1 Million Kids With Asthma Wrongly Prescribed Antibiotics Yearly

May 25th, 2011

When should doctors prescribe antibiotics to treat asthma? “The answer in 2011 is that they shouldn’t,” says Ian M. Paul, M.D., associate professor of pediatrics at the College of Medicine at Penn. State. Yet Paul and his colleagues have found that doctors do – about a million times a year.

Their study, published online May 23 and in print in the June issue of Pediatrics, looked at more than 60 million cases where children across the U.S. visited their doctors or the emergency room for asthma treatment from 1998 to 2007. They found that antibiotics were prescribed inappropriately at as many as 1 in 6 of these visits.

Healthcare experts have long been concerned about the over-prescribing of antibiotics because it can lead to the evolution of bacteria that is antibiotic resistant. The only time children with asthma should receive antibiotics is if they have an additional diagnosis – maybe a bacterial infection such as pneumonia – where the drugs would be needed.

Based on this study, researchers couldn’t determine why exactly doctors ignore guidelines and prescribe antibiotics for asthma. But they did note that children who received systemic corticosteroids (indicating a more severe attack) to treat their asthma were also more likely to receive antibiotics. “I can surmise from that that those kids were sicker, and the doctor wanted to throw the kitchen sink at it,” says Paul. Also, because asthma and pneumonia share some signs and symptoms, it is possible doctors prescribe antibiotics when they aren’t certain of their diagnosis.

Surprisingly to Paul, this is less likely to happen in emergency departments than at the doctor’s office, though the study offers no clues as to why. But in either type of visit, discussion with the doctor is key. “We found that when the doctors spent the time to educate families about asthma, they were 50% less likely to prescribe antibiotics,” Paul says. So parents should ask a doctor prescribing antibiotics to their asthmatic child what the medication is supposed to treat. If the doctor seems uncertain about the diagnosis, it’s reasonable to ask about a 24-hour waiting period to see whether asthma medications help with your child’s symptoms. “It’s really about communication with your doctor,” Paul says. Either way, ultimately, you’ve got to trust your doctor, so make sure your doctor is someone you trust.

Post-baby weight gain raises diabetes risk in next pregnancy

May 24th, 2011

Women who gain weight after giving birth for the first time dramatically increase their risk of developing pregnancy-related diabetes during their second pregnancy, a new study suggests.

Compared with women of similar height who maintain their weight, a 5-foot-4 woman who gains roughly 12 to 17 pounds after giving birth more than doubles her odds of developing diabetes during her second pregnancy, the study found. If she gains 18 pounds or more, she more than triples her odds.

(The study used body mass index, a ratio of height to weight, so problematic weight gain will vary according to a woman’s height.)

Diabetes diagnosed during pregnancy, known as gestational diabetes, is influenced by hormonal changes and normal weight gain and usually goes away after the baby is born.

It can lead to birth complications, however, and it also increases a woman’s risk of developing type 2 diabetes later in life. In addition, it makes the baby more prone to diabetes and obesity as he grows up.

The findings underscore how important it is for women to lose their baby weight and keep postpartum weight gain to a minimum, the researchers say. This applies especially to those who are overweight or obese at the start of their first pregnancy.

The overweight women in the study who lost weight post-birth substantially lowered their risk of gestational diabetes compared with those who maintained their weight.

“We acknowledge that this is not an easy thing to do,” says the lead author of the study, Samantha F. Ehrlich, a researcher at Kaiser Permanente, in Oakland, California. “It’s quite common for women to gain weight.”

The study, which appears in the June issue of the journal Obstetrics & Gynecology, included 22,351 ethnically diverse women who were members of the Kaiser Permanente health plan in Northern California. The overall rate of gestational diabetes during the women’s first pregnancy was 4.6%, and during the second it was 5.2%.

Less than 10% of the women in the study lost weight between pregnancies, which isn’t surprising given the new stresses and responsibilities that come with a newborn.

Having a baby causes a host of changes to a mother’s life and lifestyle that can influence her eating patterns, exercise habits, and work-family balance, says Truls Ostbye, M.D., a professor at Duke University Medical Center, in Durham, North Carolina, who studies postpartum obesity but was not involved in the current research.

“Many of these changes make it hard to return to a healthy weight,” he says. “But the period can also be seen as a teachable moment for positive change. [It] can be time when the mother — and the rest of the family — can refocus on a healthy lifestyle and set the new baby on a lifelong healthy trajectory.”

Pregnant women should walk regularly (with or without a stroller), keep snacking to a minimum, and avoid soda and other sugary drinks, Ostbye says. Breast-feeding can also make it easier for women to shed pregnancy pounds.

Women who breast-feed their babies for at least six months are more likely to achieve a healthy weight after pregnancy, Ostbye adds. Ehrlich and her colleagues are currently studying a weight-loss program, which includes weekly telephone coaching sessions, specifically tailored to help women with infants exercise and eat well.

“We believe that something that’s based on the telephone or a website would be easier for new moms to do than having to go somewhere to have classes,” she says.

How to Stop Incontinence From Sabotaging Your Sex Life

May 20th, 2011

It’s bad enough worrying about whether you’re going to make it to the bathroom on time to avoid an accident. But worrying about leakage during sex — that can really bring you down. If incontinence is sabotaging your sex life, at least you’re in good company. According to the American Foundation for Urologic Disease (AFUD), one in three women with stress incontinence avoids sexual intimacy because of fear of leakage during intercourse or orgasm.

5 Ways to Fix a Leaky Bladder Without Surgery

But don’t despair: Here’s a seven-step plan for coping with incontinence and getting your sex life back on track.

1. Prepare for sex.

One thing to take into account is when during sex you’re more likely to leak: If you have stress incontinence, you’re more likely to leak with penetration due to pressure on the bladder. If you have urge incontinence, you’re more likely to leak during orgasm. (Since women’s orgasms often don’t happen during intercourse, you can prepare for that moment separately.)

Either way, there are lots of things you can do to decrease the likelihood of involuntary leakage during sex while you’re working on a longer-term solution. You’ll need to experiment to see which of these makes a difference for you:

  • Avoid coffee or tea for several hours prior to sex.
  • Drink plenty of water well before having sex, but don’t drink any fluids for an hour before sex.
  • Practice “double voiding” prior to sex: Go the bathroom, then fully relax the bladder (some people recommend massaging the abdomen) and go again.
  • Put towels down, so you’re not worrying about linens if you do leak.
  • Don’t be shy about taking a “bathroom break” during sex. For women with urge incontinence, taking a bathroom break between foreplay and intercourse or between intercourse and “after-play” can make sex much more relaxing.
2. Talk about it.

No, this probably isn’t an easy topic to bring up with your partner. But isn’t it worth a few minutes of blushing if the payoff is returning to your previously joyous sex life? You might start by mentioning that you’ve been to the doctor to get help with a problem you’re really embarrassed to discuss. Tell your partner how much you miss your formerly great sex life together, and let him know that your reluctance hasn’t been because of lack of interest but because of fear of leakage and embarrassment.

You may be pleasantly surprised by your partner’s supportive reaction; it’s likely that the problem isn’t nearly the issue for him you’ve been thinking it is. After all, men have aging-related issues that affect their sexual performance, too. Your guy is probably all too familiar with the fear and shame that can accompany age-related changes affecting sex. If talking privately isn’t solving your sexual issues, working with a couples counselor or sex therapist can make it easier to talk about difficult topics.

3. Experiment with new sex positions.

Now this one your partner should have no trouble getting on board with. Here are some options to try:

  • Rear entry. When he stands or kneels behind you, it puts less pressure on the bladder and urethra.
  • Side entry. Another position that prevents his weight from being on your abdomen and relieves pressure.
  • Woman on top. When you’re on top, it’s easier to control the depth of penetration and to work those deep pelvic muscles you’ll want to strengthen.
4. See a specialist.

Ask your doctor for a referral to a urologist who specializes in incontinence. This isn’t an easy topic to bring up, but knowing how common it is might make it easier. Experts estimate that nearly one out of three women over age 40 struggle with incontinence at some point, but only 20 percent of them seek help. Wouldn’t you rather find a solution than remain a silent sufferer? Specify that you’d like a recommendation for someone who keeps up with recent research and training and is familiar with newer, more experimental therapies, such as biofeedback.

If you have any friends with whom you’d feel comfortable discussing this issue, ask if they’ve found a doctor they like. Personal referrals are a great way to find specialists who “get it.” Some hospitals and medical centers have specialized bladder health clinics where you’re likely to get up-to-the-minute expertise.

5. Strengthen your muscles with pelvic floor therapy.

Working with a physical therapist, you can rebuild strength in the deep abdominal muscles that support the bladder, using a program of exercises known as Kegels. (Many women try doing pelvic floor exercises on their own and don’t get the full benefit because they’re not doing them correctly.) Working with a pelvic floor therapist (PFT) with specialized training has been shown to increase the effectiveness of Kegels; one study found that when women worked with a PFT, 80 percent were able to control their incontinence.

Two additional techniques can boost the effectiveness of pelvic floor therapy:

  • Biofeedback. Computers attached to sensors can help you and your physical therapist know which muscles you’re working, measure muscle strength, and check whether you’re doing pelvic floor exercises correctly. Kegels can have the additional benefit of strengthening the muscles in the vaginal wall, so you and your partner may notice a sexual benefit as well. Interestingly, sex is great for the Kegel muscles, so as your revitalize your sex life, you may strengthen your bladder control as well.
  • Electrical stimulation. Some clinics offer electrical stimulation (also called pelvic floor muscle electrical stimulation, or PFES) in combination with biofeedback for people with severely weakened pelvic floor muscles. A low-grade electric current causes the muscles to involuntarily contract so patients can experience what that contraction feels like, learn to replicate it themselves, and regain muscle control.
6. Practice bladder control.

Your urologist can work with you on a process known as “bladder retraining,” which involves determining your natural pattern of urination, then setting up and following a fixed schedule of timed toilet trips, whether you feel like going or not. When you feel the need to go between intervals, you buy time by using urge-suppression techniques such as Kegels, distraction, and relaxation. You’ll also learn techniques, such as double voiding, to completely empty your bladder when you go. Over time you’ll work to increase the intervals between bathroom trips and the amount of liquid your bladder can hold.

7. Try medication.

Many doctors consider medication for incontinence a last resort, but if you’ve tried bladder retraining and pelvic floor exercises, and incontinence is still seriously impacting your sexual relationship, then medication is a smart next step. There are a number of drugs classed as anticholinergics and antispasmodics that block the signal that triggers involuntary contractions of the bladder. Some of the most popular are Detrol, Enablex, Sanctura, Ditropan, Toviaz, Vesicare, and generics containing the active ingredient oxybutynin.

In recent years, timed release once-a-day versions of these drugs have become popular. But if incontinence during sex and exercise is your primary concern, ask your doctor whether it’s more effective to take an older, multidose formula. Some women say taking one dose of a multiple-dose drug just prior to sex works better than one dose a day

What You Can Do to Prevent Urinary Tract Infections

May 19th, 2011

As women, most of us will get a urinary tract infection (UTI) at some point in our lives. Some women will get many. But there are steps that you can take to help prevent the majority of UTIs.

UTIs explained

UTIs are bacterial infections that occur in the body’s system that produces and excretes urine.  Sometimes referred to as bladder infections or cystitis, the primary symptoms are painful and frequent urination. In more serious cases, UTIs can extend up into the kidneys, called Pyelonephritis. Infections in the kidneys can produce back pain in the area known as the flank. Some infections lead to bleeding in the bladder and produce a condition known as hemorrhagic cystitis. Left untreated, UTIs can be damaging and dangerous.

Women are more prone to UTIs than men because the tube that carries urine from the bladder to the outside (the urethra) is shorter in women. So it’s easier for bacteria to get to the bladder. Anything that pushes bacteria up toward the bladder (the holding area for urine) makes a UTI more likely. So, it makes sense that anything that pushes the bacteria away from the bladder will make a UTI less likely.

Common causes of UTIs

  • Some common things that lead to increased bladder infections are wiping from back to front (after a bowel movement), having sex, and not drinking enough fluids:
  • Wiping from back to front pulls the bacteria from the rectal area up to the urethra where it makes a quick trip into the bladder.
  • Having sex causes bacteria to be pushed to the urethra, which then travels into the bladder.
  • Not drinking enough fluids can also cause a problem. Adequate fluid intake ensures that the bacteria is diluted and washed away from the bladder.

Three things you can do

  1. Always wipe front to back. Girls should learn this at a young age and it should become a life-long habit.
  2. After having sex, be sure to go urinate. The process of urination will wash away the bacteria that have been pushed up to your urethra during sex.
  3. Always drink plenty of water every day. Water will filter right into the bladder and effectively wash away all of that bacteria. Also helpful, cranberry juice is the one juice that will remain acidic as it filters into the bladder. Because of its acidic nature, cranberry juice is unfriendly to the bacteria and can be helpful in keeping infections away. And, it’s also important to know that caffeinated beverages are not helpful–they will often dehydrate you and create more bladder infection issues.

If despite these precautions, you still do get a bladder infection, see your healthcare provider and get treated quickly. It is important to treat the infection early before it spreads to the kidneys and becomes a damaging, dangerous infection

Menopause: Your Own Private Summers

May 19th, 2011

I watched with great wonder as my friend Marsha came to work last February through the snow in a sleeveless dress. “I have my own private summers,” she shared with me while fanning herself wildly as beads of sweat formed on her brow.  Now, I like hot weather, but I’m not looking forward to my own private summers when even snow can’t stop the heat! Yet as time marches on I know what’s ahead – menopause!

When does menopause begin?
Menopause is considered to have occurred after one year without a menstrual period. The average age of menopause in the U.S. is around 51, but that can vary drastically from one woman to the next. The time prior to actual menopause is called perimenopause. Symptoms vary from non-existent in some to severe in others and may last a brief time or up to five to ten years. And unfortunately, once menopause has occurred the symptoms may continue for many years in some women. It is impossible to predict how different women will be affected.

Common signs of menopause
The most common signs of menopause include hot flashes, sleeplessness, fatigue, mood changes, and vaginal dryness. Relief can be found in hormone replacement therapy (HRT) if you and your medical provider decide this is right for you. But, the use of HRT has been met with controversy in recent years due to the increased rate of breast cancers among its users. Therefore, the latest recommendation is to use HRT for symptom relief only for the limited years that symptoms are an issue. If HRT is not right for you, relief may be found in other medications, some herbal preparations, or even meditation and simple awareness of this next phase of life. All therapies should be researched and discussed with your healthcare provider. Education and knowledge are your greatest resources to making it through this transition of life.

There are benefits
Personally, I am looking forward to the decline in migraine headaches that menopause brings with it. Also, I think not worrying about birth control will be liberating. And, not having periods will be outstanding! Maybe I can find a way to enjoy my own private summers – I’ll just need to find my own private tropical island. Hopefully, you can too.