Archive for January, 2010

From time to time, I’ll write about various vitamins and how they affect our health. But what exactly is a vitamin?

A vitamin is an organic substance essential in small quantities to normal metabolism. It is found naturally in various foods, but it can also be produced artificially. A lack of vitamins can produce certain diseases.

Vitamin D has received quite a bit of press these days both in medical literature as well as in newspapers and magazines.

Vitamin D is the only nutrient the human body makes itself. Ultraviolet rays from sun exposure interact with a chemical in the skin to form an inactive version of vitamin D, which is then converted in the liver and kidneys into an active version useful to our bodies.

Because people have been warned to wear sunscreen and to limit sun exposure, though, we might not be able to manufacture enough of this vitamin on our own and may need to look for other sources.

Vitamin D can be found in a limited number of foods, including fatty fish, fish liver oils, liver, and egg yolks. Commercial milk products, breakfast cereals and juices are often fortified with low levels of vitamin D. People don’t usually eat enough of these foods to consistently cover their daily vitamin D requirements, though.

The primary benefits of vitamin D for our bodies are these:

• Bone health: Vitamin D helps the body absorb calcium and phosphorus, which are two minerals needed for strong bones. People taking vitamin D have a lower risk of bone fractures and also have been found to have a lower chance of falling in the first place.

• Brain function: People with higher blood levels of vitamin D have higher cognitive performance, including memory and thinking skills.

Low levels of vitamin D, by contrast, have been associatedwith some increased risks: cancer of the colon, breast and prostate; arthritis; diabetes; and infections, such as tuberculosis.

The accepted recommended daily dose of vitamin D is 400 to 600 international units per day. Most common multivitamins contain 400 IU. Momentum is building within the medical community to increase the daily recommended dose to at least 800 to 1,000 IU. From what I can tell, this is a reasonable recommendation. The higher level should help to strengthen bones and muscles and hopefully prevent a variety of diseases, such as those I have mentioned.

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Careful on That Ladder

It finally caught up with me. After 40-plus years of climbing ladders (mostly to get onto my roof), I recently fell off of one and injured myself.

On Dec. 13, in the middle of a relaxing afternoon, I decided to climb my extension ladder and get up on my roof to reposition a plastic tarp. Now, you must understand that in the past 37 years, I have treated hundreds of patients (mostly men) for injuries from falling off a ladder. Therefore, I have always promoted ladder safety, and I thought I had been very cautious when getting up and down on a ladder.

On this particular occasion, I climbed the ladder on my back deck to my one-story flat roof. I did what I set out to accomplish and then started back down the ladder.

I ever-so-cautiously placed my first foot on the top rung of the ladder. I started to put my other foot on the rung and, suddenly, I knew something bad was about to happen — I was going down.

In a split-second, with absolutely no chance of saving myself, I fell.

The ladder base had slipped away from the house, and I fell straight backward, landing 10 feet below, flat on my back, on top of the ladder.

I felt as if I had broken my back, it hurt so much. I lay there on top of my ladder for a few minutes — no one else was at home (another critical mistake). I realized I could move my legs and arms, so at least I knew I wasn’t paralyzed.

After a while, I managed to get up and hobble into the house. I felt like passing out from the pain and shock to my body.

My injuries turned out to include a broken right ankle, a cracked rib below my shoulder blade and a severely bruised and swollen lower back. The next day, I ended up with a cast on my leg, with instructions to not place any weight on that leg for four to five weeks. So I’m now hobbling around on crutches — not a pleasant experience — dealing with a pretty painful back. But I am slowly improving.

More than 2 million people suffered ladder injuries from 1990 to 2005. That equals about 135,000 injuries a year, and I’m sure there are many more that are not reported. The majority of ladder injuries happen at home, and mostly to men older than 40.

Injuries include but are not limited to:

• Death

• Permanent disability, from paralysis, pain or head, neck or back injuries

• Temporary disability, usually from a broken arm or a leg

• Painful arthritis in later years as a result of those injuries

• Loss of income

• Loss of recreational activities

• Loss of intimacy

My ladder safety recommendations:

• When you think about climbing a ladder, consider whether doing so is worth the risk of possible serious injury or disability.

• Never climb a ladder when no one else is at home.

• Always have another responsible person to work with you, to secure the base of the ladder and to be your conscience when you try to do something stupid (come on — we all do it) while up on the ladder.

• Check out ladder safety Web sites for information on proper ladder placement and safety.

To you ladder climbers out there, please read and think long and hard about what I have written. Women, show this article to your men. If it can happen to me, it can happen to anyone. Don’t kid yourself.

I thank God I’m alive after my accident. I see how easily, in a split second, I could have died or become permanently disabled. That just wouldn’t have been fair to my wife, my children or anyone who cares about me.

Ladders are not casual tools. They are as dangerous as a loaded gun — respect them accordingly.

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As we prepare to leave the old year behind and greet the New Year, I would like to propose the following health-related resolutions:

• If you smoke — quit.

• If you drink alcohol, do so in moderation.

• Develop a routine exercise program and stick with it.

• Improve your diet — increase fruits and vegetables and decrease fats and carbohydrates.

• Buckle up every time you enter your car.

• Don’t talk on your cell phone while driving. It’s not only very dangerous, but also now illegal.

• Get regular dental checkups and eye exams.

• If you are overweight, try to lose weight. If you can’t, at least remain physically fit.

• Use sunscreen when outside during the sunny months.

• Routinely examine your skin for any unusual changes.

• Keep your immunizations up to date — all the usual vaccinations that babies and children receive, as well as a diphtheria-tetanus booster every 10 years for adults and a yearly influenza vaccine.

• Have your blood pressure checked at every health care visit.

• Have a pap test for women beginning at age 20, continuing per doctor’s recommendation.

• Have a cholesterol level test starting at age 20.

• Have a clinical breast exam and mammogram for women beginning at age 40 per doctor’s recommendation.

• Have a blood sugar test starting at age 45.

• Have a colon screening (colonoscopy) beginning at age 50.

• Have a prostate exam for men starting at age 50.

• Do not climb ladders. (This is personal experience speaking.)

• See your doctor sooner rather than later if you have a strong family history of any significant medical problems, such as cancer, heart disease, diabetes, high blood pressure, etc.

• Avoid stress. Relax and honestly try to enjoy your life, whatever your circumstances.

After having practiced medicine for more than 37 years, I can assure you that following the above resolutions will very likely add years of healthy living to your life.

This month will mark the beginning of three years of writing this column. Reader feedback has been beyond expectations, for which I am very grateful. Please contact me if you have requests for medical topics that are important to you or that might have a broad reader appeal.

Happy healthy holidays!

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Over-the-counter cough and cold medications to alleviate cold symptoms in young children are being largely withdrawn from pharmacy shelves. This is because of unintentional misuse or overdose of these medications causing harm and, rarely, death, especially in children younger than 2.

These medications are frequently used in good faith, even though there is no scientific proof that these drugs are actually effective. This is a case in which the risks outweigh the benefits.

Health care providers are now asked not to advise the use of such drugs for children younger than 6. Some of the most common are PediaCare, Triaminic and Dimetapp.

I know this may sound discouraging when caring for a sick child, but there are useful non-drug treatments for cold and cough symptoms. Try the following, for example:

• Encourage the drinking of fluids to prevent dehydration and to help thin out mucus. Contrary to popular opinion, milk has not been proven to increase mucus formation.

• Control high fever or pain with either acetaminophen (Tylenol) or ibuprofen (Advil), giving doses once every six hours.

• Saline irrigation can be helpful for a congested or drippy nose. For infants, use rubber bulb suction to remove nasal secretions after applying saline nose drops or spray, or try sinus rinsing for older children.

• Use a cool-mist humidifier or vaporizer in the child’s room. To prevent contamination, the water inside should be replaced daily and the machine should be cleansed regularly according to the manufacturer’s recommendations. If possible, maintain indoor relative humidity between 40 percent and 50 percent.

• If a medication such as Tylenol or Advil is given, I do not advise the use of household kitchen spoons to measure doses of medication. Measuring devices that use units of milliliters (mLs,) usually are packaged with the medicine or can be obtained from a pharmacist.

• Honey can relieve coughs by increasing saliva, which coats the throat and relieves irritation. Suggested doses are half a teaspoon for children between 1 and 5 years, one teaspoon for children 6 to 11 years, and two teaspoons for children 12 and older. Do not give honey to a child younger than 1.

Sometimes, a visit to a doctor is called for. See your health care provider immediately for the following cases:

• A child younger than 2 months of age with any fever

• A child younger than 2 years of age with a fever lasting more than two or three days

• A child who complains of an earache or a severe sore throat

• Thick green nasal discharge that continues for more than seven to 10 days

• Mild symptoms that do not improve after 10 to 14 days

• A child who seems very ill to you

By the way, for children who have appropriately been prescribed antibiotics, I am frequently asked whether the drug needs to be refrigerated.

The two most commonly prescribed antibiotics — amoxicillin, which tastes like bubble gum or occasionally is fruit-flavored, and azithromycin (Zithromax), which has a cherry/vanilla/banana taste — can be kept at room temperature for up to 10 days. Refrigeration may improve the taste, but it isn’t needed to maintain potency.

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