Health and medicine blog.

Anxiety - troublesome disorder often associated with both physiological and psychological changes in the body. The emotional and behavioural symptoms can be very unpleasant and typically include apprehension, excessive worry or a feeling of impending doom. In most people, anxiety is a typical response to stress and helps one cope with a difficult situation. However, in some individuals the symptoms do become excessive and start to dictate behavior.

The majority of individuals who have chronic anxiety are referred to a psychiatrist or a psychologist. The treatment of anxiety is often a combination of drug therapy and cognitive behavior counseling. However, a number of individuals do poor with conventional medical therapies and have started to seek out alternative health care remedies. One of these therapies is the use of herbs.

There have been a number of herbs which have been evaluated for their role in treating anxiety. The most common herbs used to treat anxiety are kava, passion flower, valerian and theanine.

Kava has been the most studied and is probably the one which is the most sold in health food stores. Several short term studies have shown that it can reduce anxiety in within a few days after starting the herb. The majority of individuals who have taken kava are now unwilling to take any conventional medications.

However, recently there have been reports of Kava and liver damage. There are reports in the literature that after short term use Kava can induce a form of hepatitis and liver failure. In Europe, Kava has been banned from health food stores. In the USA, the FDA has issued warnings to health stores about this herb. Kava is currently widely available in the USA and the FDA is still deciding on its future.

Passion flower, valerian and theanine have also been shown to reduce anxiety and are considered safe. So far the side effects reported have been mild and of a short duration.

One of the major problem with herbs is that the quality and quantity is variable in each formulation. Herbs are sold as dietary supplements and thus often do not undergo the strict quality control required of a drug. Recent reports also indicate that many herbal products from the orient have contaminants; and fake products are not unheard of.

So if you are considering taking a herbal supplement for your anxiety, discuss this with your health care provider. Even though herbs are cheaper than pharmaceutical medications, you do not want to end up paying more to treat complications of these natural remedies.

What Type of Doctor?

For your primary care doctor, you might want a general or family practitioner, an internist or a geriatrician.

    * General practitioners provide health care for a wide range of medical problems. They do not focus on any one area of medicine.

    * Family practitioners are similar to general practitioners, with extra training on health care for all family members, regardless of age.

    * Internists are doctors for adults. Some internists take additional training to become specialists. For example, cardiologists are internists who specialize in diseases of the heart.

    * Geriatricians specialize in the care of older adults. A geriatrician is trained in family practice or internal medicine, but has additional training in caring for older people.

Finding a New Doctor

Once you have a sense of what kind of doctor you need, ask people you know about doctors they use and like:

   1. Friends
   2. Co-workers
   3. Other health professionals

This may be very helpful. You can make it easier for them to tell you about the doctors they like by asking questions such as, “What do you like about your doctor?”

A doctor whose name comes up often might be a good one to try. It may help to have several names to choose from in case the doctor you select is not taking new patients or does not take part in your health insurance plan. If you need more help finding names of doctors, contact a local hospital or medical center, medical society, physician referral service, or nearby medical schools.

If you belong to a managed care plan, you can get a list of doctors from the plan’s membership services office. Keep in mind that our choices will be limited to the doctors who are part of the plan.

When Your Doctor Stops Seeing Patients

Often when a doctor leaves a medical practice, he or she can arrange for you to see another doctor who will have access to all your medical records. You should go for an office visit with the new doctor before deciding if you want him or her to be your physician.

What Should You Look for in a Doctor?

Well trained and capable. A doctor who takes the time to know you well may be able to help you prevent some health problems and manage problems that do come up.

Once you have chosen two or three doctors, call their offices and talk to one of the office staff to get information about the doctor’s education and training. You can say:

“Before I make an appointment, I have some questions about the office and the practice. Can I speak to an office manager or a nurse?”

The office manager or nurse can tell you about:

    * Office policies
    * Standard insurance the office takes and whether or not they file the insurance claims for you
    * Payment methods
    * Hospitals where the doctor sends patients.

When choosing a new doctor you may want to know about:

   1. Board certification. Board certified doctors have extra training after medical school to become specialists in a field of medicine such as family practice, internal medicine, or geriatrics.
   2. Communication. Because communication is important to good health care, you want a doctor who will listen carefully to your concerns, answer your questions, and explain things clearly and fully.
   3. Type of health insurance. Does the doctor accept Medicare? See the section on Medicare for more information.
   4. The location of the doctor’s office. Will it be easy for you to get there? Is there parking?
   5. Lab work. Will I need to go to another location for blood tests or are lab tests done in the doctor’s office?
   6. Group practice. If this is a group practice, who are the other doctors and what are their specialties?
   7. Coverage. Who sees patients for the doctor if he or she is out of town or not available?

How Do You Make a Good Choice?

Find out as much as you can about the doctor and the practice. Here are more questions you may want to ask the office staff:

    * Does the doctor see many older patients?
    * Does the doctor see patients who have many health problems?
    * Does the doctor refer patients to other doctors for special problems?
    * Does the doctor treat many patients with the same chronic health problem that I have (for example, diabetes)?

The First Appointment

Before your visit:

After choosing a doctor, make your first medical appointment. Before going to the doctor’s office, write down any questions you may have. It’s a good idea to bring a list of your medicines. Include both prescription and over-the-counter drugs, even vitamins, supplements, and eye drops. The nurse is often the first person you’ll talk to in the office. The nurse usually takes your blood pressure and asks about your medications. If you’re having a problem with a medicine, the nurse will explain how to take it.

During your visit:

During your first visit, the doctor will probably take a medical history and ask questions about your health and the medical history of people in your family. The doctor will examine you. If you go to a new doctor, be sure to bring your past medical records or have them sent. Your former doctor may charge you for this service. Make a list of any drug allergies or serious drug reactions you’ve had.

During this visit take time to ask any questions you may still have about the doctor and the practice. It will be helpful to ask the doctor the following:

    * Will you give me written instructions about my care?
    * May I bring a family member (spouse, daughter, or son) to my office visits?
    * Are you willing to talk with my family about my condition?
    * Will you maintain my privacy if I ask you not to discuss my condition with anyone else?

After the visit :

After the meeting, ask yourself if you felt comfortable and confident with this doctor.

    * Were you at ease asking questions?
    * Did the doctor clearly answer your questions? If you are not sure, schedule a visit with one of the other doctors on your list.

Once you have found a doctor you like, your job is not finished. A good doctor-patient relationship is a partnership. Both you and your doctor need to work together to solve your medical problems and maintain your good health. Finding a doctor that suits your needs is an important first step. Good communication with the doctor and the office staff is key.

Depression can be treated with medications or talk therapy, and both have supporters with countless studies to prove how effective they are.

But researchers now know that all depression is not equal, and that different people need different approaches to get better. For someone suffering from depression, the bottom line is that depression can usually be treated effectively with one or a combination of treatments. The trick is figuring out which treatments work best for which people. Researchers are making progress toward the day they can do that. They’re also developing innovative new therapies that may change the way depression is treated in the future.
Some people think depression is some kind of a personal weakness, something you can will away. Research has proven otherwise. Dr. Husseini Manji, director of the Mood and Anxiety Disorders Program at National Institute of Mental Health (NIMH), says, “If you’ve got this illness, your brain chemistry is not the way it should be. Lifestyle changes can help, but you can only do so much. You have to get treatment.”

In fact, depression takes a physical toll that doctors can measure. “We’re learning that depression is associated with a number of medical consequences,” Manji said. It raises the risk of heart disease, high blood cholesterol and high blood pressure. The chance of someone dying after a heart attack is 4 times greater if they’re depressed.

Types of treatments:

1. Antidepressant Medications and Talk Therapy

Antidepressant medications and talk therapy are the most common treatments for depression. Your doctor might have to try several treatments before finding the combination that’s right for you.

2. Electroconvulsive Therapy (ECT)

For those who don’t respond to conventional treatments, electroconvulsive therapy (ECT) has been the treatment of last resort. Electrodes are placed on the head to deliver electrical impulses and cause seizures within the brain. ECT is very effective, but it has serious drawbacks: It’s costly, requires multiple hospital visits and can result in memory loss.

3. Vagus Nerve Stimulation (VNS)

This is a newer method for treating depression. It was first used for depression by Dr. Mark George of the Medical University of South Carolina and now approved by the U.S. Food and Drug Administration. VNS serves as a sort of “pacemaker” for the brain. A surgically implanted device periodically sends small electric pulses up the vagus nerve in the neck and into the brain. George says researchers don’t fully understand why VNS works, but it does. However, it does require invasive surgery.

4. Others

Advanced brain imaging techniques showing activity within the brain are allowing researchers to design newer methods for treating depression that target particular areas of the brain. Dr. Helen Mayberg at Emory University’s School of Medicine, for example, has used a technique called Deep Brain Stimulation, in which thin wires are surgically implanted into a particular area of the brain. A small current run through the wires improved depression in 4 of 6 patients. Such surgery may be impractical for large numbers of people, but Mayberg says her study proves the principle that a small electric current in this area of the brain can help treat depression. “This research may help point the way to other effective treatments,” she said.

George’s research group and others are pursuing a technique that doesn’t require surgery called Transcranial Magnetic Stimulation (TMS). In TMS, a small electromagnet on the scalp induces a current in the brain. The device can be fairly well focused in the brain and doesn’t seem to cause side effects. TMS has been promising in small studies, and a large-scale NIMH-funded study is now under way to test it more rigorously.

Another approach researchers are taking is to try to develop better medications to treat depression. Many scientists have been intrigued by the fact it often takes people days or weeks to get better with antidepressant medications even though the drugs work very quickly to affect the molecules that brain cells use to communicate with each other. Manji explained that we now know these medications are starting a process inside cells to turn certain genes on and off, and that those genes, in turn, are the ones responsible for people getting better. “There’s been a lot of research into trying to find what those genes are,” Manji said.
The genes researchers are uncovering seem to be involved in helping nerve cells grow and survive. While nerve cells in the brain don’t seem to die with depression, they do sort of “shrivel up,” as Manji put it.

“It’s good news because maybe we can do something about it,” Manji said. Several drugs targeting these new pathways are now being developed and tested, and Manji is optimistic that new medications will be available within the next few years.

Depression researchers hope that understanding the genes involved in depression will ultimately help doctors make better treatment decisions as well. Manji believes that as few as 4 or 5 genes might enable doctors to predict, with a simple blood test, which treatments will work best for which people.

None of these developments changes the fact that current treatments for depression still work for most people. “Most people bounce back and get totally back on their game if they get treated,” George stressed. If you or someone you know is depressed, it is important to get treatment as soon as possible.

Last years parabens have become a very hot topic. Many of you may be wondering what parabens are, where you find them and why they should be avoided.

First, lets begin with the what: Parabens are a group of chemicals widely used as preservatives in the cosmetic and pharmaceutical industries. Parabens are effective preservatives in many types of formulas. These compounds, and their salts, are used primarily for their bacteriocidal and fungicidal properties.

Where you find them is almost every cosmetic product. They can be found in shampoos, commercial moisturizers, shaving gels, personal lubricants, topical/parenteralpharmaceuticals, spray tanning solution and toothpaste. They are also used as food additives
. Common parabens include methylparaben (E number E218), ethylparaben (E214), propylparaben (E216) and butylparaben. Less common parabens include isobutylparaben, isopropylparaben, benzylparaben and their sodium salts. These will always be listed in the ingredients section of the product you are purchasing.

Why should we care about parabens? Parabens are considered to be safe because of their low toxicity profile and their long history of safe use; however, a few recent studies have begun to challenge this view.

It seems as if parabens act as endocrine disruptors (they disrupt our hormone system), man or woman, estrogen or testosterone. What is an endocrine disruptor? Endocrine disruptors are chemical substances, primarily man-made synthetics, that interfere with the function of the endocrine/hormone system. These chemicals mimic, block or disrupt the actions of human (and animal) hormones and, unexpectedly, do more damage at low levels of exposure than at high levels.

These chemicals can also work in sinister yet subtle ways by disrupting the body’s ability to produce adequate quantities of hormones or by interfering with the body’s hormonal pathways. One single chemical can affect many parts of the endocrine system. Often minute amounts of several of these environmental hormone chemicals can combine to create effects thousands of times more potent than a single chemical.

The endocrine system regulates every function of the body. It consists of the thyroid, pituitary, and adrenal glands, the pancreas, the ovaries and the testes, all linked to the hypothalamus in the brain. The hypothalamus is like the mainframe computer of the body, sending signals to the glands that provide the instructions for creating hormones.
When you rub body care products on your body or hair dye on your scalp you can absorb or inhale synthetic chemicals that contain endocrine disruptors which may send false signals to your body’s endocrine glands. When your glands are confused they cannot function normally and serious health problems result. In addition, when you bathe, whatever chemicals aren’t absorbed by your body are washed down the drain into the drinking water supply, where they can cause a cascade of negative environmental problems. These endocrine disruptors are affecting algae and other microscopic life, fish, whales and birds. Humans are exposed when they drink the water and eat the fish contaminated by personal care product chemicals. The government has found sunscreen chemicals in fish and human breast milk.
Endocrine disruptors are stored in a body’s fatty tissues and do not get flushed out with water, thus they accumulate over the years. It is now recognized that the dramatic increases of breast cancer, non-Hodgkins lymphoma and thyroid cancer have been linked to exposure to environmental estrogens. In particular, parabens mimic estrogen, a hormone necessary for a healthy menstruation, reproductive system and fat cell activity.A Scottish study found parabens in human breast tumors.
In the past twenty-five years in the US, alone, thyroid cancer has increased more than 45%, with more women being affected than men, and has become the number one cancer in children under age twenty, many of whom suffered from fetal endocrine disruption.
How can you protect yourself? Read every ingredient on every personal care product label and be suspicious of every chemical ingredient.
Here is a list of common products that contain parabens:
Cosmetics Foundations, powders, concealers, eye makeup (liners, shadows, mascara), facial makeup (blushes), bronzes, makeup removers, lipstick, quick-dry nail products

Pharmaceutical Products Topical dermatological medications, eye, ear and nose drops, rectal and vaginal medications, bandages, parenteral products, including antibiotics, corticosteroids, local anesthetics, radiopharmaceuticals, vitamins, antihypertensives, diuretics, insulin, heparin, and chemotherapeutic agents

Personal Care Products Moisturizing lotions and creams, dentifrices, sunscreens, cleansers and other skin care products, antiperspirants and deodorants, soaps, including liquid hand soap and toothpastes, shampoos and conditioners, colognes, and perfumes

Food Products (E210-219) Marinated fish products, salad dressings, mayonnaise, mustard, spiced sauces, processed vegetables, frozen dairy products, jams and jellies, soft drinks and fruit juices, baked goods, and candies

Industrial Products Parabens are used industrially in oils, fats, shoe polishes, textiles, and glues.