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.