Managing Your Health

Migraine is a common medical condition, affecting as many as 37 million people in the US. It is considered a system illness, not just a headache. Recent research has demonstrated that changes may begin to occur in the brain as long as 24 hours before migraine symptoms begin. Many patients have a severe throbbing headache, often on only one side of the head. Some people are nauseated with vomiting. Many are light sensitive (photophobic) and sound sensitive (phonophobic), and these symptoms can persist after the pain goes away. There are a variety of migraine subtypes with symptoms that include weakness, numbness, visual change or loss, vertigo, and difficulty speaking (some patients may appear as if they are having a stroke). The disability resulting from this chronic condition is tremendous, causing missed days of work and loss of ability to join family activities. It is sometimes possible for people to use an "abortive" medication, which, when taken early, can arrest ...

The body systems responsible for balance can be affected by gradual changes due to aging or side effects of medications. There are also a host of health problems that can lead to unsteadiness on your feet. But many stability problems caused by aging or conditions such as arthritis, stroke, Parkinson's disease, or multiple sclerosis respond well to exercises designed to improve balance. Most likely, you already engage in some activities that help sharpen balance, especially if you're an active person. Other balance-strengthening activities are routinely taught in classes held at many YMCAs and senior centers. For example: Walking, biking, and climbing stairs strengthen muscles in your lower body. A recumbent bike or stair stepper is a safe way to start if your balance needs a lot of work. Stretching loosens tight muscles, which can affect posture and balance. Yoga strengthens and stretches tight muscles while challenging your static and dynamic balance skills. Tai ch...

 Driving becomes challenging when you get older. Age-related health changes can make it hard to see at night, grip a steering wheel, or step on the brake at a moment's notice. Simple car tools, such as steering wheel covers that make the wheel easier to grip, can help. But research released in December 2017 from the AAA Foundation for Traffic Safety suggests that most older drivers aren't taking advantage of such tools. Between 2015 and 2017, researchers asked about 3,000 older adults (ages 65 to 79) about their use of adaptive vehicle tools. About 9% of respondents said they had at least one such tool. Researchers also asked older drivers if their vehicles had factory-installed safety features, such as technology that alerts you to danger when you are about to change lanes. Fifty-seven percent said they had a least one of these technologies, but only 43% of that group reported using them. Even if your vehicle isn't equipped with high-tech safety features, adaptive vehicl...

Ask the doctors Q. I feel like I have a perpetual cold all winter, every winter. I'm stuffy and sneezy and it never seems to get better. Do you think it could be allergies? How can I tell the differences? A. Colds and allergies produce many of the same symptoms: a runny nose, tiredness, and sometimes a sore throat. But they have different causes - a virus causes colds, while allergies are in immune system response to trigger substances, known as allergens. There are ways to distinguish one from the other. Colds sometimes produce a fever, but allergies never do. In addition, if you are suffering from allergies, you may also have itchy, watery eyes, symptoms that won't typically accompany a cold. But perhaps the biggest clue that can help you distinguish between a cold and allergies is the duration of symptoms. Cold symptoms rarely last more than two weeks, but allergies last as long as you are exposed to the substance that is triggering the reaction. So, if your "cold ...

You needn't spend a cent on fancy equipment to get a good core workout. Many core exercises rely on your body weight alone. But with the help of some simple equipment, you can diversify and ramp up your workouts. The following items can help you put a new twist on your core exercises. Most of them can already be found around your house or are available at low cost from a sporting goods store. Chair. Choose a sturdy chair that won't tip over easily. A plain wooden dining chair without arms or heavy padding works well. Mat. Use a nonslip, well-padded mat. Yoga mats are readily available. A thick carpet or towels will do in a pinch. Yoga strap. This is a non-elastic cotton or nylon strap of six feet or longer that helps you position your body properly during certain stretches, or while doing the easier variation of a stretch. Choose a strap with a D-ring or buckle fastener on one end. This allows you to put a loop around your foot or leg and then grasp the other tend of...

Sit-ups once ruled at the way to tighter abs and a slimmer waistline, while "planks" were merely flooring. Now plank exercises, in which you assume a position and hold it, are the gold standard for working your core, while class sit-ups and crunches have fallen out of favor. Why the shift? One reason is that sit-ups are hard on your back - they push your curved spine against the floor and work your hip flexors, the muscles that run from the thighs to the lumbar vertebrae in the lower back. When the hip flexors are too strong or too tight, they tug on the lower spine, which can create lower back discomfort. Second, plank exercises recruit a better balance of muscles on the front, sides, and back of the body during exercise than do sit-ups, which target just a few muscles. (Your core goes far beyond your abdominal muscles.) Finally, activities of daily living, as well as sports and recreational activities, call on your muscles to work together, not in isolation. Sit-up...

Ask the doctors Q. I have a family history of macular degeneration. Is there any way I can prevent it? A. Macular degeneration is a common eye condition that typically manifests in people over age 50. It damages the macula of the eye, which is located near the center of the retina, and can lead to vision loss. The macula is the part of the eye that helps you see objects that are right in front of you. When this area is damaged, you may see spots or your vision may get blurry or dark. These changes might make it more difficult for you to drive or perform other everyday activities. Macular degeneration can run in families, so if you have relatives with the condition, you may be at higher risk of developing it yourself. However, the good news is that modifiable risk factors also play an important role when it comes to developing macular degeneration. According to the National Eye Institute, you can reduce your risk by quitting smoking. Smoking cigarettes can double your risk of the...

Low energy and tiredness are among the most common reasons patients seek help from a doctor. Despite being so common, it is often challenging to come up with a diagnosis, as many medical problems can cause fatigue. Doctors engage in detective work, obtaining a medical history, doing a physical exam, and doing blood tests. The results often yield no explanations. It can be frustrating for clinicians and patients when a clear-cut diagnosis remains elusive. An attractive theory, called adrenal fatigue, links stress exposure to adrenal exhaustion as a possible cause of this lack of energy. But is adrenal fatigue a real disease? The adrenals are two small glands that sit on top of the kidneys and produce several hormones, among them, cortisol. When under stress, we produce and release short bursts of cortisol into the bloodstream. The adrenal fatigue theory suggests that prolonged exposure to stress could drain the adrenals leading to a low cortisol state. The adrenal depletion would c...

If you decide to change something in your living will or health care power of attorney, the best thing to do is create a new one. Once the new document is signed and dated in front of appropriate witnesses - not notarized, if necessary - it supersedes your old directive. The American Bar Association Commission on Law and Aging suggests that you re-examine your health care wishes whenever any of the following "five d's" occurs: 1. Decade: When you start each new decade of your life. 2. Death: When you experience the death of a loved one. 3. Divorce: When you experience a divorce or other major family change. (In many states, a divorce automatically revokes the authority of a spouse who had been named as agent.) 4. Diagnosis: When you are diagnosed with a serious medical problem. 5. Decline: When you experience a significant decline or deterioration from an existing health condition, especially when it diminishes your ability to live independently. Once you...

If you walk on busy city streets, breathing the traffic fumes may cancel out the health benefits of the exercise, a new study suggests. The London-based study, published online Dec. 5, 2017, by The Lancet, included 119 volunteers over the age of 60 who were either healthy or had stable chronic obstructive pulmonary disease or stable heart disease. They all walked for two hours midday at two different locations. One was in a quiet section of Hyde Park, where air pollution is usually within healthy limits. The other was on a busy shopping area on Oxford Street, where levels of pollutants such as black carbon, nitrogen dioxide, and fine particulate matter regularly reach dangerous levels. The walks were separated by three to eight week. All the volunteers benefited from a stroll in the park. Their lung capacity improved within an hour, an effect that lasted for 24 hours for many people. In contrast, a walk along Oxford Street barely registered any such benefit. Exercise also improv...

When Peter W., began conducting scientific studies on the health benefits of tai chi, he began noticing that tai chi works in a variety of ways, not just one. Whereas most drugs have a single active ingredient, he observed that tai chi was more like a multidrug combination that uses different components to produce a variety of effects. He formulated the idea of the "eight active ingredients" of tai chi, which he and and his colleagues now use as a conceptual framework to help evaluate the clinical benefits of tai chi, explore the underlying mechanisms that produce these effects, and shape the way tai chi is taught to participants in clinical trials (and to teachers). While different styles of tai chi emphasize different ingredients, these therapeutic factors are interwoven and synergistic. Here's a summary of one of the active ingredients. Structural integration. Tai chi looks at the body as an interconnected system, not as a collection of individual parts. As a resu...

If you're like most people, your posture could use some improvement. But how do you do that? The classic advice is to stand straight, with your head up, shoulders back, and belly in. While these are reasonable adjustments, tai chi takes a different approach that may be more effective. It aims to align the body in ways that afford safe, unstrained, and graceful postures - no the military-like, one-size-fits all, rigid stances many think of as good posture. Instead, in tai chi, good posture centers around the principle of verticality. That means the head is centered over the torso, the torso rests over the hips, and the hips are centered over the legs and feet, your base of support. Here's how to do it. 1. The spine is literally the backbone of verticality, so let's start there. Tai chi classics say, "The spine should be like a necklace of pearls hanging from heaven." Your goal should be to elongate the spine while still allowing for its natural curves. This ...

Exercises, lifestyle change, medications, and procedures can alleviate incontinence and give you your life back. A leaky bladder or a sudden urge to go to the bathroom is uncomfortable and embarrassing. But you can take steps to alleviate the problem. "Some people tell me they would have sought treatment sooner if they'd known it was this simple," says Dr. Anurag Das, director. Lifestyle changes One of the first lines of defense is pill-free and costs nothing: lifestyle change. For urge incontinence, you can try timed voiding (urinating on a schedule) and bladder guarding, which teaches you to cope with triggers that set off the urge to go, such as washing dishes or hearing water. "You squeeze your muscles to hold in urine before a trigger, which sends a message to the brain that this is not the time to go," says Dr. Das. Other lifestyle changes include watching fluid intake; quitting smoking, to reduce coughing and pressure on the bladder; and mini...

Just this week, I have seen three patients with depression requiring treatment. Treatment options include medications, therapy, and self-care. Self-care includes things like sleep, physical activity, and diet, and is just as important as meds and therapy - sometimes more so. In counseling my patients about self-care, I always feel like we don't enough time to get into diet. I am passionate about diet and lifestyle measures for good health, because there is overwhelming evidence supporting the benefits of a healthy diet and lifestyle for, oh, just about everything: preventing cardiovascular disease, cancer, dementia, and mental health disorders, including depression. Diet and emotional well-being Diet is such an important component of mental health that it has inspired an entire field of medicine called nutritional psychiatry. Mind-body medicine specialist Eva Selhub, MD has written a superb summary of what nutritional psychiatry is and what it means for you right here on ...

Maybe you're feeling tired and having trouble concentrating - or perhaps you've noticed changes in your hair or weight, or just feel blah. You might easily attribute these issues to other health problems, or to simply getting older. But these symptoms can be signs of a sluggish thyroid. The thyroid is a butter-fly shaped gland in the neck. It produces the hormones that regulate metabolism. Low levels of thyroid hormone can cause a range of symptoms, including fatigue, constipation, dry skin, brittle nails, hair changes, aches and pains, and feeling down. Untreated, an underactive thyroid (hypothyroidism) can increase the chances of developing high cholesterol, high blood pressure, and heart disease. Women are more likely than men to have problems with their thyroid, particularly as they get older. In some women, the onset of thyroid trouble is so gradual that it's hardly noticeable; in others, symptoms come on abruptly over the course of a few weeks or months. These ...

Cardio is often regarded as the exercise of choice for weight loss, but older adults can benefit from adding weight lifting too, as it helps preserve muscle mass more than aerobic workouts. A study published online Oct. 30, 2017, by the journal Obesity divided 249 overweight or obese adults in their 60s into three groups. One followed a restrictive diet of 1,200 to 1,800 daily calories. Another followed the diet and also did weight-machine workouts (four 45-minute sessions per week, targeting the major muscle groups). The third group followed the diet plus a cardio program of walking (45 minutes, four days a week, at a moderate intensity level). Over 18 months, people in both the weight training and cardio groups lost an average of 16 to 17 pounds each, while those in a the diet group lost about 10 pounds each. The participants in the two exercise groups lost more fat, but they also lost a bit more muscle mass than those following only a weight loss diet. Compared with walking, ...

 Older adults who develop hearing loss are more likely to experience greater cognitive decline and develop dementia than their counterparts without hearing problems, according to a meta-analysis published online Dec. 7, 2017, by JAMA Otolaryngology - Head and Neck Surgery. Researchers examined data from 36 studies including more than 20,000 people who underwent bot cognitive evaluations and hearing tests. Those with age-related hearing loss were more likely to have cognitive impairment or a diagnosis of dementia. The study found a small but statistically meaningful association between hearing loss and a variety of specific cognitive abilities, including executive function, memory, processing speed, and visuospatial ability (how you recognize shapes and sizes and estimate the distance between two objects). The association between hearing loss and weaker cognitive skills was still strong even after accounting for risk factors like high blood pressure and smoking. It is not yet kn...

Many people find that crossing several time zones makes their internal clocks go hayware. In addition to experiencing headaches, stomach upset, and difficulty concentrating, they may also suffer from fitful sleep. But there's no need to waste time riding out the effects of jet lag. Try these jet lag remedies the next time you travel. When you're traveling shorter distances If your destination is just one or two time zones away, it may be possible to wake up, eat, and sleep on your regular home schedule. At your destination, schedule appointments and activities for times when you would be alert at home. When you're traveling longer distances Gradually switch before the trip. For several days before you leave, move mealtimes and bedtime incrementally closer to the schedule of your destination. Even a partial switch may help. During the flight, drink plenty of fluids, but not caffeine or alcohol. Caffeine and alcohol promote dehydration, which worsens the symptom...

Even people without insomnia can have trouble getting a good night's rest. Many things can interfere with restorative sleep - crazy work schedules, anxiety, trouble putting down the smartphone, even what you eat and drink. 1. Cut down on caffeine Caffeine drinkers may find it harder to fall asleep than people who don't drink caffeine. Once they drift off, their sleep is shorter and lighter. For some, a single cup of coffee in the morning means a sleepless night. That may be because caffeine blocks the effects of adenosine, a neurotransmitter thought to promote sleep. Caffeine can also interrupt sleep by increasing the need to urinate during the night. People who suffer from insomnia should avoid caffeine as much as possible, since its effects can endure for many hours. Because caffeine withdrawal can cause headaches, irritability, and extreme fatigue, it  may be easier to cut back gradually rather than to go cold turkey. Those who can't or do want to give up caffein...

Dementia affects the man diagnosed but also raises fears for siblings and children. Here are the facts. Alzheimer's disease represents a personal health crisis, but it's also a family concern. What does it mean for your children or siblings if you are diagnosed with Alzheimer's? What does it mean for you if you if a close relative develops the condition? "People think that if their dad or aunt or uncle had Alzheimer's disease, they are doomed. But, no, that's not true," says Dr. Gad Marshall, assistant professor of neurology. "Even though family history adds to the overall risk, age still usually trumps it quite a bit. It means your risk is higher, but it's not that much higher, if you consider the absolute numbers." Family history by the numbers Studies of family history say that if you have a close relative who has been diagnosed with Alzheimer's disease - the most common form of dementia in older adults - your risk increases ...