MASTITIS

Molly couldn’t wait to bring her newborn son home from the hospital. She pictured herself breast-feeding Joey in cozy comfort, tenderly caressing his tiny head while gently rocking in the oak rocker.

But molly’s picture-perfect vision of breast-feeding soon developed an ugly blot. After a few weeks, one of her breasts became so tender and swollen, it was hard to tell who wailed louder, Joey or Molly.

Fortunately, a call to her doctor reassured Molly that she was experiencing a mild form of mastitis, an inflammation of the breast that commonly occurs in nursing mothers in the first weeks after birth. Much to her relief, Molly learned that she would not have to give up breast-feeding. In fact, breast-feeding is the prescribed treatment for mastitis.

The Case of the Clogged Duct

When a nursing mother develops a painful area in her breast and there’s no fever, it’s usually caused by a plugged milk duct. This occurs when the breast is not emptying as completely as it should. The milk backs up in the duct, resulting in inflammation.

Take Molly’s case, for example. A few weeks after Joey’s birth, she returned to work. Up until that time, Joey had nursed on and off all day, which stimulated Molly’s breasts to product lots of milk. When Molly’s work schedule abruptly cut back on the nursing schedule, her milk supply exceeded the demand. Her breasts became overly full and, by late afternoon, sore and swollen.

To make matters worse, because her breasts ached, Molly rushed nursing Joey, leaving her breasts only partially drained. Overnight, her right breast became tender, and she stopped nursing from that breast entirely, which was the worst thing she could have done. As a result, milk backed up, a duct clogged, and her sore breast turned scarlet and throbbed like the dickens.

This is a classic example of inflammatory mastitis. “When an abrupt change in the nursing pattern occurs for any reason, it sets the stage for plugged ducts and mastitis,” says Karen Ogle M.D., associate professor of family practice at Michigan State University in Lansing. Also common: Babies who previously nursed all night suddenly become sound sleepers, leaving Mom with breasts filled to the brim.

Your Breast Plan

What can you do to prevent or treat aching, throbbing breasts?

Lessen your load. “Always nurse at the first feeling of fullness,” says Dr. Ogle. Your baby’s body should be fully facing the breast during nursing. This helps him to latch on to the nipple properly and to thoroughly empty the ducts of milk. “If you are away from your baby, hand express or pump enough milk to relieve the overfullness,” says Dr. Ogle.

Break through the pain. If, like Molly, your breast becomes inflamed, you must continue to nurse to drain it. “Despite the discomfort, now is not the time to wean to the bottle,” said Dr. Ogle. Stop nursing when you have inflammatory mastitis, and you risk causing an abscess, which will have to be surgically drained.

Once inflammation subsides, however, you can wean by cutting back one feeding at a time. That way, your breasts will gradually slow down milk production.

But for now, while the inflammation persists, try to breast-feed every 1 to 2 hours, followed by gentle hand expression or pumping if necessary to relieve the plugged duct. Begin nursing on the unaffected breast until you feel milk ready to flow from the inflamed breast, then switch sides. Take acetaminophen for pain and drink plenty of fluids.

Apply a little warmth. To encourage the milk flow, apply a warn, wet towel to the sore breast before nursing. You may also help loosen a plugged duct by learning over a basin of warm water and immersing your breast before nursing.

Free your breasts. Check your bra. It shouldn’t be so tight that it constricts milk flow. Also avoid sleeping on your stomach for prolonged periods, which can cause pressure against your breasts.

When to Call the Doctor

If, despite following these tips, your breasts remain sore and red for 24 hours or you have a fever, chills or other flulike symptoms, call your doctor. It probably means you’ve developed infectious mastitis.
Infectious mastitis is caused when a bacterium such as staphylocossus aureus. The mother’s body, perhaps through a cracked nipple, and the organism settles in a milk duct.

In any case, you’ll need an antibiotic to clear things up. Stick with the full course of drugs your doctor gives you, so that re-infection doesn’t occur.

Once again, continue to breast-feed. “Don’t worry about passing the infection on to the baby,” says Dr. Ogle. It’s the breast tissue that’s infected, not the breast milk. The antibiotic that passes into the breast milk is probably fine for your baby, but you should check with your doctor to be sure.

A final Rx: Rest. You need it to build your resistance and to counteract stress, which can hamper the free flow of milk.

GUM DISEASE

For people overage 35, gum disease outranks boxing, car accidents, ice hockey, hard candy and saltwater taffy as the leading cause of tooth loss. Three out of four adults Americans will have either the mild form of gum disease––gingivitis––or the severe form––periodontitis, or periodontal disease––at some point in their lives.

Despite such statistics, nine out of ten cases of gum disease could be prevented with simple, regular care, says William Clark, D.D.S., professor of oral biology and director of the Periodontal Disease Research Center at the University of Florida College of Dentistry.

We’ll tell you exactly what proper care of your gum entails, but first, a brief explanation of how gum disease does its dirty work.

The Plaque Attack

Gum disease starts with plaque. Plaque is a particularly loathsome, sticky concoction of mucus, food particles and bacteria that forms in the tiny spaces between your teeth and the gum line. Left to sit long enough, plaque can harden into a rock-hard substance called calculus.

In gingivitis, the plaque or calculus irritates and infects the gums. Your body’s natural defenses against infection make the gums swollen and shiny, and they bleed easily when you brush or floss. As the gums swell, pockets form between the teeth and gums, providing a cozy home for even more plaque.

Gingivitis may lead to periodontitis, a severe form of gum disease caused by bacteria. In good health, the tiny culprits inhabit your mouth in very low numbers. However, poor oral hygiene gives them the green light to multiply, says Dr. Clark. They move into the pockets caused by gingivitis, and your mouth becomes a battleground. The bacteria try to gain a foothold, releasing toxins and enzymes to battle the fighter cells created by your own immune system.

The ongoing war eats away at your bones, gums and connective tissue, and over the years, your teeth loosen in their sockets. Cementum, the sensitive tissue enveloping the roots, becomes exposed, and you feel pain when you eat hot or cold foods. Occasionally an abscess will form in the pocket, and the infection will destroy yet more bone.

In both forms of gum disease, one telltale sign is bad breath. Periodontitis also brings a bad taste in the mouth.

Preventing Gum Disease

Ask anyone with dentures: Real, healthy teeth are better than false ones. Prevent gum disease, and you should keep your teeth forever. It’s not so hard to do.

Brush daily. Let’s see, when did you first hear this one? Brushing gently after every meal is best, Dr. Clark says, “But you probably don’t need to take your toothbrush to work.” (Still, it’s a good idea, so at that important meeting you’re not caught with broccoli between your teeth.)

Is brushing best done with a plain old toothbrush, with an electric one or with a more expensive gadget that shoots water into gums? It really doesn’t matter. “Electric toothbrushes are no better for most people, but they may help if you have trouble with dexterity,” says Dr. Clark. An electric toothbrush may be more entertaining to use, so you may find yourself brushing more often––which is good. Thinking about the money you shelled out may also encourage you to brush more often!

Floss frequently. “At least three or four times a week is usually enough for most people, although flossing every day is best,” says Dr. Clark. Floss cleans between teeth, where bristles often can’t go.

Get regular professional cleanings. Even with good brushing and flossing, plaque can still form below the gum line. A visit to your dentist once every six months should be enough to keep the plaque at bay. “If your gums bleed when you brush, or if they’re puffy looking, you may need cleaning more than twice a year,” says Dr. Clark.

Try a mouthwash. This is purely an extra for your arsenal. Mouthwash can kill bacteria, but it’s no substitute for brushing, flossing and cleaning.

Use a toothpick. Especially handy when you can’t brush or floss, a toothpick can get rid of the big hunks of food and stimulate your gums. Be very gentle, though, to avoid stabbing your gums.

Stop smoking. One study says smoking doubles your risk of gum disease. While there’s no proof smoking actually causes gum disease, there’s plenty of evidence that it suppresses the immune system,” and that makes it harder for your body to fight the infection and makes the infection more resistant to treatment,” says Dr. Clark.

Treating Periodontitis

Periodontal disease is irreversible, at least for now. “But if you have it, you can keep it from getting worse,” says Dr. Clark. With the kind of treatment outlined below, you may be able to stop your pain––sand save your teeth.

Pocket probing, which can measure the space between gum and tooth, shows your dentist how deep your pockets are (perioontitis-wise, not money-wise). But the traditional manual probe is slow and imprecise. You may benefit from the newer computerized probe in which a slender wire is inserted into the pocket and withdrawn in one-tenth of a second. The computer-aided probe is quicker and able to make more accurate measurements than the old-fashioned manual kind.

Planning and scaling––a very thorough cleaning of plaque and calculus from tooth and root––is the first line of attack in halting existing gum disease. One form of the procedure woks best on front teeth, using anesthesia to go deeper than usual. This method can take 10 minutes per tooth but usually causes less gum shrinkage than surgery. For planning and scaling to have a chance to work, you have to follow up with your own commitment to faithful brushing and flossing.

Fiber-optic probes can be used instead of surgery for moderate periodontitis. Entering an incision so tiny that it doesn’t need stitches, the probe pushes gum tissue aside and shines a light on the root surface, enabling the dentist to scrape off calculus. You might call this “Scraping-edge” technology.

Antibiotics are often used in conjunction with cleaning or surgery, says Dr. Clark. Oral tetracycline is the most commonly used antibiotics, and more severe cases often call for amoxicillin. One new form or tetracycline comes in plastic fibers that are placed under the gum line, slowly releasing the medication over ten days, killing bacteria while reducing pockets.

Surgery may be needed in more advanced cases of gum disease. The octor makes tiny incisions around the neck of the tooth to expose the root and bone, enabling a more thorough cleaning, removal of diseased tissue and a possible reshaping and even grafting of damaged bone and gums.

ROCKY MOUNTAIN SPOTTED FEVER

If you’re shooting off the Rockies for some skiing this winter, don’t let fear of Rocky Mountain spotted fever spoil your vacation.

First, the peak season for Rocky Mountain spotted fever is summer––not winter.

Second, even though the disease was first identified in the Rocky Mountain states, it’s actually most common in Oklahoma, Tennessee and the Carolinas.

Third, no matter which state you are in, and no matter what the season, Rocky Mountain spotted fever is hardly anything to worry about. In order to be infected, you first have to get bitten by a trick––and not just any tick. The tick has to be one of three varieties capable of carrying the disease. In addition, your personal tick has to be infected with Rickettsia rickettsii, the bacteria that cause Rocky Mountain spotted fever. And the tick usually has to hang on to your skin for quite some time before passing on the bacteria. The chances of all of the above happening to you are, well, quite slim. According to government statistics, fewer than 700 Americans a year get the disease.

While this disease is nothing to stay awake worrying about, it’s nothing to laugh at either. Rocky Mountain spotted fever can be a nasty disease, starting with flulike symptoms and progressing to delirium, pneumonia and, in some cases, even worse fates. It is treatable, but without treatment, one person in five can die, say John Krebs, a public health scientist with the federal Centers for Disease Control in Atlanta.

Staying Tick-Free

The best way to prevent Rocky Mountain spotted fever (as well as other tick-borne illnesses, such as Lyme disease) is to stop ticks from having dinner on you. Experts recommend the following.

Sport the buttoned-down look. Whenever heading into wooded or grassy areas in the summer or spring, don long pants, preferably tucked into high socks, and long-sleeved shirt to keep the creepy-crawlers away from your (to them) appetizing skin. It also helps to wear light-colored clothing. This makes ticks––which look something like small watermelon seeds––easier to spot and remove before they grab hold.

Remove attached ticks quickly. A feeding tick is disease waiting it happen. The longer it feeds, the greater the chance it will pass something on to you. “Transmission is unlikely if you remove the tick within 24 hours,” says William A. Petri, Jr., M.D., Ph.D., an assistant professor of internal medicine and microbiology at the University of Virginia in Charlottesville.

“The best way to remove a tick is simply to grasp it near the head, preferably with tweezers, and slowly extract it,” says Krebs. Try not to crush the tick, since that can spread harmful bacteria. After you’ve removed the tick, wash the area of the bite with plenty of soap and water. Incidentally, forget about using gasoline, petroleum jelly or other “simple” techniques for removing ticks, says Krebs.

Be repellent. When venturing into a wooded or grassy area on a summer day, particularly in an area known to harbor disease-carrying ticks, apply insect repellents containing DEET to your arms, legs and head. For added protection, you can spray your clothes with repellents containing the chemical permethrin.

Shield your pets. Sure, Fido loves picnics. Unfortunately, ticks love Fido. It is possible for dogs to get Rocky Mountain spotted fever, says Krebs. They may also bring disease-carrying ticks home, where they can hop on you. Protect all the members of your family by buckling your pets into tick-and-flea collars before allowing them to frolic in high-risk areas. While some of these collars are quite effective, they are no guarantee that your pets will arrive home tick-free. It’s best to also give them a good inspection as they enter the door.

Postbite Action

Should you get infected, it’s essential to get to the doctor as soon as you can. How do you know you’ve been infected? The first symptoms of Rocky Mountain spotted fever are headache, fever and muscle pain, which usually hit about a week or so after the tick passed you the germ, says Dr. Petri. “People will say it’s the worst headache they’ve ever had, and they’ll have muscle aches just everywhere.”

A rash usually appears three to four days after the first flulike symptoms appear. It typically begins on the ankles and wrists, then spreads to the trunk, the palms of the hands and the soles of the feet. Without prompt treatment at the point, the disease can then cause delirium, pneumonia, low blood pressure and vasculitis, an inflammation of the inside of the blood vessels that can “affect every organ in your body,” Dr. Petri says.

While the rash usually appears early, one person in ten won’t get it until the disease is well advanced, and another one in ten won’t get it at all. Don’t wait for the rash before getting help, Dr. Petri advises. If you’re sick and even suspect Rocky Mountain spotted fever, you must see a doctor. He’ll give you tetracycline, doxycycline or other antibiotics, which should knock out the infection within days.

Indirect Methods of Determining Body Composition

Under Weighing. This Method (called densimetric) is based on the fact that fat tissue is lighter than other body tissue-bones, muscle, blood, and water. The person is weighed while submerged underwater, with as much air as possible exhaled from the lungs. he or she is then weighed normally on the ground. By using a formula based on the two weights, the percentage of body fat can be determined.

Skin fold thickness. About 50 percent of back fat situated just below the skin, and by measuring folds of skin on certain part of the body, the percentage of body can be estimated. The most accurate measurement are obtained by using calipers; indicative body sites include the triceps (the skinfold on the back of the arm midway between the shoulder and elbow), the sub scapular area below the shoulders blades, and the area justa above the hip bone.

Total body water (hydrometry). Most fat free tissue (muscle) contains water, while fat tissue has very little. Therefore, measurement of total body water provides an estimate of Fat Free Mass (FFM). One approach to this measurement is taken by injecting a known amount of a substance that distributes itself throughout the body’s water compartments. A blood sample, taken after enough time elapsed for the substance to reach a stable concentration in the body, reveals the substance’s distribution in body water, allowing the tester to measure total body water and from that to calculate the amount of FFM. The result obtained by subtracting FFM from total body weight is the body fat content. Another approach is by putting two electrodes on a limb and measuring resistance to an electric current. The amount of electric impedence measures body water.

Whole body potassium. Almost all of the body’s potassium is contained in cells other than adipose tissue. A naturally occurring isotope of potassium exists as a fixed proportion to all potassium found in the body. The radioactive portion can be measured by counting the gamma rays it emits, and this can be used to estimate the total potassium. The greater the amount of potassium in relation to body size, the smaller the percentage of body fat.

How to Help an Adolescent with a Weight Problem

The following are tips for families and friends of adolescent with a weight problem.

DO:

• Comment favorably on constructive changes in the teenager’s eating habits.
• Compliment the teenager for avoiding situations hat trigger overating.
• Keep problem foods (high-calorie, high-fat foods) out of sight, and preferably out of the house.
• Stock tasty low-calorie foods such as skim milk product, fresh fruits, and raw vegetables in the cupboard and refrigerator.
• Encourage the teenager to plan meals and to choose healthful, low-fat cooking methods

Don’t:

• Be pessimistic
• Scold or nag if the teenager fails to keep to the diet plan; negotiation is a better approach.
• Tell other people about any failure or back sliding on the teenagers part.
• Offer food that is forbidden. (“A little won’t hurt you.”).
• Offer foods as a sign of affection. (“But I prepared it especially for you.”)

DANDRUFF

Intelligent and hardworking, Dusty Chalders has a good job, a loving wife and healthy, obedient children. He also has a little problem.

“Hey, Dusty, is it snowing out side?”
“Say, Dusty, did you drop your powder puff?”
“Yo, Dusty, have you been painting today?”

After fielding hundreds of personal comments from a few insensitive “friends,” Dusty went to his doctor for help. “Doc, you’ve got to help get rid of this dandruff,” he pleaded. “I can’t even wear my good blue suit.”

Getting A Little Flaky

Doctors aren’t sure why, but sometimes skin cells on the scalp proliferate-form, die and flake off-at an accelerated rate. “Dandruff is skin that comes off as a cohesive chunk,” says Guy F. Webster, M. D., an assistant professor of dermatology and director of the Center for Cutaneous Pharmacology at Thomas Jefferson University Hospital in Philadelphia. “It gets worse in the winter, when the air is dry, because each individual flake is less prone to stick to your scalp if it’s not moist.”
While dandruff can be itchy, and perhaps a little unsightly, the biggest concern you probably will ever have is putting up with its appearance-and perhaps a few jokes. Because dandruff is present in nearly everyone, it’s hard to call it a disease.

Dermatitis by Another Name

The problem with dandruff, however, is that it can be a serious problem cosmetically. Some people get dandruff so badly that it can dump a veritable snowstorm on their shoulders day after day. This type of flaking is called seborrheic dermatitis, a disease characterized by a profusion of flaky, itchy head scales.

In fact, dandruff and seborrheic dermatitis are so much alike-they’re even treated alike-that some doctors believe they simply are variations of the same condition. “Some people believe they’re part of a spectrum, that the most mild form of scaling disease is dandruff and that if it’s a little worse, it becomes seborrheic dermatitis,” Dr. Webster says.

But there are differences. Dandruff usually stays at home on the scalp, but seborrheic dermatitis can wander to the eyebrows, outer ears and other parts of the body. It is also accompanied by inflammation and can be quite itchy as well.

Both, however, are needless embarrassment, says Dr. Webster, because it isn’t necessary to bear either of them on your shoulders. Dandruff and seborrheic dermatitis can easily be controlled. All it requires is a little attention to your hair a little more often than you are currently used to.

The Soap and Water Cure

If you have dandruff, says Dr. Webster, chances are you are not washing your hair often enough. Since dandruff is nothing more than flaking skin, washing it away will get rid of it. How fast the flaking proliferates should determine how often you wash your hair, not whether or not your hair feels dirty. The same goes for seborheic dermatitis. The more you wash away, the less you have to display.

Every day is best. Some people can wash their hair once a week and still be dandruff-free, Dr. Webster says. People with dandruff problems usually have a problem only because they let it go too long. The notion that shampooing causes dandruff by drying out the scalp is simply not true. Washing your hair-every day, if possible-can be the cure. But you also need to know how to wash it right.

Get the right shampoo. Over-the-counter dandruff shampoos work quite well, Dr. Webster says. The best are those containing selenium sulfide (Selsun blue) or zinc pyrithione (Head & Shoulders), both of which help slow cell growth. You might also try shampoos containing salicylic acid, which can help soften and remove itchy scales.

These shampoos work best if you leave them on for 5 to 10 minutes. Whip up a good head of lather at the beginning of your bath or shower, then thoroughly rinse it out when you’re nearly done. Since these shampoos can dry your hair, you might want to use a good conditioner for the crowning touch.

Treat it with tar. Tar-based shampoos not only, well, beat the tar out of dandruff, they pump in extra body as well. You should, however, use these preparations only if you’re dark haired, Dr. Webster warns. “If you are very fair haired, tar-based shampoos may turn your hair green.”

Oil it up. If you have thick scales on your scalp that create a lot of flaking, try loosening them up by rubbing them with a little warm mineral or olive oil. Let the oil soak in for a few hours, then shampoos as usual.

Finger the fungus. It hasn’t been convicted yet, but a fungus called Pityrosporum ovale may somehow be involved in triggering dandruff. A cream containing ketoconazole, rubbed into the scalp, can exterminate the fungus and perhaps some of the dandruff as well. For most people, the less expensive anti-dandruff shampoos will work just as well, Dr. Webster says.

Get used to it. Even though you can control a flaky scalp, it’s impossible to eliminate it. Don’t even try, Dr. Webster says. “No good is served by stirring up the scalp to see if you can get the last scale off,” he says. “You can always stir up another scale.”

TIPS to Avoid Weight Gain After Stopping Smoking

Begin an exercise program to coincide with stopping smoking. As the days without cigarettes lengthen into weeks, the ability to jog, play tennis, swim, or do aerobic exercises will increase and the shortness of breath common to smokers will decrease. Soon, exercise will be a pleasure. In addition, it burn up extra calories.

Examine daily diet. Since stopping smoking can lead to a rediscovery of food, there is a temptation to overeat. Avoid high-calorie food and keep a supply of low calorie snacks on hand. These might include carrot and green pepper stick, unsalted and unbuttered popcorn, high-fiber crackers, and other low-calorie foods. Determine how many calories per day are needed based on age, height, and ideal weight and try not to eat more than this target.

Pick a convenient date for quitting. Avoid setting a target date for quitting smoking that coincides with a major holiday when rounds of parties and family get-togethers will increase the temptations to eat and drink too much.

Curtail the consumption of alcoholic beverages. The calories in such beverages are empty.

Consider the pros and cons of using nicotine gum during the first three months of abstinence.