Sunday, October 9, 2011

October is Breast Cancer Awareness Month

Breast cancer is the most common type of cancer in women and is the second leading cause of death, after lung cancer, in women. Every woman has a 12 percent (1 in 8) chance of developing it at some point in her life. The good news is that only about 3 percent of women will die from breast cancer. A number of risk factors will play a role in a woman's particular risk to breast cancer. Age plays perhaps the most important role in breast cancer risk as two out of three invasive breast cancers are found in women age 55 and older. About 10% of breast cancer cases are thought to be inherited (genetic) and the most common cause is a mutation (change) in what are called the BRCA genes. A family history of breast cancer may also be significant. Having one first-degree relative (mother, sister or daughter) with breast cancer will double a woman's risk and having 2 first-degree relatives will increase her risk about 3 x. Women who have had a longer menstrual history (i.e., before age 12 and after age 55) have a slightly higher risk of breast cancer. Post-menopausal hormone especially with progesterone has been shown to increase the risk of breast cancer. Obesity and excess alcohol use (3 or more daily) will also increase a woman's risk of breast cancer.


Risk Factors: (you cannot change)
 Age
 Inheritance (genetics)
 Family history
 Caucasian women (slightly higher)
 Dense breast tissue
 Previous breast cancer
 Prolonged menstrual history
 Previous radiation therapy
 History of diethylstilbestrol (DES) exposure


Risk Factors: (you can change)
 Obesity
 Excessive alcohol use
 Post-menopausal hormone therapy (especially synthetic hormones)
 Having no children or later in life (after age 30)
 Sedentary life style (just 2 hrs of exercise weekly will help)
 Night shift work (? changes  levels)
 Smoking (controversial)

Signs of breast cancer can be many and confusing. Lumps, swelling in the breasts or under the armpit are common signs of breast cancer. A lump that is painless, immobile, and has uneven (prickly) edges is more likely to be cancer than one which is painful, smooth and rounded. The outer quadrants of the breast are also more likely to develop a cancer than the inner quadrants. Changing of the skin especially around the nipple could also be a sign of breast cancer. The skin around the nipple may become reddened, scaly, flaky or pitted like an orange. Changes in the size and contour of the breast may also be a sign of breast cancer.


Symptoms:
 Lumps (especially fixed and prickly)
 Swelling in the breast or armpits
 Skin changes (especially around the nipple)
 Inverted nipples
 Changing contour of the breast
 Persistent pain in the breast

Breast cancer screening is extremely important and should begin with self exams at an early age. Women should familiarize themselves with their own breasts and begin self exams in their twenties. Women should know how their breast normally look and feel. Breast cancer screening guidelines for women with no increased risk factors include: 1) monthly self breast exams (after menses preferable), 2) clinical breast exams every 3 years for women in their 20s and 30s and then every year for women over 40, 3) mammograms every 1-2 years starting at age 40 and then yearly after age 50 (a screening mammogram at age 35 may also be considered).


Mammography can detect breast cancer about 1.5 years before a women can feel a lump in her breast. Remember is that when breast cancers are detected early (stage I), the survival rate in nearly 100%. 

Friday, September 23, 2011

Smoking Cessation

Tobacco use is considered the most common cause of preventable death and about half of habitual smokers will likely die of smoking-related illnesses. Quitting smoking (or at least significantly reducing smoking) will provide many health benefits. After you stop smoking, blood pressure and circulation improve, breathing becomes easier, your sense of smell and taste return and other issues such as anxiety will often improve. There is no doubt that giving up tobacco will help you live longer and the risk of cancer decreases yearly.

Quitting smoking may be the most difficult thing that you have ever done. You probably will experience intense short-term effects such as irritability, insomnia, anxiety or weight gain. Most people will try to quit a number of times before succeeding. There are a number of helpful ways to quit smoking including prescription medications and products that reduce nicotine addiction. Most experts suggest not quitting "cold turkey" due to the severely addictive nature of nicotine. You should remove all ashtrays and try to remove all traces of cigarette residue from the home. A majority of former smokers say a support network of family and friends was vital during their trials with smoking cessation. You should be open about your plans to quit and try to spend time with ex-smokers for guidance. You must try to avoid social situations with current smokers especially if they include alcohol.

Stop smoking programs, especially group ones, are designed to help smokers recognize and cope with significant difficulties that arise when attempting to quit. These programs  provide support, guidance and encouragement during the process. The best programs should include one-on-one and group counseling. There is a strong correlation between how often and how long counseling lasts and the success rate. Overall, the more intense the program, the greater the chance of success.

Nicotine Replacement: 
Nicotine patches: give a continual dose of nicotine through the skin. Several different strengths are available and the 16-hour patch works well if you are an average smoker. You slowly wean off of nicotine by switching to lower-dose patches over a course of weeks. Sixteen hour patches have less side effects like a racing heartbeat, sleep problems or headache, but may not be right for those with early morning withdrawal symptoms. The 24-hr patch provides a steady dose of nicotine through the night, therefore it helps with early morning withdrawal. The rule of thumb is that regular smokers will probably be better suited for a 24-hr patch. The recommended initial dosage for people who smoke more than 10 cigarettes per day is one 21-mg patch per day for four to six weeks. After which, you should step down to one 14-mg patch per day for two weeks. Finally, you should use one 7-mg patch (preferably a 16-hr patch) per day for the final two weeks of treatment. The patch should be put on in the morning on a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist, such as on the upper arm or chest.

Most common side effects of the nicotine patch include:
 Skin irritation
 Dizziness
 Racing heartbeat
 Sleep problems
 Headache
 Nausea

Nicotine gum: is a fast-acting form of nicotine replacement. If you have sensitive skin, you may prefer the gum to the patch. You can buy it without a prescription and it comes in 2 mg and 4 mg strengths. If you smoke more than a pack a day or upon waking, you may need to start with the higher gum dose (4 mg.) For best results chew the gum slowly until you note a tingle or hot taste. Then "park" it next to your cheek until the taste fades. Repeat the process for 20 or 30 minutes. Do not eat or drink for at least 15 minutes before and during gum use. Chew no more than 20 pieces of gum in one day. Nicotine gum is usually recommended for 6 to 12 weeks. You should taper down the amount of gum you use within six weeks. The gum can be used as needed or on a fixed schedule and most research has shown that scheduled dosing works better. A schedule of 1 to 2 pieces per hour is most common.

Side effects of nicotine gum:
 Bad taste
 Throat irritation
 Mouth sores
 Hiccups
 Nausea
 Jaw discomfort
 Racing heartbeat
 Nausea

Nicotine nasal spray: relieves withdrawal symptoms very quickly and smokers usually like the nasal spray because it is rapid and easy to use. Since nicotine is so addictive, a person can also become dependent on the nasal spray. The FDA recommends that the spray be prescribed for 3-months and that it not be used for longer than 6 months to help reduce this risk.

Common side effects can include :
 Nasal irritation
 Runny nose
 Watery eyes
 Sneezing
 Throat irritation
 Coughing

Nicotine inhalers: are available only by prescription. When you use the inhaler, a nicotine vapor which is absorbed in the mouth, not the lungs. Each puff contains about 10 times less nicotine than a puff of a cigarette. The absorption of nicotine is slower than from a regular cigarette, with peak nicotine doses occurring about 10 minutes after the end of puffing. The best results have been achieved by frequent puffing for 20 or more minutes. The recommended dose is between 5 and 15 cartridges a day, for up to 6 months.

Common side effects include:
 Coughing
 Throat irritation
 Nausea

Nicotine lozenges: are non-prescription and are available in 2 mg and 4 mg strengths. You should stop smoking when you start using the lozenge. Smokers may also consider the lower dose if they smoke less than ten cigarettes daily. The recommended dose is 1 lozenge every 1 or 2 hours for 4-6 weeks, then 1 lozenge every 2 to 4 hours for weeks two weeks and finally, 1 lozenge every 4 to 6 hours for the final two weeks. Do not eat or drink for 15 minutes before using the lozenge. Suck on the lozenge until it is fully dissolved, about 20 minutes. Do not bite, chew or swallow it.  Do not use more than one lozenge per hour, or more than 20 per day. Discontinue the lozenges after 12 weeks if not sooner. Do not use the lozenge if you continue to smoke or use any other product containing nicotine.

 Possible side effects  include:
  Trouble sleeping
  Nausea
  Hiccups
  Coughing
  Heartburn
  Headache

Medications for smoking cessation:
Welbutrin (bupropion): the mechanism of action for this agent, originally marketed as an antidepressant, is thought to be due to its ability to increase the neurotransmitters dopamine and norepinephrine, reducing cravings and symptoms of withdrawal. Patients should initiate bupropion therapy 1 to 2 weeks before their quit date, starting with 150 mg once a day for a few days, then increasing to 150 mg twice a day. Cessation rates in patients who use bupropion are generally 2 times higher than those who do not.
Clonidine: is an antihypertensive agent that also doubles smoking cessation rates. Initial recommended doses include 0.1 mg orally twice a day or the 0.1-mg/day patch applied weekly. The dose may be increased to .3mg twice daily (orally) and to 0.2 mg patch (transdermally) for up to 12 weeks.
Nortriptyline (Elavil): a tricyclic will also greatly increase the success rates of quitting smoking. The recommended initial dose is 25 mg at bedtime, gradually increasing to a target dose of 75 or 100 mg daily for 12 weeks.
Chantix (Varenicline): is in a class of medications called smoking cessation aids. It works by blocking the pleasant effects of nicotine on the brain. Your doctor will probably start you on a low dose of varenicline and gradually increase your dose over the first week of treatment. Chantix is usually taken once or twice a day with a full glass of water after eating. You will probably take varenicline for around 12 weeks. Some people have had changes in behavior, hostility, agitation, depressed mood, and suicidal thoughts while taking varenicline.

Natural herbal therapies:
Bupleurum D: is based on the formula bupleurum and dragon bone; it decreases irritability, reduces cravings, and stabilizes the emotions.  
Crave Arrest:i s a proprietary blend which has been shown to help up to with the cravings.
5HTP(5-hydyoxytryptophan): keeps serotonin levels balanced which helps with mood, cravings, and 
general well being.  
Calm Spirit: helps with excessive anxiety, stress, and emotional disturbance.

Other options:
Acupuncture: works by balancing the flow of Qi (chi) in the body and mind.Qi is frequently translated as life force or "energy flow." In acupuncture theory, addictions are due to a number of potential imbalances in the way that energy flows through the body, which is often believed due to a history of abuse or a betrayal.
Hypnosis: is now used in hospitals and medical centers. The hypnotherapist can decrease cravings and help address fears one might have about quitting, like gaining weight by giving you helpful subconscious suggestions.
Yoga: helps calm the mind and strengthen the determination. It also helps bring heightened awareness to breathing and the body, which helps with a healthier attitude toward the lungs.

Other tricks:
For those who desire to simply decrease their level smoking, try these tips:
 Buy no more than two packs of cigarettes at a time.
 Do not smoke in the house or car.
 Try different brands of cigarettes each time you buy them.
 Wait an extra 10-15 minutes when you disire a cigarette.
 Chew gum.
 Avoid smokers.
 Exercise 

Tuesday, August 23, 2011

Managing Tics and Tourette's

Tic disorders are characterized by sudden, repetitive, involuntary movements or vocalizations which appear out of context and usually last a brief second. These disorders must appear before the age of 18, they are most common in Caucasian males and cannot result from other causes such as the ingestion of stimulants or other medical conditions. Tics are either transient with a duration of less than 12 consecutive months or chronic lasting more than a year. They are fairly common in childhood and the majority of cases resolve on their own. However, in some children the tics may persist and become more complex and severe. They can be either primary (unknown cause) or secondary to things such as anxiety, stress or fatigue. Common motor tics include blinking, jerking, picking, grunting, sniffing and shoulder shrugs. Vocal tics are less common and include sounds such as coughing, grunting, belching and throat clearing. Complex tics are slower, longer, and more purposeful; they include facial grimacing, biting, banging, arm or hand flapping, coprolalia (use of obscene words) or copropraxia (obscene gestures). The best known of these disorders is Tourette's syndrome. 

Types of tic disorders

Transient (simple) tic disorder: most commonly appears at a young age and affects between 10% and 20% of school-age children. Transient tics are characterized by the presence of one or more tics, usually motor, for at least one month but less than one year. Children may experience multiple episodes of these transient tics which will usually vary in intensity over time.
Chronic tics: will last for a year or more. During that time, the patient is never without symptoms for more than three consecutive months. They may be either motor or vocal, but not both, and the symptoms must begin before age 18. The severity of the symptoms and impairment is usually much less than for patients with Tourette's disorder. Chronic tics are much less common and occur in less than one in 100 children (1%).
Tourette's syndrome: occurs less common, is more severe and is characterized by the presence of both motor and vocal tics. The estimate is that around 250,000 (one in a thousand or less) people in the U.S. have this condition. Tourette's is three or four times more common in males than females and symptoms typically begin between ages 7 and 17. In 75% of Tourette's patients, the symptoms appear by age 10 or so. The severity of Tourette's syndrome often changes over time, waxing and waining. The tics occur many times a day, usually in bouts, most days or intermittently for more than one year. Fortunately, the symptoms often improve as Tourette's patients get older. Tourette's syndrome may also be more likely to occur in children whose mothers smoked or drank alcohol in pregnancy or were low birth weight infants. Adolescents with Tourette's frequently experience a number of additional problems including: aggressiveness, behavioral disorders, self-harming behaviors,  immaturity, social withdrawal, physical complaints, psychological disorders including anxiety or panic attacks, stuttering, sleep disorders, and inappropriate sexual behaviors.

Types of phonic tics: 1) simple phonic tics which are meaningless sounds or noises like throat clearing, coughing or sniffling and 2) complex phonic tics which include syllables, words or phrases. The "echo phenomenon" is the immediate repetition of one's or another individual's words. Coprolalia (rare, 10% or less of tic disorders) is made up of inappropriate, obscene or aggressive words. It often appears first in adolescence and causes considerable distress for individuals, teachers and their families.

Younger children (under the age of 10 or so) with simple tics will generally find them difficult to control, whereas, most older people can suppress them for varying lengths of time. Often, tics are more obvious in a relaxed situation, such as watching television. Tics may be worsened by things such as stress, anxiety, illness, fatigue or excitement. Additives in food (ie, red dye 40), certain medications or stimulants may worsen tics. The symptoms of tic disorders are usually absent while sleeping. Playing a sport or concentrating on an enjoyable task (ie, books, puzzles...) are known to reduce the severity and frequency of tics.

Tics seem to worsen during the adolescent years as the symptoms become more unpredictable from day to day. Teenagers may often refuse to go to school when their tics are severe. Older children with more complex tics frequently describe feelings of strong urges relieved by the performance of a motor tic in that particular area.  A sensation of relief and reduction in anxiety levels generally follows the tic. Many sufferers also describe an inner conflict over whether or not to give in to these urges. The energy required to suppress the tics may also contribute to anxiety, preoccupation, fatigue and social withdrawal. Low self-esteem and feelings of hopelessness are also common with tic disorders.

Causes
No definitive cause of tics has been discovered; but it is believed that abnormal activity of the neurotransmitters dopamine and serotonin (chemical messengers in the brain ) may be the cause. Multi factorial genetic factors are present in about 75% of cases. Researchers also believe there is an link between genetic and environmental factors. Tic disorders may be worsened by recreational drugs such as amphetamines or cocaine or certain prescription stimulants such as Ritalin or Focalin. Occasionally, medications such as antihistamines, antidepressants, antiseizure medications, and opiates have been shown to worsen tics. Some tics may be triggered by ones environment; a barking dog may initiate a barking tic or cough may continue as vocal tic.

PANDAS: stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus. In some cases tic disorders and obsessive-compulsive disorders have been shown to develop after streptococcal infections between the ages of two and eight. No precise cause for this connection has been found, although it appears to be related to the immune system and basal ganglia of the brain. Tics will often worsen with subsequent strep infections. The treatment is different and somewhat controversial if PANDAS is suspected in that intravenous immunoglobulin (IVIG), 750 mg/kg/day for two consecutive days, may be administered and the patient may then be placed on supressive antibiotics.
.  
Diagnosis

There are no diagnostic laboratory tests to screen for tic disorders. Physical and neurological examinations are generally normal, except for the tics. Surprisingly, it is also common for the patient to have fewer tics in a doctor's office than at home. The diagnosis can be made by directly observing or videotaping the patient in a more natural setting. Children quickly learn to mask their symptoms and convert them to more socially acceptable movements and sounds. 

Physicians often disagree as to whether tic symptoms should be classified as tics or compulsions; as there is a significant overlap between tic disorders and obsessive-compulsive disorders (OCD). More than half of patients with tic disorders or Tourette's have been diagnosed with OCD; however, only a third of those meet the full criteria for OCD. Distinguishing tics from compulsions and true OCD can be very difficult. Compared to only obsessive-compulsive disorder in individuals, there will likely be an earlier age of onset and a greater percentage of males. These patients will see less response to medications such as selective serotonin reuptake inhibitors (SSRIs) and may require a neuroleptic (considered a stronger medication) to bring about improvement.

As many as 50% of children with Tourette's disorder have symptoms of attention-deficit hyperactivity disorder (ADHD). Symptoms include poor concentration, a short attention span and restlessness. On average, ADHD symptoms will manifest about two years before the tics begin. ADHD combined with a tic disorder is associated with more severe tics and greater social withdrawal. These impairments lead to higher underachievement in school and more social disabilities than one disorder alone. Although children with tics or ADHD do not  appear to have a significant impairment in intellectual functioning, they do have abnormal visual-perceptual performance and reduced visual-motor skills. Children with tic disorders are much more likely to require special education programs as these children often have underlying learning disabilities.


A team approach is best with the affected child's parents, health care providers and teachers. A comprehensive treatment plan should include the following:

 Direct observation.
 Self-reports of tic activity by the patient and parents.
 Educating the patient and family about the course of the disorder.
 Involvement with school personnel to create a positive learning environment.  
 A comprehensive assessment including cognitive ability, motor skills, behavior and social
 functioning.


Treatment
 Includes behavioral or cognitive/behavioral therapy in combination with medical treatment as
 needed.  

 

Behavioral and cognitive/behavioral therapy:


Habit reversal (is the most commonly used technique): combines relaxation exercises, awareness, and contingency management for positive reinforcement. This method shows a high success rate, 70+% . Adding the cognitive technique of distraction has been shown to help patients resist urges and to restore the patients sense of control over the tic.
Massed negative practice (MNP): is another frequently used behavioral therapy technique. The patient is asked to deliberately perform the tic movement for specified periods of time with brief periods of rest  until a conditioned level of fatigue is reached. Patients have shown some decrease in tic frequency, but the long-term benefits of massed negative practice are unclear.
Contingency management: is based on positive reinforcement, usually the by parents. Children are praised and rewarded for not performing tics and for replacing them with alternative behaviors. Contingency management appears to be of limited use outside of controlled enviroments
Self-monitoring: consists of having the patient record tics and is fairly effective in reducing some tics by increasing awareness.

 

Medications

Medication is the main treatment for refractory motor and vocal tics and should be used in conjunction with behavioral or cognitive/behavioral therapy. Because the symptoms of tic disorders overlap those of OCD and ADHD, it is essential to determine which symptoms are causing the greatest concern and impairment. 

Alpha-adrenergic receptor agonists: including clonidine (Catapres) and guanfacine (Tenex) are often first line therapy. Sedation occurs in 20% or more of cases and can often be controlled through adjusting the dosage.
Neuroleptics (antipsychotic medications): including haloperidol (Haldol) and pimozide (Orap) have significant side effects including decreased concentration, cognitive impairment, tremor, sedation, depression and rarely, tardive dyskinesia (a movement disorder that consists of lip, mouth, and tongue movements). 
Phenothiazines:  such as chlorpromazine (Thorazine) or triflupromazine (Stelazine)  may be used when haloperidol or pimozide has proven ineffective.
Atypical antipsychotics: and other agents that block dopamine receptors include risperidone (Risperdal) and clozapine (Clozaril).
Tetrabenazine: is a promising new medication and is marketed under the trade names Nitoman in Canada and Xenazine and has fewer side effects than other typical neuroleptics. It can also be used in combination with other antipsychotic medications, allowing for lower doses of both medications with substantial relief.
Selective serotonin reuptake inhibitors (SSRIs): which include such medications as fluoxetine (Prozac) and sertraline (Zoloft), can be used to treat depression and the obsessive-compulsive behaviors associated with tic disorders.
Benzodiazepines: including lorazepam (Ativan) or clonazepam (Klonipin) are used in some cases to lower patients anxiety levels.

Nutrition

Dietary changes and nutritional supplements may help treat the symptoms of tic disorders. Unknown  food or chemical allergies may worsen tic disorders. Nutritional deficiencies may also influence the severity of tic disorders. Recommendations include organic foods, avoiding pesticides, antioxidants, supplements including folic acid, magnesium, zinc and B vitamins; eliminating caffeine, and avoiding artificial sweeteners, colors and dyes (especially red dye 40).

 

Prognosis

There is presently no absolute cure for tic disorders and there is no method to determine whether the tics will be mild, severe, chronic or transient. The general consensus is that if a tic disorder is the only diagnosis, the prognosis is favorable and most patients report that their tics decrease markedly or disappeared as they enter the teenage years.  A number of studies suggest complete remission rates to be around 50% and appear to be related to early treatment when he or she was a child. While the tics themselves may decline, however, other associated problems such as obsessive-compulsive disorders and behavioral problems become more pronounced. Learning disabilities may also worsen in early adolescence. Panic attacks, anxiety, depression and alcoholism are most significant in the early adult years. Persons who were misunderstood, abused and stigmatized experience greater functional impairment as adults than those who were supported, understood and treated as children.

 

Prevention

There is some evidence that severe maternal emotional stress during pregnancy as well as severe nausea and vomiting during the first trimester may affect tic development. People with tic disorders are sensitive to stress and attempting to maintain a low-stress environment will help minimize severity of tics. Dietary changes and nutritional supplements as outlined above may help in the severity of the tics.

Wednesday, July 13, 2011

Gluten Allergy

Gluten allergies are relatively common. Some studies indicate that 1 in 150 children and 1 in 110 adults have a gluten sensitivity (or allergy). When people with gastrointestinal complaints were studied, 1 in 40 children and 1 in 30 adults were found to have a gluten sensitivity. Gluten is the sticky protein which appears in foods processed from wheat, barley and rye. Symptoms of gluten-sensitivity (GSE) can range from mild inflammation of the small intestine causing abdominal cramps, bloating, diarrhea, nausea or vomiting to severe GI disease (Celiac disease). Celiac disease causes damage to the surface of your the intestine and an inability to absorb nutrients (malabsorption). Later symptoms include eczema, allergic rhinitis, asthma, depression, dizziness, headache, palpitations, psoriasis and irritable bowel syndrome. The gluten-sensitive designation may not be appropriate in all cases, as wheat allergies are often directed toward other components of wheat or wheat products (such as bread yeast). Gluten sensitivity can develop at any point in life and symptoms may appear years later. Wheat allergy symptoms are similar, however the sensitivity is limited to the seed proteins of the wheat.
There are several ways of diagnosing gluten allergy or sensitivity: a blood test, endoscopy or starting a gluten free diet. Antibody blood tests may be used to determine if someone has a gluten sensitivities. An endoscopy may also be used to obtain images of the small intestine to determine whether damage from gluten has taken place. After eliminating all foods containing gluten from yourdiet, those who are allergic or sensitive to gluten usually find that their symptoms will dissipate in just a few days.


Foods that may contain gluten include:
Breads
Cookies
Cakes
Baked goods
Bread crumbs
Crackers
Many cereals
Couscous
Pasta

Treatment:
The obvious treatment is a gluten free diet. This diet is difficult to follow due to the severe limitations. The most frequently used grains and starch sources are corn, potatoes, rice and tapioca. Other less commonly used foods include include amaranth, arrowroot, millet, montina, lupin, quinoa, sorghum, taro, teff, chia seed, and yam. Various types of bean, soybean, and nut flours are sometimes used in gluten-free products to add protein and dietary fiber. In spite of its name, buckwheat is not related to wheat; although many commercial buckwheat products are actually mixtures of wheat and buckwheat flours, and thus not acceptable. Gram flour, derived from chickpeas, is also gluten-free. Special care is necessary when checking product ingredient lists since gluten comes in many forms: vegetable proteins and starch, modified food starch (when derived from wheat instead of corn), malt flavoring, including dextrose, unless specifically labeled as corn malt. Be careful and do your homework thoroughly any exposure to gluten trully matters, especially if you are making these choices for a child.
There are numerous websites and a tremendous amount of information available for gluten free living. The most important things are early recognition and following a strict diet.

Tuesday, July 5, 2011

HPV

Human papillomavirus (HPV) is the most common sexually transmitted infection; about 70% of sexually active Americans will be infected with HPV at some point in their lifetime. Approximately 20 million Americans are currently infected with HPV and another 6 million people become infected each year. HPV is passed on through direct contact, most often during genital or oral sexual activity. Most HPV infections are temporary and have little long-term significance. 75% of infections are gone in 1 year and 90% in 2 years. However, when the infection persists (10% of cases) there is a high risk of developing precancerous lesions of the cervix in women, which can then progress to cervical cancer. Tobacco smokers are less likely to develop HPV antibodies and therefore may not clear the infection easily. The risk of transmission to a fetus or newborn is generally low. A person may also have HPV for years and not realize they are infected or that they may be passing the virus on to a partner.

Some HPV infections can cause warts (primarily genital) which are noncancerous skin growths. Genital warts are quite contagious, while common flat or plantar warts are much less likely to spread from person to person. Genital warts may appear as small or large, raised or flat, or shaped like cauliflower. The warts may appear within weeks or months after contact with an infected partner. If left untreated, genital warts might resolve, remain unchanged, or increase. Although a wide variety of HPV types can cause genital warts, types 6 and 11 account for about 90% of all cases.

The biggest concern for HPV is cervical cancer. Cervical cancer usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular pap smears. The good news is that cervical cancer usually takes years to develop. Screening can find early signs of disease that you can treat before their is a risk of invasive cancer.

Two vaccines are available to prevent infection by some HPV types, Gardasil and Cervarix. Both protect against an initial infection with HPV types 16 and 18, which cause most of the HPV associated cancer cases. Gardasil also protects against HPV types 6 and 11 which cause 90% of genital warts. The vaccines provide little benefit to women who have already been infected with HPV. For this reason the vaccine is recommended primarily for those women who have not yet been exposed to HPV.

HPV Types and infections:
Common warts


2, 7
Plantar warts 1, 2, 4, 63
Flat warts 3, 10
Genital warts 6, 11, 42, 44
Genital cancers


Oral,
Highest risk: 16, 18, 31, 45
Other high-risk: 33, 35, 39, 51, 52, 56, 58, 59
Probably high-risk: 26, 53, 66, 68, 73, 82
6, 7, 11, 16, 32

Sunday, July 3, 2011

Benefits of Omega-3s (DHA)

Docosahexaenoic acid (DHA), an omega-3 fatty acid and key ingredient in fish oil, is essential for the growth and development of the brain and visual acuity of infants. DHA is also necessary for normal brain and eye function in children and adults. There are several types of omega-3s (including EPA and ALA); however DHA, the most potent, has the most important health benefits. The inclusion of DHA in the diet is known to improve learning, whereas deficiencies are associated with deficits in learning. Studies have shown a strong correlation between fish consumption and reduction in death from heart attack, the leading cause of death in the US. Not only does fish oil reduce triglycerides in the blood, it decreases stroke risk by it's anti-inflammatory properties. DHA deficiencies are also associated with attention deficit hyperactivity disorder (ADHD), cystic fibrosis, depression, aggression and hostility.

Our bodies naturally produce small amounts of DHA, but we must get the amounts we need from our diet or supplements. Most people in the US do not get enough omega-3s in their diet. Vegetarian diets also contain limited amounts of DHA, and vegan diets typically contain no DHA. DHA in the brain is metabolized (used) quickly, so more is needed than is generally realized. Omega-6 fatty acids (linoleic and arachidonic acid) are found in foods such as poultry, eggs, avocados, nuts, whole-grain breads and most vegetable oils. Americans typically consume much higher levels of omega-6s than omega-3s (10 or 20 to 1; should be 3 to 1), and this excess will often negate the health benefits of omega-3s. Also realize you must have at least one gram (1000mg) of DHA and or EPA, and probably 2-3 grams, daily to receive the maximum health benefits.

DHA has been used to treat:
Attention-Deficit Hyperactivity Disorder (ADHD)
Bipolar Disorder
Pre-term labor
Age Related Eye Problems
Depression
Fatigue
Alzheimer's
Memory Disorders
Heart Disease
High lipids
High Blood Pressure
Rheumatoid Arthritis
Menstrual Pain
Raynaud's Syndrome
Lupus

Perhaps one of the best sources of omega 3s (DHA) is from krill. Krill oil is made from a species of krill (Euphausia superba). Three of the most important nutrients in krill oil are: (1) omega-3 fatty acids similar to those of fish oil, (2) omega-3 fatty acids attached to phospholipids (mainly phosphatidylcholine or marine lecithin) and (3) astaxanthin, a powerful antioxidant.

Wednesday, June 29, 2011

Gallstones

Every year, more than one million Americans discover that they have gallstones, pebble-like deposits in the gallbladder that can grow to the size of a golf ball. Sludge or thick gritty secretions may also be present within the gallbladder, either alone or in conjunction with gallstones (calculi). About one half of people diagnosed with gallstones end up having their gallbladder removed. These stones, formed in the gallbladder, may pass into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of Vater. When this happens, other more serious complications may arise.

The most common symptom of gallstones is pain in the upper right quadrant of the abdomen, under the ribs. The pain may start suddenly and spread to the right upper back or shoulder blade area. It is then usually very hard to get comfortable. The pain will often occur after meals, especially greasy ones. The pain may last minutes to hours and cause difficulty taking normal or deep breaths. Gallstones can also cause nausea and vomiting, which may relieve some of the pain or pressure. Pain that occurs with a fever, nausea  and vomiting or loss of appetite may be a sign of inflammation or infection of the gallbladder (acute cholecystitis) and must be treated quickly. There are other conditions that cause similar symptoms, including heartburn, heart attack, liver problems, a stomach flu or food poisoning. 


Gallstones can be divided into the following types:
1. Cholesterol stones: light-yellow to dark-green and are generally 2 to 3 cm in length. To be classified as such, they must be at least 70-80% cholesterol by weight.
2. Pigment stones: small, dark stones made of bilirubin and calcium that are found in bile. They contain mostly bilirubin and about 20-30% cholesterol.
3. Mixed stones: typically contain cholesterol, calcium , palmitate phosphate, bilirubin, and other bile pigments. Because of their calcium content, they are often radiographically visible (seen on x-ray).

Risk factors for getting gallstones include:
 Obesity
 Estrogen
 Ethnic background (Native Americans and Mexican-Americans)
 Gender and age (women, over 40yo)
 Cholesterol lowering drugs
 Family history
 Diabetes
 Rapid weight loss

Helpful ideas to prevent gallstones:
 Lose weight
 Drink plenty of water
 Take supplemental calcium
 Take supplemental vitamin C
 Eat a low fat diet, 25% or less (but not extremely low-fat)
 Limit sugar in your diet
 Increase your fiber intake
 Consider soy protein for animal protein

Treatment:
Removal of the gallbladder: Generally done laparascopically and most patients recover within days.
Medications; Ursodeoxycholic acid (Actigall) or chenodiol (Chenix) can both help dissolve gallstones; however, this treatment can take months and stones may reoccur.
Lithotripsy: uses sound waves to break up gallstones. However, this procedure is used only for patients who cannot undergo surgery and works best on smaller single stones. Risks include pain and inflammation of the pancreas and possibly a return of the stones.

Friday, June 24, 2011

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS or spastic colon) is a bowel disorder characterized by chronic or intermittent abdominal pain, bloating, gas, and diarrhea or constipation (or both) in the absence of any detectable cause. The symptoms are generally relieved by bowel movements. IBS is more common in women (about 1 in 6) and often begins in the teens or early 20s. It is the most common intestinal complaint in a physician's office. Also, IBS is not the same as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. You must also "rule out" food allergies or gluten sensitivity as the cause of bowel symptoms, as the incidence has risen dramatically in recent years. Milk, eggs, peanuts, tree nuts (ie, walnuts), shellfish, soy and wheat account for 90 percent of all food-allergies.

It is not clear why people develop IBS. There are many possible causes such as a problem with muscles in the intestine, the nerves or an increased sensitivity to stretching or movement. A combination of factors, including stress, hormones, the immune system, and chemicals called neurotransmitters are probably involved. Stress can worsen IBS as the nerves become more active during times of stress and can cause the intestines to squeeze or contract more. Despite the variety and often severity of symptoms, IBS doesn't cause permanent damage to the colon.

Other physical and psychological issues include: loss of control over affected individuals lives, restricted activities (an average, they have to restrict their usual activities up to 25%) and a higher incidence of depression and mood disorders. These sufferers will often try multiple medications with variable effects.

Common symptoms of IBS:
Abdominal pain: is the main symptom and 25% will have chronic pain, 75% will have intermittent pain
Alternating bouts of diarrhea and constipation.
Bloating
Gas (flatulence)
Mucus in the stool.


Natural remedies for IBS:
Avoid caffeine.
Avoid alcohol.
Limit fatty foods.
Limit dairy products, fruit, and artificial sweeteners (for diarrhea).
Increase fiber (for constipation).
Increase water intake (constipation).
Avoid beans, cabbage, cauliflower or broccoli (causes
bloating or gas).
Increase exercise.
Quit or decrease
smoking.

Natural therapies:

Probiotics: supplements containing "friendly" bacteria.
Digestive enzymes: contains amylase, lactase, protease, and lipase to enhance the digestive process.
Peppermint: for its antispasmodic effect.
Chamomile: has antispasmodic properties.
Stress management.

Medical therapies:


For diarrhea:
1) Antidiarrheals: diphenoxylate (Lomotil) and loperamide (Imodium).
2)
Bile acid binding agents: cholestyramine, which prevent bile acids from stimulating the colon, slowing the passage of stools and relieving diarrhea.
3) Alosetron (Lotronex): slows the movement of stools through the bowels and decreases abdominal sensitivity. It has been shown to relieve symptoms in some women who have severe diarrhea and have failed other treatments. This medication was previously discontinued when its use was linked to ischemic bowel disease (when there is not enough blood flowing to the intestines); however, now it is approved for limited use in IBS. Be careful with this medication.


For constipation:
1) Polyethylene glycol (MiraLax): helps the stool hold on to more water, making it softer and easier to pass. This medication is popular, considered safe and can be used on a regular basis.
2) Lubiprostone (Amitiza): works by increasing the amount of fluid in your intestines, making it easier for stool to pass.
3) Laxatives (Milk of Magnesia and lactulose): work by increasing fluids in the intestine making the stool softer and easier to pass. Use osmotic laxatives sparingly.

5) Stimulants (Correctol, Dulcolax, or Senokot): speed up the intestines by irritating the lining of the colon. Use stimulant laxatives sparingly as you can become dependent on them.

For pain and cramping:

1) Antispasmodics (anticholinergics): such as dicyclomine (Bentyl), which helps prevent the cramping or spasms in the intestines.
2)Antidepressants: tricyclic antidepressants such as desipramine (Norpramin) or amitriptyline (Elavil) have been effective in controlling pain and diarrhea. SSRIs (Prozac, Zoloft...) may be preferred in older patients or in those with constipation because they have little or no anticholinergic effects.


Irritable bowel syndrome can be a chronic and debilitating condition. A diet high in fiber and water, low in fatty foods, caffeine and alcohol will have a positive effect on improving the symptoms of IBS. A combination of natural therapies with specific medications tailored to the symptoms will also help improve IBS.

Saturday, June 18, 2011

Metabolic Syndrome

Metabolic syndrome is actually the term for a combined group of risk factors: high blood pressure, high blood sugar (insulin resistance and diabetes or pre-diabetes), high lipid levels, and abdominal fat (central obesity). These risk factors double your risk of heart disease, heart attacks and strokes. They increase your risk of diabetes by five times (500%). The two most important risk factors are obesity and insulin resistance, which are generally tied together. Metabolic syndrome is becoming more and more common in the United States: approximately one fourth of adults met the criteria for metabolic syndrome and almost 50% of those over age 50 have it.

Metabolic syndrome can cause:
Damage to arteries leading to heart disease or stroke.
Decrease in the kidneys' ability to function, leading to kidney disease
and high blood pressure.
An increase in triglyceride levels, resulting in an increased risk of heart disease.
An increased risk of blood clot formation, which can cause heart attacks and strokes.
Worsening function of the eyes, nerves, and kidneys.

According to the American Heart Association and the National Heart, Lung, and Blood Institute, there are five risk factors that make up metabolic syndrome. (from WebMD)

Large Waist Size (height dependant)
For men: 40 inches or larger
For women: 35 inches or larger

High Triglycerides
150 mg/dL or higher
or on
a cholesterol medicine

Low Good Cholesterol (HDL)
For men: Less than 40 mg/dL
For women: Less than 50 mg/dL
or on
a cholesterol medicine
High Blood Pressure
Having blood pressure of 130/85 mm Hg or greater or
Using a high blood pressure medicine

High Fasting Glucose Level
100 mg/dL or higher

To be diagnosed with metabolic syndrome, you would have at least three of these risk factors.

Associated Risk Factors:
Sedentary lifestyle
Stress
Aging
Diabetes
Heart Disease
Lipid disorders
Rheumatic disorders
Schizophrenia: due to a sedentary lifestyle, poor dietary habits and limited health care.

Treatment:
Get some exercise.
Eat healthy.

Lose weight.
Stop smoking.

Medications:
High blood pressure medications: such as ACE inhibitors, ARBs, diuretics and beta-blockers.
Cholesterol lowering medicines.
Diabetes medications.
Low-dose aspirin.

Prevention is key in metabolic syndrome. This disease usually preventable and reversible. A healthy lifestyle including weight loss, stress management and medication therapy, when necessary, will prevent the long term negative effects of metabolic syndrome.

Thursday, June 16, 2011

Total Calories Matter Most

While nutrients are extremely important, a focus on calorie counting should trump restricting fat or carbohydrates. Dietitians recommend a diet rich in fruits, vegetables, whole grains, lean protein, low fat dairy, beans and nuts. Tracking calories, though, is the key to successful weight loss. Keep a diary in order to calculate your usual calorie intake. There are many free online and phone app calorie counter programs such as "myfitnesspal.com". A diet no lower than 1200 calories per day with a consistent exercise program will help you lose up to 1 pound per week.
Although total calories matter most, balance out your diet and know where your calories come from. Depending on your activity level, 50 to 60 % of your calories should come from carbs, 20 to 25 % from protein and 20 to 25 % from healthy, unsaturated fats. Limit foods with too much sugar or too much saturated fat. Keep portions small for high caloric foods that are sugary, fatty and otherwise unhealthy.
Diet alone is not enough to promote significant weight loss. In the beginning, start slow with your exercise program, then ramp up your efforts. The heavier you are, the more calories you burn. Most experts recommend at least 30 minutes of physical activity on most days in order to shed the weight.
To make the most of your exercise sessions, try short bursts of high intensity exercise, which burn more calories than consistent exercise like jogging on the treadmill. High-intensity interval workouts lead to greater reductions in total body mass compared with steady-state exercise. Don't forget to get your 10,000 steps per day. Take the stairs.

Tuesday, June 14, 2011

Calcium and Vitamin D

Recent focus on vitamin D has revealed a large percentage, up to 25%, of people appear to be deficient. The main source of this fat soluble vitamin is usually from sun exposure. As little as 15-20 minutes per day should provide adequate levels. Calcium, the most abundant mineral in the body, is found in some foods, added to others and is available as a dietary supplement. Most, 99%, of the body's calcium supply is stored in the bones and teeth where it supports their structure and function. The body uses bone tissue as a reservoir and source of calcium to maintain constant concentrations in the blood, muscle, and intracellular fluids. You should try to consume a recommended amount of calcium and vitamin D (especially if you lack sun exposure) to maintain bone health. Many people do not know what a reasonable supplement dose should be or what is too high of a dose. Kidney stones have been associated with taking too much calcium from dietary supplements. Very high levels of vitamin D (above 10,000 IUs per day) are known to cause kidney damage. Please take a moment to review the recommended daily dosing for these two very important nutrients.
                                         

                                                                                                
                                      Calcium                                       Vitamin D
                                     Recommended      Max                 Recommended      Max
 1–3 years old                 700                    2500                 600                     2500
 4–8 years old                 1000                  2500                 600                     3000
 9–13 years old               1300                  3000                 600                     4000
 4–18 years old               1300                  3000                 600                     4000
 19–30 years old             1000                  2500                 600                     4000
 31–50 years old             1000                  2500                 600                     4000
 51–70 year old males     1000                  2000                 600                     4000
 51–70 year old females   1200                  2000                600                     4000
 >70 years old                 1200                  2000                600                     4000

Vitamin D deficiency may lead to:
Rickets (children)
Bone thinning (Osteomalacia or Osteoperosis)
Bone fractures
Muscle weakness
Muscle cramps
Memory and concentration problems
? Hypertension
? Depression
? Type 2 diabetes

Calcium deficiency may lead to:
Rickets (Children)
Bone thinning (Osteomalacia or Osteoperosis)
Bone fractures
High blood pressure
Fatigue
Brittle nails
Dry skin
Coarse hair
Muscle aches
Muscle spasm
Muscle twitching
Muscle pain

Wednesday, June 8, 2011

Good and Bad Fats

Have you heard the saying "fat doesn't make you fat"? That mantra is somewhat true. Total calories are really what make you gain weight. The total amount fat you eat isn't necessarily linked with disease; what really matters to your health is the types of fats you consume. The "bad" fats (saturated and trans fats) increase the risk for diseases such as strokes, high blood pressure and diabetes. The "good" fats, monounsaturated and polyunsaturated, should be the dominant type of fat in a balanced diet, because they reduce the risk of clogged arteries, hypertension, heart disease and so on. The key is to substitute good fats for bad fats. Although you still must limit the amount of cholesterol you consume, dietary cholesterol isn't really the villain it's been portrayed as. The biggest influences on your cholesterol level, besides genetics and lifestyle, are the types of fat and total calories in your diet..

The fats to limit are:
Saturated fat: found in meats, dairy, eggs and other foods with animal fat.
Trans fat: a man-made fat (hydrogenated) found in processed, baked and fast foods.

Fats and oils to consume in moderation include:
Monounsaturated fat:
  Olive, canola, and sesame oils
  Avocados, nuts, such as almonds, cashews, pistachios or peanuts (unsalted).
Polyunsaturated fat:
  Corn, cottonseed, and safflower oils
  Sunflower seeds and oil
  Soybeans and soybean oil
  Seafood

The American Heart Association (AHA) recommends that we get 20% to 30% of our calories from fat. Most Americans get 35% or more.

Saturated fat is concentrated in meats and dairy products. Animal products supply most of the saturated fat in our diet. They're also found in packaged foods such as cookies, crackers, and chips. Highly saturated vegetable fats such as coconut, palm or palm kernel oil, and cocoa butter can also be unhealthy in high levels. Coconut oil is used for movie popcorn, but some theaters have replaced it with canola. There's no need to completely avoid foods with saturated fat in the name of good health as they contain a multitude of nutrients such as protein, vitamins, and minerals. Fats also help your body absorb some nutrients and produce hormones. The bottom line: there's no actual dietary requirement for saturated fat because your body produces what it needs. Just try to keep saturated fat to less than 15 % of your total fat intake.

Trans fat contributes to clogged arteries and it's been linked to certain cancers, including breast and colon or rectal. Researchers from Harvard School of Public Health have estimated that eliminating trans fats from the American diet could prevent about a quarter of a million heart attacks and related deaths every year. Most of the trans fats we eat are the end product of hydrogenation. Hydrogenation (the addition of hydrogen) converts oil into a firmer, tastier product with a longer shelf life. Partially hydrogenated fat (trans fat) is gradually being removed from packaged foods, but it's still found in things such as stick margarine, shortening, fast food, cookies, crackers, granola bars, and microwave popcorn. There is no dietary requirement for trans fat and it should be avoided; although it's nearly impossible to do so unless you prepare all of your meals personally.

Here are simple ways to avoid bad fats:
Avoid packaged foods when possible. Instead, choose whole, fresh and foods you make at home. For example, make your own macaroni and cheese from scratch. Eat lean sources of protein, use low-fat dairy products, whole grains, legumes, fresh fruits and vegetables. Use healthy oils such as olive, canola, and sunflower oil or small amounts of tub margarine for cooking.

When it comes to good-for-you fat, seafood stands out. Seafood contains omega-3 fats (called DHA, docosahexanoic acid and EPA, eicosapentanoic acid) and unsaturated fat. They are considered central to a growth, development and for heart health. Omega-3 fats are linked to lower levels of blood triglycerides, reduced risk of clots and strokes, heart health among other benefits.

Here are some examples of healthy daily fat allowances:
1,800 calories diet:
  40 to 70 grams of total fat
  12 grams or less of saturated fat
  2 grams or less of trans fat  
2,200 Calories a Day:
  50 to 85 grams of total fat
  15 grams or less of saturated fat
  3 grams or less of trans fat

Fats supply essential fatty acids (Omega 3's and Omega 6's) since your body is incapable of producing them. In addition, fat transports vitamins A, D, E, and K, known as the fat-soluble vitamins, into and around the body. Fat is also necessary for maintaining healthy skin, and it plays a central role in promoting proper eyesight and brain development in children.

Tips to avoid the bad fats:
1. Use liquid plant oils for cooking and baking. Olive, canola, and other plant-based oils are rich in heart-healthy unsaturated fats.
2. Ditch the trans fat. In restaurants, steer clear of fried foods, biscuits, and other baked goods.
3. Switch from butter to soft tub margarine. Choose a product that has zero grams of trans fat, and make sure it does not contain partially hydrogenated oils.
4. Go lean on meat and milk. Beef, pork, lamb, and dairy products are high in saturated fat. Choose low-fat milk, cheeses in small amounts and lean cuts of meat.

Friday, June 3, 2011

A Common Cold or Something Else

I hope this post helps you to decide whether or not you should seek medical attention if you have a "head cold". Physicians see a lot of people for simple colds and often reassure them they just need a little more time and supportive therapy. A cold, which is generally caused by a viral infection, usually resolves after 3 or 4 days. Colds usually present with sneezing, watery eyes, a sore throat, headache, congestion or a watery runny nose. Usually, though, there is not significant fever. These symptoms will usually respond to over-the-counter (OTC) medications including decongestants, mucolytics such as Mucinex, Tylenol or Advil, antihistamines and time. Vitamin C is also helpful in higher doses along with lots of fluids. Rest and isolation are also recommended at the onset to prevent the spread through airborne particles. Also, a majority of people do not realize that most sore throats are most often viral in origin and therefore do not respond to antibiotics. Of course the cause may also be due to a strep (bacterial) infection, which will require a course of antibiotics. This may also be seen in those with inflamed or enlarged tonsils (tonsillitis).

The "flu" is quite different in that you will generally feel sick with aches, pains (especially muscle or joint), fever and occasionally rigors (tremors or shakes). People will often say their whole body hurts. Early treatment (first 48 hrs) with Tamiflu or Relenza can make a significant difference in the duration and severity. Otherwise, fluids, rest and the above OTC meds will also help. Flu shots will usually protect you from acquiring the seasonal flu, but that is not a guarantee as there are many strains.
Sinusitis presents with pain around the eyes, cheeks, nose or forehead, a headache, dry cough, or heavier discharge from the nose. Sinusitis may be a chronic condition and often requires prolonged antibiotic therapy. Nasal washing with a neti pot or NeilMed bottle may also be helpful.

When someone has a persistent and often deep cough that brings up yellowish or greenish mucus, this could be a sign of acute bronchitis or an upper respiratory infection that may require antibiotics. If these symptoms are associated with significant shortness of breath and fever, then pneumonia may be the cause. This condition is more serious and should be evaluated right away.

When symptoms do not improve in a few days or seem significantly worse, you should probably seek medical attention. Physicians can also prescribe other medications which may help to improve the symptoms and occasionally help you resolve a cold sooner.

Monday, May 30, 2011

Migraine Headaches

Migraines are chronic headaches that can cause significant pain lasting from 4 hours to several days. About 30 million Americans suffer from migraines, with women being affected three times more often than men. Around 75% of sufferers have a family history of migraine. Symptoms can be so severe that all you want to do is to lie down in a dark, quiet place. The pain of migraine is believed to occur when brain cells trigger the trigeminal nerve to release chemicals which cause swelling of blood vessels on the surface of the brain, causing pain and inflammation. The typical migraine headache affects one half of the head and is pulsatile in nature. Typical symptoms may include photopbobia or phonophobia (increased sensitivity to light or sound), nausea and vomiting (also called "sick headaches"). Once the attack is full-blown, many people will often be sensitive to anything touching their head. One-fourth of people who suffer from migraine headaches will perceive an aura, a sign or warning that a migraine will soon occur. The diagnosis is usually based on medical and family history. CTs and MRIs may also be obtained to rule out more serious causes.

Types of headaches:
Migraines: see above
Tension headaches: Also called chronic daily headaches; tension headaches are the most common type of headaches. These muscle contraction headaches usually cause mild to moderate pain, especially at the base of the skull.
Mixed headache syndrome: This is a combination of migraine and tension headaches.
Cluster headaches: The least common and the most severe. The pain of a cluster headache is intense and may be described as having a burning or piercing quality that is either throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still. The pain is usually located behind one eye or in the eye region. Cluster headaches can occur one to three times per day during a cluster period, which may last weeks to months.
Sinus headaches: Sinus headaches are often associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose and may be associated with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever or facial swelling.The pain usually intensifies with sudden head movement or straining.
Hormonal headaches: Also called menstrual migraines, are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Birth control pills may also trigger these headaches in some women.

Migraine triggers include: (this is only a partial list)
Stress: at work or home is well known to cause migraines.
Physical factors: intense physical exertion may provoke migraines.
Foods: some migraines appear to be triggered by certain foods (or food dyes) such as alcohol, cheeses, chocolate, aspartame, excess caffeine or mono sodium glutamate.
Sensory stimuli: bright lights, certain scents such as perfume or paint thinner and secondhand smoke can also trigger migraines.
Changes in sleep patterns: either missing sleep or getting too much.
Physical factors: Intense physical exertion (including sexual activity) may provoke migraines.
Hormonal changes: fluctuations in estrogen seem to trigger headaches in many women. They will often report headaches immediately before or during their periods, when they have a major drop in estrogen. Oral contraceptives and hormone replacement therapy may worsen migraines. However some women may be helped by continuous therapy.
Environmental changes: changes in weather can prompt a migraine.
Medications: certain medications may aggravate migraines.

Medical Treatment: (directed at preventing the headaches and treating the acute pain)

Preventive treatment:
Blood pressure medications: beta-blockers (atenolol, propranolol, timolol) and calcium channel blockers (verapamil)
Antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor) and desipramine (Norpramin)
Antiseizure medications: gabapentin (Neurontin), topiramate (Topamax) and valproic acid (Depakote)

Acute pain treatment:
Acetaminophen-isometheptene-dichloralphenazone (Midrin): Dichloralphenazone is a mild sedative and Isometheptene is a vasoconstrictor, causing constriction (narrowing) of blood vessels
Dihydroergotamine (D.H.E): available as an injection or nasal Spray (Migranal). It is an ergot alkaloid, which acts as a potent vasoconstrictor, narrowing blood vessels
Ergotamine tartrate/caffeine (Cafergot): both vasoconstrictors, which act to constrict blood vessels.
Triptans: sumatriptan (Imitrex, generic), rizatriptan (Maxalt), naratriptan (Amerge, Naramig), zolmitriptan (Zomig), eletriptan (Relpax), almotriptan (Axert). They causine blood vessel constriction and inhibit inflammation.



Nausea medications:
Metoclopramide (Reglan)
Prochlorperazine (Compazine)
Promethazine (Phenergan)


Non-prescription medications:
Ibuprofen: Advil, Motrin or generic (best value)
Excedrin Migraine: Tylenol, aspirin and caffeine (works well).
Caffeine: such as hot tea or coffee. Avoid heavy use as it may trigger migraines.



Nutritional supplements:
Magnesium
Coenzyme Q10 (CO Q10)
Riboflavin (Vitamin B2)
Feverfew (Tanacetum)
Ginger
Ginkgo

Common food triggers:
MSG (Mono sodium Glutamate)
Unsaturated oils
Aspartame
Nitrites and other preservatives.
Food dyes
Beer, red wine
Alcohol (in general) 
Oranges, strawberries
Avocados
Eggs
High glycemic foods.
Soy
Cheeses
Chocolate
Dairy
Coffee, tea (especially heavy use)
Energy drinks