Constipation – Clearing Out Life’s Little Roadblocks

Constipation is not exactly a dinner topic, but it is a condition that affects almost every living person at one time or another. It’s a common complaint at the doctor’s office.

Constipation is defined as infrequent bowel movements or difficult passage of stools. The normal number of bowel movements for adults ranges from one or more per day to two to three per week. For most people, going without a bowel movement for several days is a temporary condition and does not lead to any obvious discomfort or health problems. One may begin feeling uncomfortable when constipation lasts more than a few days. It should be noted that constipation does not build up toxins in the gut, nor does it lead to cancer.

There are many causes of constipation, some of the more common being:

- Inadequate amounts of fiber in your diet.

- Insufficient liquid intake.

- Lack of physical activity.

- Side effect of some medications, especially narcotic pain medications such as Vicoden and Percocet.

- Changes in daily routine or lifestyle.

- Colon cancer (rare).

There are two methods of dealing with constipation including:

Life style changes

- A high fiber diet including beans, whole grains, fresh fruits and vegetables, and less dairy, red meat and processed foods.

- Adequate fluid intake.

- Regular exercise.

- Trying not to delay a bowel movement when one has the urge.

Laxatives

- Fiber supplements are natural and very safe. Examples include Metamucil and FiberCon which are safe and effective to use daily.

- Stool softeners, such as Colace and Surfak, add moisture to the stool.

- Stimulants help increase intestinal motility. Examples include Dulcolax, Senekot, and Correctol. (It’s best not to use these too often.)

- Osmotics bring more fluid into the intestines causing easier passage of stool. One of the most common which I recommend is Miralax available without a prescription.

- Saline laxatives also help to draw fluid into the intestines. Examples include milk of magnesia and Haley’s M-O.

- Lubricants, such as a dose of mineral oil, help the intestines to pass the stool more easily.

I want to take this opportunity to talk about colon cleansing which is enema therapy that is claimed to help flush the toxins out of the colon. There is absolutely no scientific proof that there are toxins in the colon which can cause any harm. Most substances good or bad have been absorbed into the body in the small intestine which is not affected by enemas. In fact, colon cleansing can flush out needed electrolytes before they can be absorbed by the colon and also wash out beneficial intestinal bacteria. Don’t flush your money down the toilet on this misguided treatment.

From my experience, if you suffer from constipation and follow my advice in this article, you can save a trip to your doctor. But if symptoms persist or worsen, by all means get professional advice.

Childhood Immunizations Still Necessary to Prevent Serious Disease

Small pox, polio, diphtheria, tetanus, measles, mumps and rubella are all potentially life-threatening diseases that have been almost completely eliminated from our society during our lifetimes. The reason for this is the routine childhood immunization program that has been widely accepted in the United States, as well as most of the modern world.

We often hear about the supposed side effects of immunizations, but we rarely hear about children getting the very diseases that the vaccines protect against. That’s because the immunization program has worked so well in preventing diseases that could have killed millions and caused untold suffering.

In fact, we’ve been so successful immunizing children and preventing diseases that some might wonder whether vaccines are still needed.

Here’s why immunizations are still necessary:

- Newborn babies are immune to many diseases, because they have antibody protection from their mothers. This immunity is mostly gone by the end of the first year of life, leaving unvaccinated babies susceptible to the abovementioned vaccine-preventable illnesses.

- Although our country has virtually eliminated these diseases, many Third World countries with poor immunization programs are still plagued by vaccine-preventable illnesses. These diseases are only a plane ride away. An infected traveler could bring such an illness back to the States, where it could spread rapidly if people were not adequately immunized.

- In the U.S., pertussis (whooping cough) is making a comeback, and tetanus is still infecting some people.

- Widespread immunization is necessary because it helps to keep a disease from spreading within a population. This helps to protect those few who, whether by choice or by necessity, are not immunized.

Immunizations are safe. A decade ago, an unsubstantiated study tried to link immunizations to autism. A well-publicized article from England sounded the alarm connecting the measles, mumps and rubella vaccine to autism. This started a grassroots movement that has led many to reject all vaccinations. However, the majority of the authors of that article have withdrawn their support for it, and the lead author was found guilty of professional misconduct and had his license to practice medicine revoked.

Many well-controlled scientific studies have all concluded that there is no scientific or statistical relationship between immunizations and autism.

Unfortunately, the rates of immunized children entering kindergarten in Santa Cruz County are some of the lowest in the nation, with only 84 percent fully vaccinated. The San Lorenzo Valley is even lower, with just 65 percent fully immunized.

Just recently, Felton had a measles scare, prompting a major investigation. The outcome was favorable this time, as it did not infect anyone except the carrier, but a significant epidemic could spread through our area in the future because of our low immunization rates.

Until vaccine-preventable illnesses are eliminated worldwide, as with deadly smallpox — a result of the most successful immunization program ever — I strongly recommend that as many of our children as possible be routinely immunized and thus protected from potentially life-threatening diseases.

Local Bill Furthers Breast Cancer Treatment

Women’s health just took a leap forward with the passage of California Senate Bill 1538, authored by former state Senator Joe Simitian, which requires that women with dense breast tissue as determined by a mammogram be informed that they have the condition.

Women with dense breast tissue will be made aware of the fact that a tumor may not be seen on the mammogram, that they are at a higher risk for breast cancer, and that they should talk to a doctor about the condition. They will also be informed about other breast screening options.

This law came about as a suggestion to Mr. Simitian from a local Santa Cruz woman, Amy Colton, who has dense breast tissue and developed breast cancer in spite of having had routine mammograms. Kudos to Amy for championing this issue.

About 40 percent of all women have dense breast tissue, and many are unaware of their condition. Well over half of the cases of breast cancer in these women were missed with only routine mammography.

After skin cancer, breast cancer is the most common cancer in women in the U.S. Although, we usually associate breast cancer in women, it does occasionally occur in men.

The most common symptoms of breast cancer are:

- A breast lump

- Any change in the nipple, especially discharge or bleeding

- A change to the breast skin, such as the appearance of a dimple or pitting of the skin

- A change in size or shape of the breast

It is not clear why some women get breast cancer and some don’t.

It would seem that breast cancer is caused by an interaction between one’s genetic make-up and/or one’s environment. About 10 percent of breast cancer can be linked to inherited defective genes passed down through generations of a family. Blood tests are available to determine who may have these genes.

Known risk factors for breast cancer are:

- Increasing age — it’s more common in women older than 55

- A family or personal history of breast cancer

- Inherited genes

- Beginning your period at a young age or beginning menopause at an older age

- Post-menopausal hormone therapy, using a combination of estrogen and progesterone

- Drinking alcohol

Tests and procedures to detect breast cancer include:

- Breast exam, including self-exams as well as routine exams from a doctor

- Mammograms

- Breast ultrasounds

- Using a needle for a biopsy (removing a specimen of the suspected tissue for examination)

Current treatment guidelines for breast cancer are too large of a topic for this report.

Let me just say that tremendous strides are being made in the successful treatment of this disease.

Fortunately, the majority of breast changes do not turn out to be cancerous. Even if you have had a recent normal mammogram, see your doctor if you find any changes in your breasts, and work with your doctor to have routine breast exams and testing.

Poison Oak

It’s that time of year again when I treat an increasing number of patients suffering from poison oak rash.

Having treated thousands of cases of poison oak in my career, I’d like to share with you what I’ve learned about this miserable affliction.

The poison oak plant, which is so prevalent in our locale, contains an oil in its sap called urushiol. This oil is found in all parts of the plant — leaves, stems and roots.

Even in extremely minute quantities — say, a billionth of a gram — it can cause a very severe allergic reaction in the skin. This usually occurs within 24 to 36 hours of exposure.

Roughly 85 percent of the population is susceptible to this rash, and a lucky 15 percent has a natural resistance to it. Unfortunately, I’m in the first group.

You can be exposed to the oil by direct contact with any part of the plant or by indirect contact with an object that has urushiol oil on it, such as your own hands, clothing or tools. There have been reported cases of the smoke from burning poison oak causing either a skin rash or a reaction in the lungs, although I have never seen this in any patient I’ve treated.

Once you make contact with the oil, you have only a matter of minutes to wash it off before it will bind to the skin and begin the allergic rash.

The best way to remove the oil from the skin is to rinse with lots of water and then wash with soap and water. Most any kind of soap will do. Also, wash any object that may have come in contact with the oil using soap and water, including the clothes you were wearing.

Don’t forget to do the same to your shoes, tools and pets. Urushiol oil can remain active on inanimate objects for more than a year.

There are a number of over-the-counter products, including Tecnu and Zanfel, that are sold to be used on the skin after exposure to poison oak to remove the oil. I have heard mixed reviews on their effectiveness. For now, I’ll stick with water and soap.

A poison oak rash will always eventually clear up on its own if one is willing to wait it out. And there are abundant home remedies to cure poison oak, none of which has been proven to be effective.

However, there is effective, proven and safe medical treatment for those who wish not to suffer for several weeks.

Your doctor may prescribe some form of a steroid cream that is stronger and much more effective than over-the-counter cortisone cream.

If the rash is more serious, and especially if it involves the face, systemic treatment may be necessary. This involves the use of cortisone pills called prednisone, which is my preferred treatment, or a steroid shot. Either of these treatments is safe and very effective for most patients.

Your doctor will help determine the best treatment for your particular condition.

The bottom line is that you should avoid contact with poison oak, wash your skin and clothing as soon as possible if you do come in contact with any part of the plant, and see your doctor for effective medical treatment.

Battling Vision Diseases

March is National Save Your Vision month — a good time to consider some of the more common eye diseases that could affect one’s vision.

It is said that by age 75, a majority of us will develop problems with our eyes that could lead to serious vision loss. At that age, more than one half of people will have cataracts, and around 20 percent will have either macular degeneration or glaucoma.

These diseases are all related to the aging process, which of course we cannot change. But there are some things we can do to reduce the risk.

Cataracts

Cataracts are a condition caused by the clouding of the normally crystal-clear lens of the eye. This results in hazy vision, increased visual glare, seeing halos around lights, and poor night vision.

A cataract can develop in one or both eyes.

Some risk factors are increasing age, excessive exposure to sunlight, diabetes, excessive alcohol consumption and smoking.

As cataracts worsen, surgery often becomes necessary. This involves removing the cloudy lens and replacing it with a plastic lens implant. This is routine surgery with minimal risk and great benefit.

Macular degeneration

Macular degeneration occurs with failure of the macula, the center of our retina that is responsible for clear vision.

There are two types of degeneration. Dry macular degeneration is the most common and is caused by a thinning and breakdown of the macular tissue. Wet macular degeneration can progress from the

dry variety and is due to leaky blood vessels around the macula and is often more serious. Both types can cause serious central blurring and even a central blind spot.

Treatment for dry macular degeneration involves taking antioxidant vitamins, and for the wet variety there are new drugs that prevent leaky blood vessels.

Glaucoma

Glaucoma is caused by increased pressure that builds up inside the eyeball. It results in damage to the optic nerve, which interferes with the transmission of images to the brain, resulting in severe loss of vision.

Treatment begins with eye drops, which usually need to be used or the rest of one’s life.

Several different surgical procedures are also available for some types of glaucoma.

Possible prevention

There are things you can do to help save your vision, including:

- Wear sunglasses when outdoors during daylight

- Quit smoking

- Moderate alcohol consumption

- Control chronic diseases such as diabetes and hypertension

- Exercise regularly and eat a diet with lots of fresh fruits and vegetables

See your doctor immediately if you have any obvious visual change.

People between the ages of 18 and 50 should have routine eye exams every two years, and every year after the age of 50.

Children need routine eye exams as well. Ask your child’s doctor about the frequency.

 

Hair Loss

 

Hair loss is a normal part of aging for men and even for some women. It is estimated that two thirds of men will begin to become bald by the age of 60.

The most common form of baldness, called male or female pattern balding, is often controlled by genetics.

It has been commonly believed that baldness is passed down through the mother’s genes, but it is now recognized that the father’s genes play a role, too.

Women’s hair-loss pattern is different from that of men, in that women tend to have generalized thinning of the hair rather than distinct balding patterns. Hair loss increases with women’s age, as it does with men, but about 10 percent of premenopausal women will start to lose hair.

There are many other less-common causes of balding, including some cancer treatments, severe emotional stress, hormonal changes during pregnancy, severe infections, strict dieting, thyroid disease, certain medications and some vitamin and nutritional deficiencies.

There is as yet no cure for baldness, but there is an abundance of treatments touted as curing baldness or at least lessening further hair loss. In fact, American males collectively spend around $ billion a year on these products. Most nonprescription treatments, especially those that are not FDA approved, are worthless in spite of the claims and testimonies.

There are now two approved medicines for treating baldness.

Rogaine (Minoxidil and generics) is an over-the-counter topical solution. It has been shown to be somewhat helpful in halting further hair loss and possibly encouraging new hair growth. It is also the only medication approved to treat female pattern baldness. Both sexes must continue to use this medicine indefinitely. Hair loss starts again when it stops being used.

The other drug, Propecia (Finasteride), is a prescription medication, approved only for men and taken as a pill by mouth. It also has been shown to slow or prevent further hair loss.

Both Rogaine and Propecia have potential side effects that make it advisable to speak with a doctor before using either drug.

There are many untrue myths about causes of baldness, including:

- Excessive wearing of a hat.

- Frequent exposure to sun.

- Daily shampooing.

- Use of hairspray and gel.

Losing 50 to 100 hairs a day is considered normal.

The bottom line is that if you are experiencing what you consider to be hair loss that bothers you, you should talk to your doctor or a dermatologist. Do this before spending a lot of hard-earned money on worthless treatments.

Advance Directive Allows Just-In-Case Decisions

None of us would ever want to be incapacitated to the extent that we could not make decisions affecting our well-being. Unfortunately, for some of us, that day may come.

For most individuals, that time comes later in life, but for others it happens much too early.

What sort of medical situations could cause such a scenario? You could be incapacitated by accident or illness, such a serious head injury, heart attack, stroke, Alzheimer’s disease, meningitis or many other illnesses, diseases, and injuries.

To help in these situations, California has established an Advance Health Care Directive — sometimes referred to as a “living will” — that instructs physicians as to your wishes for medical treatment if you were to be incapacitated and unable to make decisions on your own.

Under California law, this form allows you to name an agent, granting that person power of attorney, to make health care decisions on your behalf should you become incapacitated.

Your agent should be a trusted person, either a family member or a friend, who has your best interests at heart, understands your wishes and will act accordingly. Two alternates may also be named.

The directive must be dated and executed in the presence of, and then signed by, two witnesses or a notary. A witness cannot be your physician, any of his or her employees or any employee of a care facility. At least one of the witnesses cannot be related to you by blood, marriage or adoption and must not be entitled to any part of your estate upon your death.

The most important function of the directive is to permit health care providers to either prolong or not prolong your life and to keep you pain free according to your wishes. You may also state your desire for organ donation, if you so choose.

It is important to make such decisions when you are of healthy mind and body. Don’t put your loved ones in the difficult position of guessing what type of care you would want in an end-of-life event.

All adults need advance directives. Talk to your physician if you have any questions.

You can download a directive form at http://www.sutterhealth.org/health/advance-directive-english.pdf.