7/18/14

IBS Cramps vs. Menstrual Cramps (PMS)

A female GI doctor who specializes in women’s GI issues addresses IBS vs. menstrual cramps related to PMS.

What are the differences between IBS cramps and those from premenstrual syndrome? For this article I consulted with Diana Y. Wu, MD, a gastroenterologist with the Center for Women's Gastrointestinal Health.

“The main difference between menstrual cramps and IBS cramps would be the timing,” begins Dr. Wu. “Menstrual cramps usually occur a few days before onset of menstruation, whereas IBS cramps can occur at any time, especially in the mornings, after eating, or in times of stress/anxiety. IBS cramps can often be relieved by having a bowel movement. Menstrual cramps tend to be lower in the pelvis and not necessarily relieved with defecation. It tends to resolve after the menstrual cycle is completed.”

The cause of the cramps in irritable bowel syndrome and in PMS differs.
In PMS the cause is hormones called prostaglandins, which is why the anti-prostaglandin drug, ibuprofen, is so effective at relief. The prostaglandins cause uterine contractions, and that’s the “cramping” that a woman feels.

“Irritable bowel syndrome is characterized by chronic abdominal pain, and associated with changes in stool frequency or consistency (e.g., diarrhea or constipation) in the absence of any physical cause that is detectable by our current medical investigations,” explains Dr. Wu. “The pain is usually relieved or ameliorated with a bowel movement.”

Perplexing
“The pathophysiology of IBS remains unclear and is believed to be multifactorial,” continues Dr. Wu. “Despite multiple investigations, data have been conflicting and no abnormality has been found to be specific for this disorder.”

I’ve never had IBS so I can’t describe what the cramping feels like. But I’ve had cramping from premenstrual syndrome and microscopic colitis, and they feel identical.

Ironically (though not surprisingly), prostaglandins are implicated in flare-ups of microscopic colitis, though research in this area is scant. I know that the cramping I had, during the microscopic colitis flare, was related to this benign inflammatory bowel disease because when it happened, I had already completed menopause. Very fascinating!

But prostaglandins don’t seem to be involved in the cramping of IBS.
Causes of IBS are not clear. “The traditionally favored hypotheses are: alterations in gastrointestinal motility (no predominant pattern of motor activity has emerged as a marker for IBS), visceral hypersensitivity, alteration in fecal flora (such as after gastrointestinal infection/food poisoning), bacterial overgrowth, food sensitivity or a genetic predisposition.”

Bacterial overgrowth and food sensitivities are theorized to be causative factors behind microscopic colitis, which is often misdiagnosed as IBS…and vice versa.

Dr. Wu further explains, “Visceral hypersensitivity (increased sensation in response to stimuli) is a frequent finding in irritable bowel syndrome patients. Several studies have focused on increased sensitivity of visceral nerves in the gut, triggered by bowel distention or bloating, as a possible explanation for IBS symptoms.

“About half of patients with IBS experience bloating in addition to abdominal pain. They may have a measurable increase in abdominal girth associated with bloating (sensation of abdominal fullness), and this may be due to impaired transit of intestinal gas loads.”

Is there a way a woman can tell if the cramps she feels are IBS related or from PMS or mid-cycle cramping?


“There is no way to know for sure. However, typically IBS cramping is relieved with defecation.”

7/10/14

How to Lessen Anxiety over Moles and Melanoma

If you suffer from mole anxiety, here are several ways to significantly reduce your fears that you might have, or will get, melanoma.

Digital Serial Dermoscopy
This wonder of technology will give you great peace of mind. I not only have written about this technology before (having interviewed two physicians), but I’ve had this procedure done and will continue having it done.

Moles are photographed, then examined on the computer screen under high magnification by the dermatologist. Not only that, but the computer database compares the image to data from melanoma and then comes up with a rating. The rating can be a number or color.

The computer does NOT diagnose melanoma, but it indicates that a mole is suspicious or has characteristics that resemble melanoma more than it resembles a benign lesion.

Based on the rating, the doctor will then decide on further action (or not).

Now imagine the reduction in your anxiety when the doctor tells you, “All of your moles look very stable. You don’t have to come back for another 18 months.”

Serial digital dermoscopy is done yearly, every 18 months or even every two years (depending on the doctor’s recommendations, though you can have it done as often as you’d like).

The same moles are photographed, and the computer program compares new photos to previous images and will detect changes -- earlier than a dermatologist possibly can, even with their handheld dermoscope.

Home Mole Mapping
Map out your lesions at home, using a large sketch book. Even if your drawings of various body parts are crude, at least this way you’ll have an idea of where you have moles, so that you will know if new ones have appeared. This will reduce a lot of anxiety.

Illustrate
If you can illustrate, then draw and render your moles; this will significantly reduce anxiety. I’ve done this (I can illustrate shape and texture, plus draw scaled-up images; I knew someday this skill would come in handy). Many artists may not think to do this.

Whip out your favorite illustrating tool and draw your moles, capturing variations in color, patterns, texture, border, etc. Then, when it’s time to do monthly self-exams, you’ll have a better chance of detecting a change.

Monthly Self-Exam
Commit to a self-skin exam every month without fail. This way you won’t wonder, “When did this mole begin changing?” or, “Did this mole look this way only a few weeks ago?” The monthly will cut a lot of anxiety.

Annual Clinical Exam
Have a dermatologist examine your skin from head to toe, and make sure they use a dermoscope. This will lower anxiety. Better yet, have the doctor look you over twice a year.

Know that only 30 percent of melanomas arise in pre-existing moles (Yale School of Medicine).

Next, to reduce mole anxiety, you can consider getting an application for your smartphone that works in a similar way to digital serial dermoscopy. This type of app is new, but it does NOT replace the type of digital serial dermoscopy that I described previously. Consider it an adjunct to your skin health surveillance program.

Finally, to rid yourself of mole anxiety, have the spot removed and biopsied. Don’t put this off. Just get it done. Depending on your insurance plan, you won’t have to pay for this other than the copay.

As for the annual or biannual screening exams, your insurance probably won’t cover this, but think of the investment as part of your overall beauty and health indulgences. How much money have you spent in the past 12 months on the following: manicures, pedicures, facials, hair extensions, belts and shoes you didn’t need, etc.?

The digital dermoscopy I use costs $250 (includes screening exam). This is about the cost of one manicure a month for a year, which many women don’t think twice about spending money on. You may need to make a trade-off if the funds aren’t there. However, if you want to get rid of mole anxiety as much a possible, the money spent to do this will be well worth it.

Source:
http://medicine.yale.edu/dermatology/patient/101_36878_Chapter%2022%20Melanoma.pdf

Elderly Parent Refuses to Go to ER: How to Make Them

Here is how to make a stubborn elderly parent go to the emergency room.

Have you ever heard of a case in which an elderly person died because their medical treatment was delayed, because family members couldn’t get that individual to visit the emergency room?

I’ve always wondered how it’s not possible for the adult child of an elderly person, who’s compromised by an illness or injury, to make them get into a car and be driven to an emergency room.

I made my elderly mother, who refused to go to the ER, get in the car and be driven to the ER.

She was delirious and wouldn’t keep still, requiring nonstop supervision. The delirium ultimately had been diagnosed as a side effect from a type of medication that, in a very small percentage of recipients, causes a reactive “psychosis.”

The drug had been prescribed by a neurosurgeon to mitigate fluid buildup in her brain as a result of a recurrence of a chronic subdural hematoma.

So to this day, we’ll never know how much of that “psychosis” was brought on by the increasing blood and fluid in her brain (sounds frightening but she fully recovered).

My elderly mother flat-out refused to go to the emergency room, even though I and my father were insisting on this.

My father had orthopedic issues and was not in a position to use a hands-on approach to make my mother get into the car.

Look, if you have an elderly parent who needs to go to the ER, and he or she refuses, there is NOTHING stopping you from doing what you intuitively know is the right thing to do!

I forced my mother into the car. This sounds like I used violence, but all I did was stand behind her, place my hands on her upper arms, and “force” her to walk out of the kitchen, through the laundry room and into the garage. There was no way she could break loose.

Holding her upper arm with one hand, I opened the car door with the other hand, and I made her get into the front seat. I turned her body to face the open door and pushed downward, making her lower, and I guided her into the seat, lifting her legs into the car, then quickly closing the door. I then put her seatbelt on.

My father and I knew she’d try to get out. I quickly got in behind her as my father put on the automatic lock for all the doors. This way my mother couldn’t open her door. She was still verbally delirious and insisting she be let out.

The drive to the hospital took 40 minutes, during which I kept my hands firmly on my mother’s shoulders while I sat behind her. 

Several times she reached for the door handle, and I didn’t quite trust that automatic lock. I kept her pinned against the seat with my hands. She kept saying she wanted to jump out.

The CAT scan at the emergency room revealed the chronic subdural hematoma, and since the scan looked pretty much the same when compared to one that had been taken a few days ago, the ER doctor deemed my mother’s behavior to be an adverse reaction to the drug.

She was admitted and underwent a second burr-hole operation to correct the cSDH, then fully recovered within a few weeks.

You do NOT have to injure or bruise an elderly parent in order to “force” them to walk to a car, get in, and be driven to the ER.
If your elderly parent can’t walk (my mother had no problem walking), then pick them up. If your parent is heavy, then of course, picking them up won’t always be an option.

If it’s impossible to get them into a chair with wheels or a wheelchair and roll them to the car, then hoist them in, or if two people find they can’t dually carry the person, then call 9-1-1.

If an elderly person falls and can’t move much, leave them be and let professionals do the moving!

When my elderly father blacked out, fell, hit his head and had an altered mental status at 3:00 in the morning, I found him on all fours (elbows on floor). This was a week after he had total knee revision surgery. 

Though he was conscious, all 190 pounds of him, combined with the inability to realize he needed to try to get into a seated position on the floor, made his body dead weight. I took the mobile phone into another room and dialed 9-1-1.

He didn’t want me to call 9-1-1, and my mother was even swayed by his insistence that he was alright (by then she had talked him into making his way, along the floor, to a seated position on the floor with his back against the bed).

But I wouldn’t have it. Within minutes, four EMTs arrived and properly transferred my father, neck brace and all, into a special chair and secured him in it, then carried the chair down a flight of stairs and out the front door. He fully recovered.

So as you can see, there’s really NO reason why you can’t somehow, some way, get an elderly parent to the emergency room, no matter how much they refuse to go.

Racing Heart after Climbing Stairs: Cause & Solution

If your heart races after you climb a flight of stairs, here’s why and how to solve this problem.

When I worked as a personal trainer at a large gym, I’d have my clients simply walk up a flight of stairs to see if they’d get a racing heart.

I just want to first encourage those who experience a racing heart after going up a flight of stairs to have a complete exam by a cardiologist.

Though I’m not a medical doctor, it’s within my realm of fitness expertise to state that a healthy person (no heart troubles) who’s de-conditioned due to lack of exercise will experience a racing heart after climbing stairs fast enough. Even a slow pace can get the heart rate shooting up in an otherwise healthy person.

When I was in a volleyball club years ago, consisting of primarily 20-somethings, these young people hated having to climb five flights of stairs to get to the fifth story of the building where the courts were set up — and these were experienced volleyball players. Going up flights of stairs is no picnic, even to athletes.

Climbing stairs, to any out-of-shape individual, is a bear, and it’s expected that their heart would be racing at the top.

If climbing stairs produces other symptoms besides a racing heart, this would be cause for concern, such as chest pain, nausea and feeling faint.

A heart that’s not conditioned will race under exertional circumstances, even in the absence of an abnormality, heart disease or other medical condition. The fix is to exercise.

You may already think you’re getting plenty of exercise, including “going up and down the staircase at home a hundred times a day.”

But use of a staircase in the activities of daily living is not sufficient to overcome the racing heart issue.

Program for Preventing a Racing Heart from Climbing Stairs in a Healthy Individual 
Incorporate twice weekly sessions of high intensity interval training. HIIT will teach your heart to get used to brief high loads of exertion, and to recover quickly from them. HIIT is superior to inducing this kind of cardiac fitness when compared to steady state aerobic sessions.

For best results, conduct HIIT using a staircase. One of the versions of this that’s very effective is to dash up a flight of stairs while holding dumbbells or weight plates. The “dash” can be a walk, if that’s all you can do with the weights.

The objective is to move as fast as you can (even if it’s a slow pace) while holding the weights. At the top of the stairs your heart should be racing. That’s the objective. If it’s not racing, go faster or use heavier weights. Keep adding on. 

So if holding 10 pound dumbbells no longer is difficult even with a fast trot, then use 15-pounders.

At the top, set down the weights and walk around for one to two minutes, then do another set (four or five total) Do not sit or stand still during the rests. Keep moving during the recovery.

For beginners, you should have rating of perceived exertion of 6-7 at the top of the staircase. For fitter people, aim for an RPE of 8-10. This is based on a scale of 1 to 10, where 1 = how you'd feel soaking in a hot tub, and 10 = how you'd feel after trying to outrun a train.

The ideal staircase is at least 30 steps (two or more flights), but don’t climb so many steps that after 30 seconds, you’re still climbing. This is supposed to be short, brief bursts of exertion, not a pacing type of movement.

To prevent your heart from racing from casual use of a staircase (like on the job or around the house), you must get your heart racing via HIIT, and twice a week is all you need. On one or two additional days, yes, I encourage steady state cardio. But if you rely only on steady state, it won’t produce the spectacular results of HIIT.

Zero Calcium Score: Can You Benefit from Daily Aspirin?

Here’s information if you’ve ever wondered if it would be worth it to take a daily aspirin even though you’re calcium score is zero.

Are you wondering if there would be any benefit to taking a daily aspirin because your coronary calcium score is zero? Would popping a small aspirin every day make your risk of heart attack even lower?

I wondered about that, as I my calcium score is zero; I figured that adding a daily aspirin would really, really make me resistant to a heart attack.

Now, a study has come out answering this question. Michael D. Miedema, MD, the study’s lead author, says, "Many heart attacks and strokes occur in individuals who do not appear to be at high risk."

Dr. Miedema points out that treating only those people with a high risk of heart attack with a daily aspirin means that a “substantial portion of patients” without high risk will go on to have a heart attack that maybe could have been prevented with daily aspirin therapy.

Aspirin, because it’s a blood thinner, can cause internal bleeding. This is the problem with taking this drug when you aren’t at high risk for a heart attack; you risk internal bleeding to prevent a heart attack that would have never occurred in the first place.

The American Heart Association recommends aspirin for those who have known cardiovascular disease or who are at high risk for a heart attack. This drug is not advised for those at low or even intermediate risk.

Dr. Miedema’s study looked at over 4,200 participants who were followed for about seven years. They were grouped according to their calcium scores. Heart attack rates in each group were calculated.

Results
Subjects with calcium scores over 100 were two to four times more likely to benefit from daily aspirin than to be harmed, even if they didn’t qualify for daily use according to the current AHA guidelines.

Subjects with a calcium score of zero were two to four times more likely to suffer harm from aspirin than any benefits.

These results stood ground even when traditional risk factors were accounted for.

The results mean that significant plaque buildup means this individual is “much more likely to prevent a heart attack with aspirin use,” says Dr. Miedema, “than to suffer a significant bleed.”

But conversely, if you have a zero calcium score, the daily aspirin would result in more harm than anything good  --  even if you have any risk factors for heart disease (e.g., high cholesterol).

Dr. Miedema says that a zero calcium score “is associated with a very low risk of having a heart attack.” He adds that such individuals may not benefit from preventive drugs.

Well, that does it for me. I have not yet taken the daily aspirin, and I have decided not to. Why risk internal bleeding, which I’d more likely suffer than a heart attack, what with my zero calcium score? Nevertheless, if you’re not sure what to do, consult with a board certified cardiologist.

Source: http://www.sciencedaily.com/releases/2014/05/140509172919.htm