Pregnancy and Bladder Control

Pregnancy and Bladder Control
One more surprise for your pregnant body: little bladder leaks!

Isn't pregnancy great?! Your body goes through a zillion wonderful, crazy, awful, mysterious changes — totally out of control, on its way to delivering your cute little bundle of joy. And, for many women, those changes include occasional urine leaks. As your baby grows, it puts pressure on your bladder. A sneeze, cough or even a hearty laugh adds even more pressure on your bladder and can trigger this "bladder weakness." According to medical experts, your situation is common and most likely temporary.
More than 50% of first time pregnant moms and up to 85% of second-timers develop bladder weakness.

Bladder weakness may begin in the first trimester but it's more common in the third trimester when the baby's growth accelerates. Then the expanding uterus leans up against the bladder almost continuously. A pregnant woman produces large amounts of progesterone, a muscle-relaxing hormone that helps make room for baby but can also contribute to unwanted urine leaks. About 40% of pregnant women also may experience urge incontinence: a sudden, uncontrollable need to urinate. So how can the mother-to-be hold on against Mother Nature's barrage to her bladder?
Good news! Bladder weakness usually goes away quickly once baby is born.

It usually clears up within a few days to a few weeks after birth as muscle tone returns and hormone levels drop to normal. It can hang around longer if mom is a little older than usual, or if this is not her first pregnancy, or if she had a particularly difficult delivery. And, a few women may continue to have some weakness ongoing. However, diet, exercise, biofeedback, bladder retraining, medications, and several other treatments are available to help minimize or eliminate lingering bladder weakness. POISE® absorbent products can also help play a role by offering outstanding absorbency (better than similar length maxi pads!) and helping lock in wetness and odor with special absorbent materials. At any rate talk to your doctor at the first sign of bladder weakness. (S)he will be able to help determine what's best for you.

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Caring for Your New Organ

Caring for Your New Organ

Most transplant recipients are at risk of a rejection episode at some point. A rejection episode can be scary, but it usually does not mean that the organ has stopped, or will stop, working. Rejection occurs when your immune system tries to destroy your new organ, which is a natural response. Your immune system is "programmed" to fight foreign invaders in your body such as viruses, bacteria, and, unfortunately, your new organ. Today's anti-rejection medications are stronger and better able to prevent rejection episodes than ever before. 
Preventing Organ Rejection

The best way to prevent rejection is to take all medications exactly as prescribed by your doctor - take them in the right amount, at the right time, without missing a single dose. CLICK HERE for tips to help you stick to your medication regimen and CLICK HERE for advice in case you have problems getting your medications. If you do miss a dose, call your transplant coordinator right away.
What to Do if Rejection Occurs

Rejection can be stopped if it is recognized and treated early. Many patients do not have any symptoms of rejection, which is why it is so important to keep your follow-up exams with your transplant team. However, by learning the warning signs of rejection, you can take an active role in keeping your transplanted organ working properly. Being aware of the signs of rejection and calling your doctor as soon as symptoms occur can prevent serious damage to the organ. The table below lists some of the warning signs of rejection.

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Diseased Blood Vessels

Diseased Blood Vessels

Transplant recipients have a higher risk of developing diseased blood vessels. Some anti-rejection medications increase the risk of high cholesterol (blood fats), which can clog arteries and restrict the flow of blood to the heart and brain. 

Coronary artery disease is more likely to develop when the amount of fat in the blood is too high. Vessels supplying blood to the heart become narrowed. Large deposits of fat can completely block blood vessels and stop the flow of blood. If an artery that supplies blood to your heart becomes blocked, a heart attack can occur. Symptoms of a heart attack include cramping, heavy feeling in the chest, shortness of breath, and extreme tiredness. If you experience any of these symptoms, go to a hospital emergency room right away.

Likewise, cerebrovascular disease refers to diseased arteries in the brain. If an artery that supplies blood to the brain becomes blocked by deposits of fat, a stroke can occur. Partial blockage may temporarily reduce the blood supply to the brain. A complete loss of blood supply to the brain results in a stroke. Symptoms of a stroke include lightheadedness, dizziness, paralysis, loss of ability to speak, slurred speech, confusion, and inappropriate behavior. If you experience any of these symptoms, go to a hospital emergency room right away.

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Kidney Disease

Kidney Disease

Kidney function is often decreased in transplant recipients. This may be caused by a pre-existing condition such as diabetes, hypertension, or injury to the kidney before a transplant. Or it may be caused by medications used to prevent rejection after a transplant. The best way to help prevent kidney disease is to keep your blood pressure and blood sugar under control and to maintain a healthy weight. In addition, regular checkups with blood and urine tests will give your doctor important information for detecting early changes in kidney function and allowing appropriate steps to be taken.

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Diabetes

Diabetes
Glucose is the main sugar found in the blood and it is the body's main source of energy. However, too much sugar in the blood can cause many health problems, including diabetes, heart disease, kidney injury, nerve damage, and eye problems. It may also be related to rejection or the use of steroids.

Insulin, which is produced by the pancreas, enables glucose to move from your blood into cells so it can be used as energy. In patients with diabetes, the pancreas does not produce enough insulin or the body does not respond to insulin. Glucose is not absorbed and blood levels become high.

Diabetes after a transplant is more common in transplant recipients who have a family history of diabetes as well as those who are overweight, are taking steroids, or have hepatitis C. Diabetes after a transplant is also more common among African Americans and other ethnic groups. For all transplant recipients, it is best to eat a healthy diet and exercise regularly to avoid weight gain and reduce the risk of developing high blood glucose or diabetes.

Signs and Symptoms of Diabetes

For most people, the normal range of blood sugar before eating is less than 126 mg/dL. Your blood glucose will go up after you eat. You may need your transplant team's supervision for controlling your blood sugar.

The signs of high blood sugar include:
Frequent urination
Extreme thirst and hunger
Sudden weight loss
Blurred vision
Repeated infections
Fatigue
Headache

Controlling Blood Sugar Levels

A healthy diet is needed to prevent diabetes or to help control your glucose if diabetes does occur. Be sure to choose foods from the 5 main food groups: grains, vegetables, fruits, milk, and meat and beans. The American Diabetes Association recommends eating:



Eat whole grains, breads, and cereals such as barley, bran, oats, wheat, and brown rice (1 ounce is about 1 slice of bread, 1 cup of breakfast cereal, or _ cup of rice)
Eat dark-green vegetables such as broccoli, spinach, and green beans
Eat a variety of fruits such as berries, apples, pears, and peaches
Choose low-fat dairy products such as skim or low-fat milk, yogurt, and cheese
Choose high-protein foods such as fish, poultry, lean meat, eggs, nuts, and beans

The main nutrients that are found in the foods we eat include carbohydrates, proteins, fats, vitamins, and minerals. Carbohydrates provide energy. Healthy carbohydrates include whole grain breads, whole grain cereals, peas, beans, lentils, fruits, and vegetables. Proteins are also important for increasing energy and strength. Choose low-fat dairy products, fish, chicken, and lean meat for a good source of protein. In addition, high-fiber foods such as beans, peas, whole grains, bran cereals, vegetables, and some fruits, such as apples, pears, peaches, and oranges, are healthy for people with diabetes because they can help lower blood sugar and fat.

How much you need to eat each day depends on how many calories your body burns. Maintaining your body weight requires a balance between calorie intake and the number of calories you use each day through regular daily activities and exercise. Many transplant recipients are surprised at how few calories are needed to maintain a healthy body weight. Your transplant coordinator or dietician can help determine your recommended daily calorie intake. Limiting the amount of fats and sugar in your diet can also help to maintain a healthy level of blood sugar.


Treatment Options for Controlling Diabetes

There are several types of medications that are currently available for patients with diabetes. The table below lists some of the medications that are used to treat diabetes. They are grouped by how they work to control blood sugar.

For many transplant recipients, insulin injections 2 to 4 times a day or an insulin pump is the best option for controlling blood sugar. Or, you may be given an oral medication to control blood sugar levels. Your transplant team will determine which medication is right for you.

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High Blood Pressure

High Blood Pressure

High blood pressure (hypertension) is a common problem for up to 90% of transplant recipients. 

Blood is carried from the heart to all parts of the body in vessels called arteries. Blood pressure is the force of blood pushing against the walls of the arteries as it is being pumped through them. Hypertension occurs when the force of blood against the artery walls is greater than normal, causing the heart to pump harder. High blood pressure can damage the arteries and the heart, increasing the risk of a stroke, a heart attack, kidney problems, or heart failure.

Blood pressure is always reported as 2 numbers: the systolic and diastolic pressures. Both numbers are important. Systolic pressure is the highest pressure when the heart beats, pumping blood into the arteries. Diastolic pressure is the value when the heart is at rest, in between beats. Systolic pressure is reported first, followed by diastolic (for example, 120/80 mm Hg — 120 is the systolic pressure and 80 is the diastolic pressure, and mm Hg refers to millimeters of mercury, which is the standard measurement for blood pressure).

What Causes High Blood Pressure?

For many patients, the cause of hypertension is not known. However, people with kidney disease, diabetes, or high blood pressure before the transplant are at higher risk of high blood pressure after the transplant. Other factors that contribute to high blood pressure after a transplant include a diet high in salt, clogged arteries, high blood fats, smoking, obesity, and some anti-rejection medications such as cyclosporine, tacrolimus, and steroids (prednisone).

Diagnosing High Blood Pressure

People with a blood pressure of 140/90 mm Hg or higher are considered hypertensive. While most transplant recipients should have a blood pressure of 130/80 mm Hg, the ideal blood pressure can vary from person to person. Be sure to ask your transplant team what your ideal blood pressure should be and what is considered too high and too low.Classification Systolic Pressure (mm Hg) Diastolic Pressure (mm Hg)

Normal Less than 120 Less than 80

Prehypertension 120-139 80-89

Stage 1 hypertension 140-159 90-99

Stage 2 hypertension 160 or higher 100 or higher



High blood pressure usually does not cause any symptoms, which is why it is important to have yours checked by your transplant team at regular follow-up exams. Your transplant team may also want you to monitor your blood pressure closely while at home. Getting your own blood pressure cuff may be recommended. Your local pharmacist can help you select a blood pressure cuff that is easy to use and relatively inexpensive. Some insurance plans will pay for a cuff.

It is a good idea to take your blood pressure cuff with you to your follow-up exams so you can get a good reading. Many digital cuffs tend to run about 10 points higher than traditional blood pressure cuffs used in doctors' offices.
Risk Factors for Hypertension That You Can Change

Making some lifestyle changes can lower your blood pressure and prevent hypertension. The table below lists recommended changes for healthier living.

Managing Hypertension

Too much salt (sodium) in your diet may increase your chances of developing high blood pressure. It is recommended that you eat no more than 2,000 milligrams (mg) of sodium a day, which equals about 1 teaspoon of table salt. Recent studies have shown that a diet with less than 1,500 mg of sodium (less than 1/2 teaspoon of table salt) can lower your blood pressure even further. It is important to read food labels to see how much sodium there is in each serving of food. It can be very surprising to learn that some foods have higher amounts of sodium than you would expect.

To reduce the amount of salt that you eat, make these dietary changes:
Do not add salt to your food — this can reduce your sodium intake by 50%
Cook with as little salt, onion salt, or garlic salt as possible
Use herbs and spices to add flavor instead of salt
Avoid salty foods such as crackers, pretzels, potato chips, salted nuts, salted popcorn, and salted french fries
Avoid canned, processed, or preserved foods that contain high amounts of salt (sodium) such as processed meats, canned soups, vegetable juices, frozen dinners, and pickles
Avoid instant dinners or side dish mixes that include seasoning packets (eg, Hamburger Helper®, Rice-A-Roni®, Top Ramen® noodles)
Avoid the use of soy sauce, canned spaghetti sauce, packaged gravy, and seasoning mixes
Do not use salt substitutes (Lite Salt®, No Salt®, Salt Sense®) unless your transplant team says it is okay because they can be high in potassium

Drinking too much alcohol can also raise your blood pressure. If you drink alcoholic beverages, limit them to only a moderate amount, which is 1 drink a day for women and 2 drinks a day for men. A drink consists of 12 ounces of beer (150 calories), 5 ounces of wine (100 calories), or 1 ounce of 80-proof liquor (100 calories).


Treating High Blood Pressure With Medication

Sometimes hypertension can be controlled with lifestyle changes such as diet and exercise, but most patients also require medication. There are a variety of medications for treating and controlling hypertension. The most commonly prescribed medications include ACE inhibitors, ARBs, calcium channel blockers, beta-blockers, and diuretics. Some of these medications may have interactions with certain anti-rejection medications. Listed in the table below are some of the anti-hypertensive medications that are currently available. You can go to the American Heart Association Web site at www.americanheart.org for more information.

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Maintaining Your Health After a Transplant

Maintaining Your Health After a Transplant
Keeping a healthy outlook on life

After an organ transplant, there is hope for the future. However, there are a number of health concerns that you will face after transplantation. For example, there is the chance that your new organ will not always function as well as it should. Transplant recipients also have a higher risk of developing certain conditions such as high blood pressure, high blood fats, heart attack, stroke, diabetes, kidney problems, liver disease, and bone disease. Infection and cancer are also conditions to be aware of. For more information about infection and malignancy (cancer) after a transplant, CLICK HERE.

Some conditions can affect any transplant recipient and some conditions are specific to the type of organ transplant. This section focuses on those conditions that can affect all types of organ transplant recipients. Being aware of these conditions and taking steps to prevent them is a good way to stay healthy after transplant surgery.

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Heart Information (Uptodate)

HEART TRANSPLANTATION OVERVIEW

— Cardiac transplantation, also called heart transplantation, has evolved into the treatment of choice for many people with severe heart failure (HF) who have symptoms despite maximum medical therapy. Survival among cardiac transplant recipients has improved as a result of improvements in treatments that suppress the immune system and prevent infection.

Unfortunately, the number of heart donors has reached a plateau despite an increasing number of potential recipients. More than 5000 cardiac transplants occur each year around the world, although it is estimated that up to 50,000 people are candidates for transplantation [1]. This critical organ shortage means that healthcare providers must strictly evaluate who should receive a heart transplant.

REASONS FOR HEART TRANSPLANTATION

— The American Society of Transplantation has published recommendations to guide healthcare providers about which patients should be considered for transplantation [2]. The major reason for cardiac transplantation is to improve survival. A second important reason is to enhance quality of life. (See "Indications and contraindications for cardiac transplantation").

Criteria for heart transplantation — The primary task in selecting candidates for heart transplantation is the person's prognosis. There are many predictors of need for transplantation; the best predictor is the amount of oxygen required by the body, called VO2. This is measured as a person exercises on a treadmill.

The major reason for cardiac transplantation is to improve survival. Thus, being able to predict how a person will do after transplantation is the most important part of the patient selection process.

The benefit of transplantation is clear if a person requires continuous intravenous (IV) medications in the hospital. In unhospitalized patients, the following requirements have been recommended for consideration for cardiac transplantation:
A history of repeated hospitalizations for heart failure
Need for ventricular assist device or artificial heart to support circulation
Increasing types, dosages, and complexity of medications
A reproducible VO2 of less than 14 mL/kg per minute

Patients are stratified into low, medium, and high risk of death without transplant. The final decision about listing a patient for transplant is determined by an established cardiac transplant center.

Deciding who gets a donor heart — To ensure that donor hearts are distributed fairly, an organization known as UNOS (United Network for Organ Sharing) has created a system. This system spells out rules that consider time on the wait list, the severity of illness and the geographic distance between the donor hospital and the transplant center, measured in increasing 500 mile distances from the donor hospital. This system is regularly reviewed and revised with input from a wide variety of interested parties, including transplant professionals, recipients, and donor families.

PRE-HEART TRANSPLANT EVALUATION

— People who meet VO2 requirements must also be evaluated for underlying medical problems, which may prevent a person from being eligible for transplantation. These include:
Fixed pulmonary hypertension
Active infection
Cancer

Other factors will also be considered, including the person's age and the presence of diabetes or lung disease.

Pulmonary hypertension — The major problem that prevents a person from being eligible for cardiac transplantation is fixed pulmonary hypertension. People with fixed pulmonary hypertension have an increased risk of right ventricular failure in the immediate postoperative period; during this time, the right ventricle in the donated heart must work especially hard to provide oxygenated blood to the body.

Fortunately, pulmonary hypertension can often be improved by using medications, including nitroprusside, nesiritide, dobutamine, milrinone, prostaglandin E1, prostacyclin, and inhaled nitric oxide. Milrinone therapy is highly effective, and is often used to determine if pulmonary hypertension is treatable. If pulmonary hypertension is controlled, a patient may be considered for transplantation.

Infection and cancer — Two other reasons transplantation may not be possible are active infection and cancer of any kind. Both of these problems can be worsened by the medications given after heart transplantation. Even without preexisting cancer, the risk of developing cancer is increased following transplantation as a result of anti-rejection medications.

Other concerns — There are a number of other conditions that may affect a patient's ability to receive a cardiac transplantation, depending upon the individual situation.
In the past, many programs routinely excluded people over the age of 55 to 60. However, carefully selected people in this age group (or older) have a survival rate comparable to that of younger patients. As a result, most centers now focus on the patient's "physiologic" age, which emphasizes the health of major organ systems (eg, kidneys, liver) and the number and severity of other underlying medical problems.
Diabetes can interfere with wound healing and increase the risk of infections and vascular (blood vessel) complications. However, people with diabetes who do not have diabetes-associated complications in the kidney, retina, or nerves appear to do as well as people without diabetes who undergo heart transplantation. ("See "Patient information: Preventing complications in diabetes mellitus").
Advanced lung disease can increase the risk of postoperative lung complications, including infection. In addition, recent pulmonary embolism (blood clot) with or without infarction (tissue death) are reasons to delay transplantation. Most centers treat a pulmonary embolism with anticoagulants (blood thinners) for six to eight weeks. (See "Patient information: Pulmonary embolism").

Other conditions that can limit a patient's ability to undergo cardiac transplantation include:
Advanced liver (hepatic) disease. Cirrhosis, for example, can limit survival and increase the risk of death both before and after surgery. (See "Patient information: Cirrhosis").
Renal (kidney) insufficiency. The immunosuppressive drug cyclosporine can be toxic for the kidneys, especially if there is preexisting kidney disease. A combined kidney-heart transplantation may be offered to patients who could require transplantation of both organs within a few years. Over 100 cases of such combined transplantation from single donors have been reported. (See "Patient information: Chronic kidney disease").
A number of other conditions increase the risk of complications, either due to the condition itself or the need for anti-rejection medications after transplantation. These conditions include: advanced peripheral vascular disease (claudication), severe obesity, advanced cardiac cirrhosis (liver disease caused by heart failure), active peptic ulcer disease, gallstones, and diverticulosis.

PSYCHOLOGICAL EVALUATION

— All heart transplantation candidates must have a complete psychological evaluation during the initial screening process. This helps to identify factors in a person's life that could cause difficulty during the waiting period, recovery, and postoperative period. A commitment to and understanding of the importance of anti-rejection medications is critical to the success of heart transplantation.

Finally, all patients are screened for the use and abuse of alcohol and other recreational drugs (marijuana, cocaine, heroin). Anyone who abuses drugs or alcohol currently or in the recent past is not a good candidate for transplantation since post-transplant drug or alcohol abuse occurs frequently.

Potential heart transplant recipients are advised stop smoking. Many centers will not list active smokers, and will check urine nicotine levels to ensure that the person has truly quit smoking. Recreational drugs, alcohol, and cigarette smoking are known to be harmful to the heart. Because the supply of donor hearts is limited and the demand is great, preference must be given to people who are likely to benefit the most and survive longest as a result of their transplant.

OUTCOME AFTER FIRST HEART TRANSPLANT

Survival — Approximately 85 to 90 percent of heart transplant patients are living one year after their surgery, with an annual death rate of approximately 4 percent thereafter. The three-year survival approaches 75 percent. (See "Prognosis after cardiac transplantation").

The outcome of patients undergoing heart transplantation for complex congenital (from birth) heart disease is similar to that of patients with other forms of heart disease. The one-year survival rate in people with congenital heart disease is 79 percent; at five years, the survival rate is 60 percent.

Prognosis — There are a number of factors in both the recipient and the donor that are associated with poor outcomes after transplantation.

Recipient factors — Factors associated with an increased risk of death up to one year after transplantation include:
Preoperative need for artificial breathing support (ventilator)
If the heart transplantation is the second
Heart conditions other than coronary artery disease or cardiomyopathy
Preoperative need for heart function assistance with a ventricular assist device
Being female
Being underweight or obese

Donor factors — A variety of donor factors affect the early outcomes:
A female donor is associated with increased one-year mortality.
The age of the donor heart does not affect long-term survival, although coronary artery disease is increased in hearts from donors over 63 years of age due to the presence of narrowing in the coronary arteries.
Thickening of the left ventricle (left ventricular hypertrophy) in the donor heart is associated with poorer outcomes compared to a heart without thickening.
Elevated blood levels of troponin I and T in the donor, which are markers of heart muscle damage, increase the risk of early heart failure.

Causes of death — There are four major causes of death after cardiac transplantation, which occur at different times:
Sudden (acute) rejection
Infections other than cytomegalovirus (CMV)
Artery disease in the transplanted heart vessels (allograft vasculopathy)
Lymphoma and other malignancies

Early mortality — Cardiac transplant recipients have an average of one to three episodes of rejection in the first year after transplantation. Between 50 and 80 percent of people experience at least one rejection episode. Acute rejection is most likely to occur in the first three to six months, with the incidence declining significantly after this time.

In the first year, most deaths are due either to acute rejection (18 percent) or infections (22 percent). Infections often develop as a result of the anti-rejection medications and weakened immune system that are required to prevent rejection.

Late mortality — Rejection is less common after the first year, and by four to five years after transplantation, less than 10 percent of deaths are the result of rejection.

However, development of rapidly progressing coronary artery disease in the arteries of the transplanted heart (called allograft vasculopathy), becomes the most common cause of death by five years. The number of fatal cancers increases over time as well. (See "Prevention and treatment of cardiac transplant vasculopathy").

Infections remain a significant cause of death after the first year. These infections are the result of a weakened immune system, and can develop from common bacteria and viruses in the community or from uncommon infections.

Posttransplant lymphoproliferative disease (PTLD) is a type of cancer that occurs in patients who use immunosuppressive medications. PTLD includes non-Hodgkin lymphoma (NHL). Most cases of PTLD occur in the first year after transplant. Among patients who develop lymphoma, the overall survival rates are between 25 to 35 percent at five years. (See "Patient information: Diffuse large B-cell lymphoma in adults" and see "Lymphoproliferative disorders following solid organ transplantation").

OUTCOME AFTER REPEAT HEART TRANSPLANTATION

— Some people must consider a second heart transplant if rejection or allograft vasculopathy develops. Slightly more than 2 percent of heart transplant cases are retransplants every year.

Survival after heart retransplantation is related to the time interval between the first transplant and the retransplant; a person is less likely to survive when this interval is short (ie, less than two years). When the interval between the first transplant and retransplantation is more than two years, the one-year survival is similar to that of a first transplantation (75 percent).

WHERE TO GET MORE INFORMATION

— Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:
Patient Level Information:

Patient information: Preventing complications in diabetes mellitus
Patient information: Pulmonary embolism
Patient information: Cirrhosis
Patient information: Chronic kidney disease
Patient information: Diffuse large B-cell lymphoma in adults
Professional Level Information:

Indications and contraindications for cardiac transplantation
Prognosis after cardiac transplantation
Prevention and treatment of cardiac transplant vasculopathy
Lymphoproliferative disorders following solid organ transplantation
Acute cardiac allograft rejection: Diagnosis
Acute cardiac allograft rejection: Treatment
Arrhythmias following cardiac transplantation
Left ventricular dysfunction after orthotopic cardiac transplantation
Lipid abnormalities after cardiac transplantation
Natural history and diagnosis of cardiac transplant vasculopathy
Rehabilitation after cardiac transplantation

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.
National Library of Medicine

(www.nlm.nih.gov/medlineplus/hearttransplantation.html, available in Spanish)
National Heart, Lung, and Blood Institute

(www.nhlbi.nih.gov/health/dci/Diseases/ht/ht_whatis.html)
American Heart Association

(www.americanheart.org)
European Society of Cardiology

(www.heartfailurematters.org)
United Network for Organ Sharing (UNOS)

(www.transplantliving.org)

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Heart Health

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Cardiac rehabilitation
By Mayo Clinic staff
Original Article:http://www.nlm.nih.gov/medlineplus/heartsurgery.html
Definition

Cardiac rehabilitation — also called cardiac rehab — is a customized program of exercise and education, designed to help you recover after a heart attack, from other forms of heart disease or after surgery to treat heart disease.

Cardiac rehabilitation is often divided into phases that involve monitored exercise, nutritional counseling, emotional support, and support and education about lifestyle changes to reduce your risks of heart problems. The goals of cardiac rehabilitation are to help you regain strength, to prevent your condition from worsening and to reduce your risk of future heart problems.

Cardiac rehabilitation programs increase your chances of survival. Both the American Heart Association and American College of Cardiology recommend cardiac rehabilitation programs.
Why it's done

Cardiac rehabilitation is an option for people of all ages and with many forms of heart disease. In particular, you may benefit from cardiac rehabilitation if your medical history includes:
Heart attack
Coronary artery disease
Heart failure
Peripheral arterial disease
Chest pain (angina)
Cardiomyopathy
Certain congenital heart diseases
Coronary artery bypass surgery
Angioplasty and stents
Heart transplant
Heart valve replacements

Don't let older age hold you back from joining a cardiac rehabilitation program. Even if you're older than 65, you're likely to benefit from cardiac rehabilitation.
Risks

Cardiac rehabilitation isn't appropriate for everyone who's had heart disease. Your health care team will evaluate your health to make sure you're ready to start a cardiac rehabilitation program.

Rarely, some people suffer injuries, such as strained muscles, sprains or broken bones, while exercising as a part of cardiac rehabilitation. Your health care team will carefully monitor you while you exercise to lower this risk and will teach you how to avoid injuries when you exercise on your own.
How you prepare

If you've had a heart attack or heart surgery or if you have another heart condition, ask your doctor about joining a cardiac rehabilitation program. Insurance and Medicare often cover the costs of cardiac rehabilitation.
What you can expect

During cardiac rehabilitation
Cardiac rehabilitation often begins while you're still in the hospital and continues with monitored programs in an outpatient setting until home-based maintenance programs can be safely followed.

The first stages of most cardiac rehabilitation programs last about three to six months. During that time, you may work with cardiologists, nurse educators, dietitians, exercise rehabilitation specialists, occupational therapists, physical therapists, psychologists and psychiatrists.

Cardiac rehabilitation has four main parts:
Medical evaluation. Initial and ongoing evaluation helps your health care team check your physical abilities, medical limitations and other conditions you may have, and keep track of your progress over time. Your health care team looks at your risk factors for heart disease, stroke or high blood pressure. This helps your team tailor a cardiac rehabilitation program to your individual situation, making sure it's safe and effective.

Physical activity. Cardiac rehabilitation improves your cardiovascular fitness through walking, cycling, rowing, or even jogging and other endurance activities. You may also do strength training (lifting weights, for example) to increase your muscular fitness.

Don't worry if you've never exercised before. Your cardiac rehabilitation team will make sure the program moves at a comfortable pace and one that's safe for you, but in general you should exercise three to five times a week. You'll be taught proper exercise techniques, such as warming up and stretching.
Lifestyle education. Guidance about diet and nutrition helps you shed excess weight and learn to make healthier food choices aimed at reducing fat, sodium and cholesterol intake. You receive support and education on making lifestyle changes and breaking unhealthy habits, such as smoking. You also learn how to manage pain or fatigue you may have. Cardiac rehabilitation also gives you ample opportunity to ask questions about such issues as sexual activity. Finally, it's critical you closely follow your doctor's advice on medications.
Support. Adjusting to a serious health problem often takes time. You may feel depressed or anxious, lose touch with your social support system, or have to stop working for several weeks. If you get depressed, don't ignore it because depression can make your cardiac rehab program more difficult, as well as impact your relationships and other areas of your life and health. Counseling will help you learn healthy ways to cope with depression and other feelings, and your doctor may also suggest medications such as antidepressants. Vocational or occupational therapy will teach you new skills to help you return to work.

Although it may be difficult to start a cardiac rehabilitation program when you're not feeling well, you'll benefit in the long run. Cardiac rehabilitation can guide you through fear and anxiety as you return to an active lifestyle, with more motivation and energy to do the things you enjoy.

Cardiac rehabilitation helps you rebuild your life, both physically and emotionally. As you get stronger and learn how to manage your condition, you'll likely return to a normal routine, along with your new diet and exercise habits. It's important to know that your chances of having a successful cardiac rehab program rest largely with you; the more dedicated you are to following your program's recommendations, the better you'll do.

After cardiac rehabilitation
After your initial cardiac rehabilitation program ends, you'll need to continue the diet and exercise habits you learn during cardiac rehabilitation for the rest of your life to maintain its heart health benefits.
Results

Cardiac rehabilitation is a long-term maintenance program — something to follow for the rest of your life. After about 12 weeks, you probably will have developed your own exercise routine at home or at a local gym. You may also continue to exercise at a cardiac rehab center. You may remain under medical supervision during this time, particularly if you have special health concerns. Education about nutrition, lifestyle and weight loss may continue, as well as counseling. For best success, make sure your exercise and lifestyle practices become lifelong habits.

Over the long term, you gain strength, learn heart-healthy behaviors, improve your diet, cut bad habits, such as smoking, and learn how to cope with heart disease. You'll also decrease your risk of coronary artery disease and other heart conditions.

One of the most valuable benefits of cardiac rehabilitation is often an improvement in your overall quality of life. If you stick with your cardiac rehab program, you're likely to come out of your cardiac rehabilitation program feeling better than before.

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Message: Deep tissue massage

What is deep tissue massage?
Deep tissue massage is a type of massage therapy that focuses on realigning deeper layers of muscles and connective tissue.

It is especially helpful for chronically tense and contracted areas such as stiff necks, low back tightness, and sore shoulders.
Some of the same strokes are used as classic massage therapy, but the movement is slower and the pressure is deeper and concentrated on areas of tension and pain. 

How does deep tissue massage work?
When there is chronic muscle tension or injury, there are usually adhesions (bands of painful, rigid tissue) in muscles, tendons, and ligaments.
Adhesions can block circulation and cause pain, limited movement, and inflammation. 
Deep tissue massage works by physically breaking down these adhesions to relieve pain and restore normal movement. To do this, the massage therapist often uses direct deep pressure or friction applied across the grain of the muscles.

Will deep tissue massage hurt?
At certain points during the massage, most people find there is usually some discomfort and pain.It is important to tell the massage therapist when things hurt and if any soreness or pain you ecperience is outside your comfort range.
There is usually some stiffness or pain after a deep tissue massage, but it should subside within a day or so. The massage therapist may recommend applying ice to the area after the massage.

What conditions is deep tissue massage used for?
Unlike classic massage therapy, which is used for relaxation, deep tissue massage usually focuses on a specific problem, such as: Chronic pain
Limited mobility
Recovery from injuries (e.g. whiplash, falls, sports injury)
Repetitive strain injury, such as carpal tunnel syndrome
Postural problems
Ostearthritis pain
Fibromyalgia
Muscle tension or spasm
Chronic pain
Limited mobility
Recovery from injuries (e.g. whiplash, falls, sports injury)
Repetitive strain injury, such as carpal tunnel syndrome
Postural problems
Ostearthritis pain
Fibromyalgia

Muscle tension or spasm
According to the August 2005 issue of Consumer Reports magazine, 34,000 people ranked deep tissue massage more effective in relieving osteoarthritis pain than physical therapy, exercise, prescription medications, chiropractic, acupuncture, diet, glucosamine and over-the-counter drugs. Deep tissue massage also received a top ranking for fibromyalgia pain.
People often notice improved range of motion immediately after a deep tissue massage. 

What can I expect during my visit?
Massage therapists may use fingertips, knuckles, hands, elbows, and forearms during the deep tissue massage.You may be asked to breathe deeply as the massage therapist works on certain tense areas. It is important to drink plenty of water as you can after the massage to flush metabolic waste from the tissues. 

Precautions
Massage is not recommended for certain people:infectious skin disease, rash, or open wounds
immediately after surgery immediately after chemotherapy or radiation, unless recommended by your doctor people with osteoporosis should consult their doctor before getting a massage
prone to blood clots. There is a risk of blood clots being dislodged. If you have heart disease, check with your doctor before having a massage pregnant women should check with their doctor first if they are considering getting a massage. Massage in pregnant women should be done by massage therapists who are certified in pregnancy massage.
massage should not be done directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures.
infectious skin disease, rash, or open wounds

immediately after surgery
immediately after chemotherapy or radiation, unless recommended by your doctor
people with osteoporosis should consult their doctor before getting a massage
prone to blood clots. There is a risk of blood clots being dislodged. If you have heart disease, check with your doctor before having a massage
pregnant women should check with their doctor first if they are considering getting a massage. Massage in pregnant women should be done by massage therapists who are certified in pregnancy massage.
massage should not be done directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures.
Additional tips
don’t eat a heavy meal before the massage
if it's your first time at the clinic or spa, arrive at least 10 minutes early to complete the necessary forms. Otherwise, arrive 5 minutes early so you can have a few minutes to rest and relax before starting the massage.

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Message :Thai massage

What is Thai massage?
Thai massage is believed to have been developed by Jivaka Kumar Bhaccha, physician to Buddha, more than 2,500 years ago in India.

It made its way to Thailand, where the Ayurvedic techniques and principles gradually became influenced by traditional Chinese medicine.

For centuries, Thai massage was performed by monks as one component of Thai medicine.

What does Thai massage feel like?
Thai massage is more energizing and rigorous than more classic forms of massage.

Thai massage is also called Thai yoga massage, because the therapist uses his or her hands, knees, legs, and feet to move you into a series of yoga-like stretches. Many people say Thai massage is like doing yoga without any work.

Muscle compression, joint mobilization, and acupressure are also used during treatment.

People describe Thai massage as both relaxing and energizing.

What should I expect during my visit?
Thai massage is usually done on a padded mat on the floor.

No oil is applied, so you are fully dressed. You are usually asked to bring or wear comfortable clothing to the massage.

A typical Thai massage is 60 minutes to two hours long.

What conditions is Thai massage used for?
Many people find that Thai massage has the following benefits:relaxes
reduces stress
improves circulation
increases energy
increases flexibility
improves range of motion
centers the mind and body
relaxes
reduces stress
improves circulation
increases energy
increases flexibility
improves range of motion
centers the mind and body
Precautions
Massage is not recommended for certain people:infectious skin disease, rash, or open wounds

immediately after surgery

immediately after chemotherapy or radiation, unless recommended by your doctor

prone to blood clots. There is a risk of blood clots being dislodged. If you have heart disease, check with your doctor before having a massage

pregnant women should check with their doctor first if they are considering getting a massage. Massage in pregnant women should be done by massage therapists who are certified in pregnancy massage.

massage should not be done directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures.
infectious skin disease, rash, or open wounds

immediately after surgery

immediately after chemotherapy or radiation, unless recommended by your doctor

prone to blood clots. There is a risk of blood clots being dislodged. If you have heart disease, check with your doctor before having a massage

pregnant women should check with their doctor first if they are considering getting a massage. Massage in pregnant women should be done by massage therapists who are certified in pregnancy massage.

massage should not be done directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures.
Additional tips
Don’t eat a heavy meal before the massage

If it's your first time at the clinic or spa, arrive at least 10 minutes early to complete the necessary forms. Otherwise, arrive 5 minutes early so you can have a few minutes to rest and relax before starting the massage.

Be sure that your massage therapist has your complete health history, because people with certain conditions should not have Thai massage.

If you feel discomfort at any time, let your massage therapist know.

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Massage for Neck and Back Pain?

Question: Massage for Neck and Back Pain?

My husband and some of my friends are postal carriers and they are always saying that their backs, shoulders, and necks hurt. What type of massage should they get?

-Deana
Answer: There are several types of massage they may be interested in. The most common type of massage in the United States is Swedish massage. It's also known as massage therapy.

Massage therapists apply oil or lotion on the skin and mainly use long smooth strokes. People who have never had massage before usually start with Swedish massage.

They might also be interested in deep tissue massage. Deep tissue massage is used for chronic tight or painful muscles, postural problems, and repetitive strain. This type of massage targets the deeper layers of muscle and connective tissue.

There is often some level of physical discomfort during the massage, as the massage therapist works on the deeper muscle layers. People usually feel sore for one to two days after the massage.

Another option is shiatsu, a form of Japanese bodywork. Clothing is usually worn during the shiatsu treatment, so it is a good treatment if someone prefers to remain fully clothed.

The therapist applies localized finger pressure to points on the body. Because the pressure is so localized, the pressure of shiatsu feels deep.

Your husband and friends may have partial insurance coverage for massage and should find out about that, because their coverage may limit the types of massage they can choose from.

Although it's no substitute for the human touch, a massage cushion may be worth considering. Some of them cost $100 or less. Massage cushions can fit on many chairs or can be placed on a sofa. Stores like Target, Sharper Image, Bed Bath and Beyond, and Staples usually have floor models for people to try. Compare features, because some massage cushions can give localized massages to particularly tense areas on the back.

Carrying a heavy weight every day, lifting while bending, and carrying weight asymmetrically can increase the risk of disc herniation and joint problems.

That's why in addition to massage, they may want to consult a doctor of chiropractic. Chiropractic may help to prevent damage and injury to joints, and there is evidence that it's as effective as conventional therapy at relieving some types of back pain. People are also usually taught self-care strategies.

Many chiropractic clinics offer massage therapy, so the two could even be combined.

Yoga might also help relieve muscle tension and improve strength and flexibility. It's something you could do together. Yoga classes cost about $10-$15 per class at yoga studios, and sometimes less at gyms and community centers.

And finally, your husband's family doctor should be aware of his symptoms to see if he needs further evaluation.

Anyone experiencing any of the following symptoms should contact their doctor immediately and before starting any alternative therapy:Persistent back pain
Back pain that awakens you in the night
Changes in bowel or bladder function
Numbness, weakness, or pain around the genitals, arms, or legs
Fever, chills, sweats
Any other unusual or new symptoms

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Pregnancy massage

What is pregnancy massage?

Pregnancy massage is massage therapy specifically tailored for the expectant mother's needs. It is also called pre-natal massage.

How is pregnancy massage different from regular massage?
The mother's body must be properly positioned and supported during the massage, using pillows and padding. Proper positioning ensures comfort and safety for the mother and baby.

Also, some massage techniques, such as deep tissue work, cannot be used. Certain areas of the body should be avoided during pregnancy.

What are the benefits of pregnancy massage?
Pregnancy massage has been found to reduce stress, decrease swelling in the arms and legs, and relieve aches and pains in muscles and joints.

It's a popular complementary therapy during pregnancy for back pain, when choices for pain relief, such as medication, are often limited.

Not only can massage be physically beneficial, but the human touch can be comforting and provide emotional support during pregnancy.

Massage therapy has been found to reduce anxiety and depression.

Who do I go to for pregnancy massage?

Look for a massage therapist who is certified in pregnancy massage.

That means that the therapist has had specialized training in pregnancy massage, and knows what is safe for the mother and baby.
Precautions
Many massage therapists do not recommend massage in the first trimester.

Also, women with certain health conditions may not be able to have pregnancy massage.

It's best to consult your doctor and a certified pregnancy massage therapist.

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10 Most Popular Types Of Massage Therapy

1) Swedish Massage Therapy

This is the most common type of massage therapy in the United States. It is also known as Swedish massage or simply massage therapy.

Massage therapists use long smooth strokes, kneading, and circular movements on superficial layers of muscle using massage lotion or oil.

Swedish massage therapy can be very gentle and relaxing. If you've never had massage before, this is a good one to try first. To learn more, read the full article on Swedish massage.

2) Aromatherapy Massage

Aromatherapy massage is massage therapy with the addition of one or more scented plant oils called essential oils to address specific needs.

The massage therapist can select oils that are relaxing, energizing, stress-reducing, balancing, etc. One of the most common essential oils used in aromatherapy massage is lavender.

Aromatherapy massage is particularly suited to stress-related conditions or conditions with an emotional component. To learn more, read the full article on aromatherapy massage.

3) Hot Stone Massage

Heated, smooth stones are placed on certain points on the body to warm and loosen tight muscles and balance energy centers in the body.

The massage therapist may also hold stones and apply gentle pressure with them. The warmth is comforting. Hot stone massage is good for people who have muscle tension but prefer lighter massage. To learn more, read the full article on hot stone massage.

4) Deep Tissue Massage

Deep tissue massage targets the deeper layers of muscle and connective tissue. The massage therapist uses slower strokes or friction techniques across the grain of the muscle.

Deep tissue massage is used for chronically tight or painful muscles, repetitive strain, postural problems, or recovery from injury. People often feel sore for one to two days after deep tissue massage. To learn more, read the full article on deep tissue massage.

5) Shiatsu

Shiatsu is a form of Japanese bodywork that uses localized finger pressure in a rhythmic sequence on acupuncture meridians.

Each point is held for for two to eight seconds to improve the flow of energy and help the body regain balance.

People are normally pleasantly surprised when they try shiatsu for the first time. It is relaxing yet the pressure is firm, and there is usually no soreness afterwards. To learn more, read the full article on shiatsu.

6) Thai Massage

Like shiatsu, Thai massage aligns the energies of the body using gentle pressure on specific points. Thai massage also includes compressions and stretches.

You don't just lie there--the therapist moves and stretches you into a sequence of postures. It's like yoga without doing any work. Thai massage is more energizing than other forms of massage. It is also reduces stress and improves flexibility and range of motion. To learn more, read the full article on thai massage. Also, see photos of a Thai massage session.

7) Pregnancy Massage

Also called prenatal massage, pregnancy massage is becoming increasingly popular with expectant mothers. Massage therapists who are certified in pregnancy massage know the proper way to position and support the woman's body during the massage, and how to modify techniques.

Pregnancy massage is used to reduce stress, decrease swelling, relieve aches and pains, and reduce anxiety and depression. The massage is customized to a woman's individual needs. To learn more, read the full article on pregnancy massage.

8) Reflexology

Although reflexology is sometimes called foot massage, it is more than simple foot massage. Reflexology involves applying pressure to certain points on the foot that correspond to organs and systems in the body. Reflexology is very relaxing, especially for people who stand on their feet all day or just have tired, achy feet. To learn more, read the full article on reflexology.

9) Sports Massage

Sports massage is specifically designed for people who are involved in physical activity. But you don't have to be a professional athlete to have one-it's also used by people who are active and work out often. The focus isn't on relaxation but on preventing and treating injury and enhancing athletic performance.

A combination of techniques are used. The strokes are generally faster than Swedish massage. Facilitated stretching is a common technique. It helps to loosen muscles and increase flexibility.

10) Back Massage

Some massage clinics and spas offer 30-minute back massages. If a back massage is not expressly advertised, you can also book a 30- or 40-minute massage and ask that the massage therapist to focus on your back

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Massage Therapy

What is Massage Therapy?

Massage therapy, also known as Swedish massage, is the most common form of massage therapy in the United States.

Massage therapists use long, smooth strokes, kneading and other movements focused on superficial layers of muscle using massage oil or lotion.

How Does Massage Therapy Work?

Massage therapy improves circulation by bringing oxygen and other nutrients to body tissues.

It relieves muscle tension and pain, increases flexibility and mobility, and helps clear lactic acid and other waste, which reduces pain and stiffness in muscles and joints.

Why Do People Get Massage Therapy?

People get massage therapy for relaxation or for a variety of health conditions: Back pain
Inflammatory conditions such as arthritis and tendinitis
Stress relief and stress-related conditions
Headaches and migraines
Muscle and related conditions such as spasms, strains and sprains
Repetitive strain injury, such as carpal tunnel syndrome
Circulatory and respiratory problems
Post-injury and post surgical rehabilitation
Back pain
Inflammatory conditions such as arthritis and tendinitis
Stress relief and stress-related conditions
Headaches and migraines
Muscle and related conditions such as spasms, strains and sprains
Repetitive strain injury, such as carpal tunnel syndrome
Circulatory and respiratory problems
Post-injury and post surgical rehabilitation

Massage therapy relieves stress. It is thought to help the body's stress response by lowering levels of hormones such as cortisol.

Massage therapy also appears to enhance immune function.

What a Typical Massage Therapy Session is Like

A typical massage therapy session is between 40 and 90 minutes. Your massage will begin with a brief consultation and review of symptoms, medical history, and lifestyle.

You will be asked to undress (many people keep their underwear on) while the massage therapist is out of the room, and lie face down under a sheet on a padded massage table.

The massage therapist will knock on the door to make sure you are ready. The massage therapist re-enters the room and will then adjust the face rest and pillows to ensure that you are comfortable and properly positioned. Tell the massage therapist if you are too warm or cold.

The massage therapist uses a light oil or lotion on the skin and begins the massage. A full body massage usually begins on the back and then moves down to the legs. You will then be asked to turn over so you are face up. The massage continues on your arms, legs, neck, and abdomen.

You are underneath the sheet at all times, and in North America, only the part of the body being treated at any one time is uncovered.

After the massage, the massage therapist leaves the room so you can get changed.

Take your time getting up. If you sit or stand too quickly you may feel lightheaded or dizzy.
Will Massage Therapy Hurt?

Massage therapy shouldn't hurt. Occasionally there is mild aching when the massage therapist applies pressure over "knots" and other areas of muscle tension. If the pressure is too strong for you, let the massage therapist know.

How Will I Feel After a Massage?

Most people feel calm and relaxed after a treatment. Occasionally, people experience mild temporary aching for a day.

Precautions

Massage therapy is not recommended for certain people:
People with infectious skin disease, rash, or open wounds
Immediately after surgery
Immediately after chemotherapy or radiation, unless recommended by your doctor
People prone to blood clots. There is a risk of blood clots being dislodged. If you have heart disease, check with your doctor before having a massage
Pregnant women should check with their doctor first if they are considering getting a massage. Massage in pregnant women should be done by massage therapists who are certified in pregnancy massage.

Massage should not be done directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures.

Additional Massage Tips

Don't eat a heavy meal before the massage.
If it's your first time at the clinic or spa, arrive at least 10 minutes early to complete the necessary forms. Otherwise, arrive 5 minutes early so you can have a few minutes to rest and relax before starting the massage.

Read more...

Skin Care: 5 Tips for Natural Skin Care

Tip 1: Give Yourself a Dry Brush Exfoliation

A dry brush exfoliation can be done in the morning before you shower. It eliminates dead skin cells and allows the skin to detox (skin is the largest organ of elimination). Dry brush exfoliation also improves lymph and blood circulation and decreases puffiness. An added benefit is that the gentle pressure is calming to the nervous system. To give yourself a dry brush exfoliation, you'll need a soft, natural bristle brush.

What is a Dry Brush Exfoliation?
A dry brush exfoliation involves the use of a soft, dry brush to gently brush the skin. It is recommended by holistic practitioners to remove dead skin cells, improve the circulation of blood and lymph, and enhance detoxification through skin. The gentle pressure is also thought to have a calming effect.

How is Dry Brush Exfoliation Done?
The only tool needed is a soft, dry, skin brush, preferably with natural bristles.

Step 1
Stand in the shower with the water off.

Step 2
Starting at your feet, start brushing in small circles towards your heart. Apply very light pressure, avoiding broken skin, skin rashes, or areas where the skin is thin, such as the face or inner thighs.

Step 3
After you've finished both legs, move on to your arms. Brush from your fingertips, again towards your heart.

Step 4
Reach around and brush from your back towards your stomach.

Step 5
When you are finished, begin showering.

Tip 2: Rev Up Your Digestion

In alternative medicine, good skin is a reflection of a good digestive system. People with skin disorders such as acne, rosacea, and psoriasis often suffer from constipation, imbalanced "good" vs. "bad" bacteria, leaky gut, and other digestive conditions. The two most common sluggish digestion culprits are:

Culprit #1: Not Enough Water Water bathes cells and eliminates waste products, preventing constipation. 5 Ways to Boost Your Water Intake

Culprit #2: Not Enough Fiber Most people lack fiber in their diets - the average person eats only 12 g of fiber a day. In 2002, the National Academy of Sciences Food and Nutrition Board established recommended fiber intakes. For men aged 19-50 years, 38 g fiber is recommended, and for men over 50, 31 g fiber is recommended. For women aged 19 to 50 years, 25 g fiber is recommended,and for women over 50, 21 g fiber is recommended.

Some suggestions:

Add Whole Grains - Choose whole grain products over refined. Have brown rice instead of white or make your own 50:50 combination.
An Apple a Day - Have an apple, skin on, as a snack.
Eat Cauliflower - Try this delicious Roasted Cauliflower recipe!
High-fiber snacks - Snack on nuts, seeds, and dried fruit, such as dates, figs, and prunes.
Try a "Prune Power" Smoothie - Prunes are a great source of fiber. Start your day with this tasty Prune Power smoothie.
Eat Beans and Legumes - Open a can of your favorite beans or legumes. Rinse them well and add them to your meal.
Ground Flaxseeds - For any easy fiber boost, sprinkle ground flaxseeds (available at health food stores) on rice, salads, oatmeal, or any other meal. Store flaxseeds in the fridge.

Tip 3: Invigorate Sluggish Circulation

Do you sit at your desk for hours, only getting up to go to the bathroom? One of the best things you can do for your skin, stress level, and overall health is to get moving! Inactivity may affect skin and promote bloating and puffiness, acne, cellulite, and loss of muscle tone. You'll learn more about exercise in Step 9 of the Wellness Makeover. Here are some quick suggestions:Take a quick break to go outside and walk around the block.
Book a massage therapy appointment.
Close your door and stretch.
Go to the gym.
Start each morning by stretching.
Get a skipping rope.
Take a quick break to go outside and walk around the block.
Book a massage therapy appointment.
Close your door and stretch.
Go to the gym.
Start each morning by stretching.
Get a skipping rope.

Tip #4: Avoid Excess Sugar

Most people do not realize this but excess sugar is considered one of the main causes of premature aging. The more sugar we eat, the more sugar we have entering our bloodstream. Over time, this can result in a process known as glycation, which is when a glucose (sugar) molecule damages a protein molecule by sticking to it. The new molecules formed are called advanced glycation end-products, or AGEs. AGEs damage collagen in skin, cartilage, and ligaments and promote a loss of elasticity. Wrinkles form and skin begins to sag.Try This - It may seem impossible to reduce your sugar intake, but it can be done! A gradual approach works best. In the next week, choose one thing you're going to do to decrease the amount of sugar you consume. For example, start by cutting the amount of sugar in your daily coffee or tea by half. Every week, find another way you can decrease your sugar intake. Pretty soon, you'll be surprised at how far you've come!
Try This - It may seem impossible to reduce your sugar intake, but it can be done! A gradual approach works best. In the next week, choose one thing you're going to do to decrease the amount of sugar you consume. For example, start by cutting the amount of sugar in your daily coffee or tea by half. Every week, find another way you can decrease your sugar intake. Pretty soon, you'll be surprised at how far you've come!

Tip #5: Eat Some Good Fats

Essential fatty acids are simply fats your body cannot live without. They are needed to make cell membranes, hormones, and other body chemicals. Essential fats are thought to keep your heart healthy, fight inflammation, and possibly prevent cancer. They are also particularly important to people with inflammatory conditions such as eczema and acne, and also for people with dry skin. People with essential fat deficiency sometimes notice bumps on the backs of their arms. Here are my suggestions on getting more essential fats: Flaxseed and walnut oil - Use flaxeed oil or walnut oil with balsamic vinegar as a salad dressing. Be sure to keep these oils refrigerated. They should not be heated or used for cooking.
Cold water fish - Sardines are a good source of essential fats. Salmon is another good source, however these salmon accumulate toxic polychlorinated biphenyls (otherwise known as PCBs) in their body fat during the 95 percent of their lives they spend at sea.
Supplements - Consider fish oil supplements.

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Anti-aging Cosmetic Surgery

Anti-aging Cosmetic Surgery

As we all age with time, our skin stays as the first evidence to inform our age. Considering anti aging treatment in terms of cosmetic surgery. Coming next are some useful information, which can well serve your objectives



Forehead Lift: A forehead lift is performed in conjunction with a facelift to achieve a more harmonious and complete facial enhancement. A forehead lift is also appropriate for treatment of certain inherited traits. Adults, who are there in their early periods, have a low brow or who already have deep frown lines due to stress or over activity of muscles may benefit from the procedure. A forehead lift can improve rigidity of the skin. Another face-lifting procedure, 'endoscopic facelift' is the medical name for an improved plastic surgical technique that provides facial enhancement with minimal scars. Endoscopy is also a technique, which allows faster healing, and results in fewer side effects than traditional techniques.
Eyelids lift: Next to your 'face skin', the eyelids are the facial features to show signs of aging resulting dull appearance in even the most energetic individual. Blepharoplasty or an eyelid cosmetic surgery can return youthful elegance to an individual's face, making the eyes appear brighter and more refreshed. Browpexy is another procedure used to lift the brow without surgery. Some individuals experience an accumulation of fat in the lower eyelids creating persistent bags under the eyes. These bags, however, are not always related to aging. This tendency may be inherited and may appear in early life before the aging process becomes noticeable. Other individuals may notice the skin of the upper eyelids may become lax and impart a hooded appearance to the upper eyelids and, in severe instances, even obscure vision.
Neck lift: The neck lift can be considered as the part of the facelift which happens behind the ear and down into the neck. This procedure tightens the neck skin upward behind the ears.
Anti aging Laser Skin Resurfacing: Laser resurfacing is a method to give candidates, magically softened, healthier-looking skin by smoothing wrinkles, scars and other blemishes. It is a relatively new technology that is proving to be less abrasive to the skin than traditional treatments. Noticeably, the results of laser resurfacing are immediate, especially when used to remove fine to moderate wrinkles.
Chemical Peel: this technique makes an individual look years younger by removing and softening age-related wrinkles and premature wrinkling caused by sun exposure. Depending on the degree of wrinkling, a light, medium or deep peel may be recommended.
Unluckily, some of the outcomes of these on the anti aging cosmetic surgeries are temporary, lasting few months. But without feeling tired, many prefer doing the treatments again and again.

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Cosmetic And Plastic Surgery

Cosmetic And Plastic Surgery

Many of us are unhappy with certain aspects of our appearance and we wish that we could alter them. Apart from this time too takes a toll on our looks. As we grow older our body begins to degenerate slowly altering the way we look. Some of us would like to arrest or reverse this effect. Today it is possible to do so with the help of cosmetic and plastic surgery. Cosmetic and plastic surgery comprises of a number of surgical procedures to change one's physical appearance and make it more pleasing. Aesthetic plastic surgery can be performed on many parts of the body. The results and risks of plastic surgery vary from person to person. You must understand the risks involved before undertaking this surgery. You should consult a good plastic surgeon and for ask for details before deciding to undergo surgery. Given below are some of the procedures that you can undergo:


Breast Augmentation (Augmentation Mamaplasty): In this procedure uses breast implants to increase the size of the breasts. This is also known as breast enlargement or breast enlargement.
Breast Reduction: This procedure reduces the size of large and dropping breasts.
Breast Lift (Matopexy): This procedure lifts and gives a better shape to breast that are sagging.
Liposuction or Lipoplasty (Suction-Assisted Lipectomy): This procedure removes the extra fat in different parts of the body. The three types are tumescent, ultrasonic and super-wet.
Tummy tuck (Abdominoplasty): This procedure removes extra fat and skin from the abdomen area.
Nose Surgery (Rhinoplasty): this procedure mends or modifies the nose.
Face Lift/Facelift (Rhytidectomy): This procedure removes excess skin from the forehead, face and neck in order to reduce wrinkles from developing.
Eyelid Surgery (Blepharoplasty): Once this procedure is done the eyes no longer look droopy and tired.
Botox Injections: These injections paralyze or freeze the face muscles to prevent them from developing wrinkles.
Facial Implants: This procedure uses implants to improve the cheeks and chin.
Ear pinning (Otoplaty): This procedure brings the ears closer to the head.
Hair Restoration: In this procedure hair from one part of the head is transplanted to another part of the head.
Laser Skin Resurfacing: this procedure decreases the wrinkles that develop on the skin due to exposure to the sun.
Hyaluronic Acid: This natural substance is injected into the body to be used as skin filler.
Laser Hair Removal: This procedure removes unwanted body hair permanently.
Before you decide to undergo plastic surgery ensure that you consult a good plastic surgeon and understand the procedure and the risks involved completely, before you make a final decision.

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Stomach Ulcers in Children

Stomach Ulcers in Children

Stomach ulcers is not an "adult disease". Children can also develop stomach ulcers.

Why do children develop stomach ulcers?

Researchers are not sure of the exact reason children develop stomach ulcers. Unlike adults who develop stomach ulcers mostly as a result of a h. pylori infection, children do not usually develop stomach ulcers because of h. pylori infections. It is believed that many children develop stomach ulcers as a result of medication.

What to do if your child has a stomach ulcer

If your child is diagnosed with an h. pylori-related ulcer, make sure that your child takes all of the antibiotics as directed by the doctor. Follow the instructions that the doctor has given you even if the symptoms have disappeared. If the symptoms are no longer present, it doesn't mean that the infection is gone.

If your child has a medicine-related ulcer, her doctor will tell you to avoid the medications that caused the ulcer, including any medication containing ibuprofen or aspirin. Also, be sure to give your child the medication prescribed by the doctor.

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What is Celiac Disease?

What is Celiac Disease?

Celiac disease is an illness in which the inside lining of the small intestine is damaged after eating wheat, rye, oats, or barley.

Celiac disease is a common cause of malabsorption. It is a disease caused by intolerance to gluten. Gluten is a protein found in wheat, rye, and barley. Interance to gluten causes the lining of the intestine to loose its villi. Villi are tiny folds in the intestine that absorb nutrients.

Celiac disease can occur at any age but it often occurs in children. Close relatives of a person with celiac disease have about a 5-10% chance of developing celiac disease themselves.

Celiac disease is also called celiac sprue, gluten sensitive entropathy and non-tropical sprue.

Symptoms of Celiac Disease?

In early stages, symptoms of celiac disease may be limited to anemia and early-onset osteoporosis. In later stages of celiac disease, the following symptoms may be present:
Bleeding gums
Dry skin
Foul smelling diarrhea
Bloating
Green stool
Weight Loss
Anemia
Stools that stick to the toilet bowl
Bone pain
Bone tenderness
Soreness of lips and tongue

How is Celiac Disease Diagnosed?

Celiac disease is difficult to diagnose in early stages. In later stages, the doctor will examine stool for fat, take an x-ray of the bowel, take a biopsy of the lining of the small intestine and blood tests.

Can Celiac Disease be Treated?

Celiac disease can be treated. The most common treatment options is to eliminate foods from the diet that contain gluten. If the patient is severly malnurished, intravenous fluids may be temporarily given while the gluten-free diet is taking hold.

After the gluten-free diet is started, the villi will regain their normal shape and regain their ability to absorb nutrients. Stools and weight will also return to normal.

Unexpected Sources of Wheat
stamps and envelopes
canned broth
imitation bacon
veggie burgers
soy sauce
soy marinades
mustard
chewing gum
laxatives

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Black Stool

Black Stool

Black stool usually means that the blood is coming from the upper part of the gastrointestinal tract. The blood might be coming from the esophagus, stomach, and the first part of the small intestine. Blood will typically look like tar after it has been exposed to the body's digestive juices. Stomach ulcers caused by ibuprofen, naproxen, or aspirin are common causes of upper GI bleeding.

Common causes of black stool are:
Bleeding stomach or duodenal ulcer
Gastritis
Mallory-Weiss tear (a tear in the esophagus from violent vomiting)
Trauma or foreign body
Bowel ischemia (a lack of proper blood flow to the intestines)
Vascular malformation

Other causes of black stool include:
Consuming black licorice
Consuming lead
Consuming iron pills
Medicines (Pepto-Bismol)
Eating too many blueberries

Melena is a term used to describe black, tarry, and foul-smelling stools.

What to do when you have Black Stool

Talk to your doctor. Your doctor will want to know the exact color to help find the site of bleeding. Your doctor will probably perform an endoscopy or special x-ray studies.

Information for your doctor

When you visit your doctor, they will take a medical history and perform a physical examination, focusing on your abdomen and rectum.

The following questions may be included in the history to better understand the possible causes of your bloody or dark stools:
Is there blood on the toilet paper only?
What color is the stool?
When did it develop?
Have you had more than one episode of blood in your stool? Is every stool this way?
Are you taking blood thinners or NSAIDs (ibuprofen, naproxen, aspirin)?
Have you ingested black licorice, lead, Pepto-Bismol, or blueberries?
Have you had any abdominal trauma or swallowed a foreign object accidentally?
Have you lost any weight recently?

Treatment for Black Stool

Treatment depends on the cause and severity of the bleeding. For serious bleeding, you may be admitted to a hospital for monitoring and workup.

Prevent Black Stool

You can help prevent black stool by:
Reduce your risk of constipation, hemorrhoids, diverticulosis, and colon cancer by eating vegetables and foods rich in natural fiber and low in saturated fat.
Avoid prolonged, excessive use of anti-inflammatory drugs like ibuprofen, naproxen, and aspirin.
Limit alcohol intake. Large amounts of alcohol can irritate the lining of the esophagus and stomach.
Do not smoke. Smoking is linked to peptic ulcers and cancers of the GI tract.

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Questions for your doctor about Alzheimer's

Questions for your doctor about Alzheimer's


Preparing questions in advance can help patients have more meaningful discussions with healthcare professionals regarding their condition. Patients or their caregivers may wish to ask their doctor the following Alzheimer's disease-related questions:
Am I at risk for Alzheimer's disease?

How do you know that my symptoms are caused by Alzheimer's disease?

Can I tell if my parent’s symptoms are caused by Alzheimer’s disease or just aging?

What tests will you use to diagnose Alzheimer's disease?

At what stage is my Alzheimer's disease?

What kind of medication will you prescribe for my Alzheimer's disease?

What side effects should I look out for?

Are there any over-the-counter medications that I should avoid?

Will other chronic medical conditions such as heart disease or arthritis be complicated by Alzheimer’s disease?

Am I going to have to stop driving?

Will I have to move out of my home?

Is there anything I can do to prevent Alzheimer's disease?

If one of my parents had Alzheimer’s disease, am I at greater risk for it?

What specific dangers should I guard for in a parent with Alzheimer’s disease?

Can you recommend a support group or other services available for caregivers and family members of Alzheimer’s patients?

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Ongoing research for Alzheimer's disease

Ongoing research for Alzheimer's disease


There are many avenues of continuing research for Alzheimer's disease, only some of which are progressing through medical clinical trials. Some areas of research include:
Genetics. Scientists believe that they may have discovered genes linked to the development of Alzheimer's disease. The genes, ApoE4 and SORL1, appear to be more common in people with Alzheimer's disease. However, not all people with the gene develop Alzheimer's disease and some people without the gene may also develop the disease. Therefore, it is thought that these genes may make carriers more susceptible to Alzheimer's disease, although other factors may also be involved in its development.

Inflammation. Some studies have indicated that inflammation around the brain may contribute to the progression of Alzheimer's disease. This has lead to the belief that medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be beneficial as both a preventive measure and as a means of slowing disease progression. However, clinical trials have shown negative results. Moreover, some types of NSAIDs such as aspirin or ibuprofen may interact poorly with Alzheimer’s medications. Chemicals called cytokines are produced during inflammation and may be detectable in blood tests to make it possible to diagnose Alzheimer's disease earlier.

Antibiotics. A few studies have found the presence of bacteria including Chlamydophila in the brains of Alzheimer's patients, and lab studies have shown that some antibiotics can interfere with the accumulation of dangerous proteins in the brain. However, more study is needed before antibiotics become part of standard Alzheimer's care.

Vaccine. Although there is no cure for Alzheimer's disease, scientists have been working on various types of vaccines that may be able to prevent the development of the plaques and tangles that seem to be closely connected with Alzheimer's disease. One attempt was the AN-1792 vaccine, which was designed to enable the immune system to recognize and attack amyloid plaques. However, despite promising results, clinical trials of the vaccine were stopped when it was discovered that the vaccine may have contributed to inflammation of the brain and spinal cord experienced by some of the participants.

Estrogen. Some studies have indicated that estrogen may be linked to the development of Alzheimer's disease, although the precise relationship is unknown. It appears that estrogen used by menopausal women may protect the brain and slow the progression of Alzheimer's disease. However, in clinical trials, this link was not confirmed and evidence showed that the use of estrogen with progestin (a common combination in the contraceptive pill) may increase the risk of developing Alzheimer's disease. In addition, use of hormone replacement therapy has been linked to increased risks of breast cancer in women.

Testosterone. Older men with lower testosterone levels appear to be a greater risk of developing Alzheimer's disease or cognitive impairment. Only a few studies have been conducted so far on the value of testosterone supplementation among older men to enhance cognitive function. Results have been mixed.

Insulin. One early study showed that insulin therapy reduced the level of beta amyloid protein in the blood (the protein that causes the plaques associated with Alzheimer's disease). It appears that insulin is somehow related to the protein's metabolism, and that people with higher levels of insulin have fewer symptoms of dementia.

Diagnosis. Scientists are working on a number of ways to confidently detect and thus treat Alzheimer's disease earlier than what is currently possible. Methods under investigation include blood tests, modified imaging tests, genetic tests and improved risk factor calculations.

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Lifestyle considerations for Alzheimer's disease

Lifestyle considerations for Alzheimer's disease


Alzheimer's disease can be overwhelming for both the patient and the patient’s loved ones. In the early stages of Alzheimer's disease, patients and their loved ones may become frustrated with memory loss or the inability to complete simple tasks. This may result in depression or anger. As the disease progresses, patients usually experience more substantial dementia that may affect their ability to perform self-care tasks such as bathing and dressing and may require professional care in a nursing home.

Alzheimer's disease also presents certain safety issues. For example, people with Alzheimer's disease are more likely to be injured around the home. Injuries may be caused by falls that occur when the parts of the brain responsible for balance and coordination are affected. Additionally, the memory loss that is associated with Alzheimer's disease may make it unsafe for patients to cook (especially over a direct heat source), drive and otherwise live independently. It may be necessary to take certain safety precautions in the home, such as installing railings around the bath or shower and setting the water temperature to a lower level to avoid scalding.

Family support is an essential aspect of Alzheimer's care and treatment. It is important that loved ones understand the patient’s limitations and adjust their behavior and communication strategies accordingly. As the disease progresses, patients may exhibit strange behavior such as aggression or forgetting the names of immediate relatives. This can be a traumatic experience for close friends and family. In some cases, individual or group therapy is beneficial for those coping with the consequences of Alzheimer's disease in a close friend or family member.

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Prevention methods for Alzheimer's disease

Prevention methods for Alzheimer's disease


There is much that is unknown about Alzheimer's disease, including the cause or causes and how to slow or stop its progress. Because of this, Alzheimer's disease is a difficult disease to prevent.

There is some evidence that indicates that people who sustain severe head injuries are more likely to develop Alzheimer's disease later in life. For this reason, it is important to always wear a seatbelt while traveling in a car and to wear protective headgear while operating a motorcycle or bicycle, or while playing contact sports.

Other studies have shown that oxidative stress, the process of cell damage by free radicals, contributes to the risk of developing Alzheimer's disease. Oxidative stress can be prevented by consuming foods that are high in antioxidants, such as olive oil, fish and fresh fruit and vegetables. It can also be prevented by taking supplements of vitamin A, C and E, although a physician should always be consulted before starting any supplements.

It is also becoming clear that maintaining brain health by remaining physically and mentally active throughout life, especially in later life, is important. This includes controlling weight, blood pressure and cholesterol levels. It is not known whether physical and mental activity directly reduce the risk of developing Alzheimer's disease, but scientists agree that it appears reasonable that keeping the body and mind healthy is beneficial on many levels.

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Treatment options for Alzheimer's disease

Treatment options for Alzheimer's disease


At this time, there is no cure for Alzheimer's disease, nor is there any way of slowing the progress of the disease. However, there are treatment options available that can minimize or stabilize patients’ symptoms, and in some cases delay the necessity of nursing home care.

A physician may prescribe medication for cognitive symptoms (e.g., memory loss, loss of language function). Some Alzheimer's medications are designed to maintain the levels of a brain chemical called acetylcholine. Acetylcholine is a neurotransmitter, which means that it carries electrical signals from one neuron to another. This chemical is essential for memory, judgment and learning. Medications that delay the breakdown of acetylcholine are called cholinesterase inhibitors. These medications may not be as effective among patients with advanced disease. Other Alzheimer's medications regulate the function of another neurotransmitter, glutamate, which is important for learning and memory. Studies have shown that these two medications — the cholinesterase inhibitors combined with glutamate receptor blockers — may be more effective than either medication used alone with severe disease.

It is thought that Alzheimer's disease may be caused or exacerbated by the presence of free radicals, a type of molecule that can damage cells and has been known to cause cancer and other medical conditions. Some physicians might recommend vitamin E, an antioxidant, used in combination with other antioxidants to reduce oxidative damage to the brain.

Behavioral or psychiatric symptoms may first be treated with methods other than medications. This usually includes identifying the potential trigger for the symptoms and attempting to resolve it. Many times this involves making adjustments to the environment that the patient lives in, for example simplifying the environment or increasing the time between stimulating events (e.g., bath-time, getting dressed). A few studies have also examined the use of aromatherapy to reduce agitation and dementia. Other possible interventions include massage therapy, exercise, and even pet therapy.

In addition to non-drug methods, a physician may recommend certain medications to control behavioral or psychiatric symptoms. It is important that these medications be used with caution because people with dementia are more likely to experience severe side effects than most people. Medications that may be prescribed for patients with behavioral or psychiatric symptoms include:
Antidepressant medications to treat depression and low moods

Anti-anxiety medications to treat anxiety or verbally disruptive behavior

Antipsychotic medication to treat hallucinations, delusions or aggression

Medications to treat sleep problems

In recent years, numerous complementary and alternative therapies and supplements have been promoted for Alzheimer’s disease and its symptoms. However, in most cases, these treatments have not been studied in clinical trials and have not been approved by the Food and Drug Administration (FDA) for use by Alzheimer's patients. Many alternative treatments are marketed as dietary supplements, which only have to prove they are safe. They are not tested for effectiveness in treating a disorder. Some alternative treatments include:
Coenzyme Q10. An antioxidant that occurs naturally in the body and may help reduce the presence of free radicals.

Ginkgo biloba. An herb that is claimed by some to improve memory. The National Center for Complementary and Alternative Medicine (NCCAM) is conducting a long-term study on the use of ginkgo biloba in healthy elderly people to prevent the onset of dementia.

Huperzine A. An herbal supplement that may function in a similar way as cholinesterase inhibitors.

Phosphatidylserine. A type of lipid (fat) that may protect nerve cells from degenerating.

Omega-3 fatty acids. These fatty acids are already known to be protective of the heart, and populations that consume large amounts of omega-3 fatty acids such as those found in fish oil appear to have a reduced incidence of Alzheimer's disease. However, clinical trials have not shown any affect on the course of the disease once symptoms have begun to show. Rather, it appears that omega-3 fatty acids might have a protective, long-term effect.

It is important to discuss the use of alternative treatment methods with a physician before they are started. Some alternative remedies could interact with prescribed medication or lead to more serious health complaints.

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