000 people, most of whom have fled Somalia since the outbreak of a civil war there in 1991.

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Coping with a Dengue Fever Outbreak

Simon Robinson

It's been an interesting first few days. I arrived in New Delhi last week to take over as the Bureau Chief for South Asia after nearly eight years in Africa. India's capital is currently in the grip of one of the biggest dengue fever outbreaks for years.

More than 1700 people in Delhi have been diagnosed with dengue, a virus spread by the bite of the female Aedes Aegypti mosquito. Thirty five people have died in Delhi alone; nationally the outbreak has killed 109.

In Africa, or at least in parts of Africa, I'd become used to covering up in the evening to avoid being bitten by mosquitos carrying malaria. But Aedes Aegypti, which breeds in stagnant water, bites during the daytime so I have to learn a whole new level of discipline.

People who are unlucky enough to become infected come down with a high fever, skin rashes and agonizing joint pains. Their blood platelet count drops as well, which is what can prove fatal.

The outbreak has spread to neighboring Nepal and Pakistan. In Pakistan's port city of Karachi, 17 people have died of the disease in the past week or so.

Newspaper commentators joke that the smoke from the fireworks used in this weekend's celebrations for Diwali, the Hindu festival of lights, will scare away all the mosquitoes. Let's hope so.

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Choose Your Fish Wisely

Alice Park

There are a lot of good reasons to eat seafood—recent studies have linked the omega-3 fatty acids found in deep water fish to a lower risk of heart disease; fish are a good source of protein, and early studies hint that pregnant women who eat fish or take fish oil supplements are more likely to carry babies to full term, and to enhance their babies’ cognitive development.

But eating more fish isn’t easy. The healthy bonus that comes from fish, it seems, has a price. The same fats that make fish so good for the heart and the body also attract dangerous toxins, from dioxins to polychlorinated biphenyls (PCBs), the man-made byproducts of the electrical industry. (While PCBs have not been created since the 1970s, trace amounts still linger in waters.) In addition, the lean muscle of the ocean’s biggest and most powerful swimmers can become sinkholes for methylmercury, a potentially brain- and liver-damaging metal formed when salts are processed by certain anaerobic bacteria. Is it safe to eat fish at all? Are the benefits of eating fish enough to outweigh these risks? How much fish is safe to eat? Which kinds of fish and seafood have the most omega-3 fatty acids and the lowest levels of contaminants?

Two reports released this week may finally provide some answers for those trying to decide between surf or turf. Both the Institute of Medicine and researchers at Harvard School of Public Health report that more Americans could be benefiting from the high protein and healthier fat found in fish, and that for most people, these benefits do indeed outweigh the risks of consuming contaminants. Not surprisingly, both studies note that some populations, including pregnant women and young children who may be at greatest risk of suffering from contaminant poisoning, should avoid consuming too much of the larger fish species that are likely to have the highest levels of methylmercury or PCBs.

The IOM report, Seafood Choices, Balancing Benefits and Risks, provides recommendations for four populations—women who are or may become pregnant or who are breast-feeding; children younger than 12; adult women who are not planning to become pregnant and adult men; and adults at risk of heart disease—but the core advice for all groups is the same: it’s safe, and healthy, to eat up to two 3 oz. servings of fish each week. Young children and pregnant women, however, should make sure that these servings don’t include shark, swordfish, tilefish or king mackerel, the largest predatory species that contain the highest levels of methylmercury.

The Harvard authors, whose report appears in the Journal of the American Medical Association, also found that eating fish carries significant health benefits. Based on their review of several years of previously published studies, they found that eating 3 oz. of farmed salmon a week could reduce the risk of death from heart disease by 36% and the risk of overall death by 17%. While contaminants like methylmercury and PCBs can indeed cause neurological problems, the benefits gained from eating fish often outweigh the smaller risk these toxins pose.

What it means: While Americans are eating more fish on average today than at the turn of the century, we’re not eating the healthiest kinds of seafood. The most popular form of seafood, shrimp, is high in cholesterol and contains low levels of omega-3 fatty acids. And that cafeteria staple, fish sticks, contain very low levels of methylmercury but are equally poor sources of omega-3 oils; a 3.5 oz serving contains one-twelfth the amount of oils found in the same-sized portion of farmed salmon.

So if you’ve been eating too much of the less healthy offerings from the sea, or avoiding fish altogether because you’ve been worried about the contaminants they may contain, take some advice from the Harvard researchers. The best way to avoid the potential dangers of an all-surf diet, they say, is to vary the types of fish you eat. Atlantic herring, wild salmon, sardines and Atlantic cod are among the fish with the lowest methylmercury levels; while the larger species, like king mackerel and swordfish, contain some of the highest levels. For more on the IOM’s report, visit www.iom.edu.

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A Little Quitting Help for Smokers

Carolyn Sayre

Smoking is a tough habit to kick, with 41% of smokers trying to quit ever year and only 10% of them actually succeeding. Wouldn’t it be great if you could just pop a pill and take away those unhealthy urges?

That may be a reality someday soon. Researchers at the University of Chicago have found that in a small double blind study a new drug – naltrexone, which blocks the effects of narcotics and has been used in the past to treat heroin addicts - used in conjunction with behavior therapy and nicotine patches helps stop women lighting up. The study found that the novel treatment combo increased success rates in women smokers by nearly 50%. The results will be published in the journal of Nicotine and Tobacco Research this month.

The study’s relatively small sample size examined 110 men and women who reported smoking a pack a day – approximately 20 cigarettes – for a period of 25 years and had unsuccessfully tried to quit several times. Half of the participants took 50 milligrams for a period of eight weeks – starting three days before they tried to quit – the other half was given placebos.

The researchers defined a successful cessation as “not smoking daily for one week and not smoking even a puff at least one day in each of two consecutive weeks at any point in the trial.” After eight weeks the results were in - 62% of men and 58% of women on naltrexone stopped smoking – but in the group taking placebos 67% of men and 39% of women had quit. As a result, the research was only significant in women. In the study the drug helped assuage the women’s cravings and reduce their withdrawal symptoms.

What it Means:

It is unclear yet whether Naltrexone will be helpful in a larger population since the sample size was small. However, what is clear is that scientists are getting closer to developing one drug that really helps smokers quit. In July, a new drug – varenicline – was reported to help 40% of the study’s large sample size stop in nine weeks.

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