According to a large-scale, ongoing study published in the Aug. 18, 1999, issue of The Journal of the American Medical Association, women with osteoporosis who took either 60 milligrams (mg) or 120 mg of raloxifene daily had a 35-50 percent reduction in the risk of developing vertebral fractures, compared to women who took a placebo. The three-year study of 7,705 women aged 31 to 80 also showed that raloxifene helped build bone mineral density in the neck and spine.

The effects were more pronounced among women taking 120 mg of raloxifene, the study showed.

Raloxifene is a member of a class of drugs called “selective estrogen receptor modulators” (SERMs), which work by mimicking the effects of the hormone estrogen in some parts of the body while countering the effects of estrogen on other bodily tissues and organs. Raloxifene is currently approved by the Food and Drug Administration (FDA) only for the prevention of osteoporosis, but some studies suggest that it may help prevent breast cancer.

Osteoporosis afflicts 28 million Americans, 80 percent of whom are women.

Gilbert Ross, M.D., medical director of the American Council on Science and Health (ACSH), in New York, gives accolades to the new study and raloxifene. “Raloxifene will be an important new drug in the therapeutic arsenal. The new study took the osteoporosis issue one step further, saying that raloxifene not only increases bone mineral density but also lowers risk of fractures,” he says. “I predict that as the study continues, there will be reductions in fracture rates in other parts of the body.”

The risk of fractures in other parts of the body was not reduced in this three-year study.

Some women take estrogen supplements to stave off osteoporosis. Estrogen protects the bones and the heart but may slightly increase the risk of breast cancer. “Estrogen therapy preserves bone mineral density, but to date there have been no large clinical trials proving a benefit regarding fractures,” Dr. Ross points out.

In an accompanying editorial, Michael R. McClung, M.D., of the Providence Health System and Oregon Osteoporosis Center, in Portland, writes that “osteoporosis is no longer a disorder about which nothing can be done. Considering the current options for the prevention of bone loss and the reduction of fracture risk now available, the clinical challenge is to translate these new advances into the mainstream of routine medical practice in an appropriate manner by focusing on fracture reduction in high-risk patients.”

Although the study was not designed to look at breast cancer risk, women who took raloxifene did, in fact, have a lower risk for breast cancer, study authors note. The study also showed that women who took raloxifene had an increased risk of a blood clots in the veins, a condition called “venous thromboembolism.”

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Type 2 diabetes is typically seen in overweight or obese adults. People with type 2 diabetes typically have normal or higher than normal amounts of the hormone insulin in their blood. But their insulin does not lower blood sugar levels as well as it should. The levels of blood sugar thus rise, and, if chronically elevated, lead to a number of serious complications. These can include kidney failure, blindness, nerve and blood vessel disorders in the legs and feet, and heart disease.

While type 2 diabetes accounts for the great majority of diabetes in the United States, it had not been as common in Japan. It has, however, been much more frequently diagnosed there during the last 10 years, according to the study authors. These investigators, from Osaka and Tokyo, wanted to determine if smoking cigarettes was a risk factor for diabetes in Japanese men, as it is thought to be for American and other Western men.

In Japan, employers are required to conduct annual employee health examinations. The investigators followed the health status of 1,266 men who were 35 to 59 years old at the start of the study in 1994. The study lasted until 1999, so the subjects’ blood sugar levels were measured six times. The participants also completed a questionnaire on health-related behaviors at each health examination. These included queries about smoking, alcohol consumption and physical activity, plus medical history, family history of disease, and use of prescription medications. Body weight and height, as well as blood pressure were measured each year.

The authors found that as the number of cigarettes smoked per day and the subject’s length of time as a smoker increased, so did the risk of developing impaired fasting blood glucose, which is an early indicator of diabetes. Compared to people who had never smoked, even former smokers had an increased risk of both impaired fasting glucose and type 2 diabetes (by 62 percent and 8 percent, respectively). For current smokers, the risk of diabetes increased — by more than threefold for those who smoked 21 to 30 cigarettes per day, and more than fourfold for those who smoked more than 31 cigarettes per day.

Ex-smokers were heavier than people who had never smoked; the authors noted that this might in part account for their increased risk of diabetes, since being overweight is a known risk factor for diabetes.

The authors concluded: “Our findings support the conclusion that the number of cigarettes smoked daily and the number of pack-years of exposure are closely associated with the risk for impaired fasting glucose and type 2 diabetes.” They continued, “Our findings provide evidence that cigarette smoking is a modifiable risk factor that could be targeted for prevention of diabetes.”

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Ease stiffness, keeping joints well lubricated.

Combat fatigue and increase energy.

Help relieve anxiety and depression.

Improve balance and function.

Increase flexibility and mobility.

Help prevent shortening of muscle fibers and expand range of motion without stressing or straining joints.

Improve posture, which protects joints in the neck, back, hips and knees.

Build muscle strength gradually.

Improve breathing.

Yoga and tai chi are also excellent for arthritis patients because they encourage a safe, gradual, individualized approach. “With tai chi you can go as slowly as you need to and do what’s comfortable for you,” said Kade Gray, chief instructor at the School of Tai Chi Ch’uan in Austin. “You can stay balanced, controlled and relax into it, without worrying about anybody else’s standards. You move slowly and don’t stress the joints at all. As you practice more, your body becomes more limber and you can perform bigger movements if you want.”

Some yoga is better than others. The Arthritis Foundation warns against “power yoga,” for instance. According to health educator Marian Garfinkel, of the Division of Rheumatology at the University of Pennsylvania School of Medicine, it can be harmful for people with arthritis and trigger flares. It’s very different from traditional yoga, which is gentle and moves slowly from one pose to another.

MacInerney agrees. “Ideally arthritis patients, even young ones, should find a yoga class for older people. If they go to the wrong class, it’s not going to be a pleasant experience. Anyone who offers yoga to seniors is used to working with people with limitations.”

There are also different tai chi styles. Most consist of slow, synchronized movements that are easy to learn. However, the quick, active Chen style is not recommended for most people with arthritis, according to the Arthritis Foundation.

Of course, beginning any exercise, especially with arthritis, can be challenging at first. “It may hurt a bit in the beginning,” MacInerney said. “It can be difficult to distinguish between the normal pain of arthritis and pushing a posture too far. I often talk to my students with arthritis about good pain vs. bad pain.”

The bottom line is not to push too hard. “I advise arthritis patients to notice how flexible they are at night and then to see how much ground they’ve lost the next morning. They want to recapture that ground. Beyond that, they need to be more careful, taking it slowly,” said MacInerney, who adds that he has seen good progress with arthritis patients. “I have a student who thought he had to give up driving because of arthritis in his neck. He couldn’t turn his head. He gained much more range of motion in his neck from yoga and was able to keep driving.”

Tai chi practitioners also see its impact on arthritis. “I suffered from arthritis before starting tai chi,” said Gordon Baker of Austin. “After two months, some time between learning the move ‘single whip’ and the ‘second brush knee push movement,’ I realized I was no longer having any pain in my hand or arm.”

Gray had a similar experience: “I used to suffer from arthritis. Since I’ve been practicing tai chi, I don’t have arthritis pain anymore, and my joints are much stronger. I’ve also seen tai chi help many of my students who have arthritis. They tell me their joints feel much better now.”

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An increasing number of arthritis patients are finding the ancient practices of yoga and tai chi to be fun and gentle ways to relieve pain and gain flexibility and strength. “Tai chi is a great way to ease yourself back into an exercise routine,” said Tom Gohring, director of the School of Tai Chi Ch’uan in Austin, Texas. “The nature of tai chi’s movement is especially good for arthritis. It works the joints, giving them a full rotation.”

Tai chi’s alignment also gives students an awareness of how to hold their bodies, according to Gohring. “Often the way people stand strains their knees and joints. With tai chi, they learn a more centered position, which places their weight correctly. This puts less stress on the joints and helps strengthen them.”

In many ways, yoga and tai chi are tailor made for arthritis according to yoga and tai chi instructors and the Arthritis Foundation. According to these experts, they
Are gentle, fluid and adaptable.

Are non-competitive.

Can be modified to suit individual restrictions and needs.

Go at a slow, flowing, relaxed pace.

Are low or non-impact.

Are relaxing and ease stress.

Are available and affordable.

As arthritis patients practice tai chi and yoga they gain more than physical progress. “One of the primary benefits comes from the mental aspects of yoga,” said Charles MacInerney, yoga instructor and owner of Expanding Paradigms in Austin. “With arthritis the immune system is out of balance and overactive. Researchers have found that the meditative components of yoga — relaxation, meditation, visualization, emphasis on thoughts, diaphragmatic breathing — help balance the immune system.”

MacInerney explains that yoga works on multiple levels: “On the mechanical level it moves the joints through their range of motion. It also stimulates the nervous system. You also get increased activity of the endocrine system through the massaging action of the postures. And then you impact the psychological through emphasis on attention: not thinking about your income taxes.”

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The findings, together with the results of a related study, suggest that bedding in households of asthmatic individuals should be washed with chlorine bleach, reported Dr. Peyton A. Eggleston of Johns Hopkins University in Baltimore, Maryland, at a conference of doctors who specialize in treating allergies.

Eggleston and co-workers looked at the effect of solution of 1 part sodium hypochlorite bleach to 20 parts diluent on three proteins that can trigger allergies. They found that the bleach solution quickly broke the proteins down to small fragments that are incapable of producing an immune response, Eggleston said.

The results are encouraging, but practical application of the strategy to other household items, such as rugs, upholstered furniture, or curtains, has not been worked out, he noted.

Aerosols released by the interaction of chlorine with these fabrics could be hazardous, and the possibility of bleaching or otherwise damaging the material means that it is too early to suggest that families of asthmatics attack the whole house with chlorine, Eggleston told Reuters Health.

In a separate study, Eggleston’s group attempted to clear 13 households of cockroach allergen by eradicating the insects and scrubbing all accessible surfaces with a strong household detergent.

At 2 months, the levels of cockroach allergen levels dropped by an average of 93% in the kitchen, 84% in the living room, and 78% in the bedroom. Although further small reductions were achieved over 4 months, the concentrations of the remaining allergen in these homes were still high enough to cause allergic reactions in sensitive individuals, Eggleston said.

“The type of detergent is probably important, and we need a better understanding of what materials are most effective in removing these proteins from the environment,” he noted. “We may have to look at something different from the standard household detergents, possibly testing some of the non-ionic detergents that are used in commercial and industrial settings,” he concluded.

The studies were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

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The best way for health clubs to meet this need is through the development of cross-training programs. From a clinical standpoint, cross training enables individuals to place significant demands on the heart and circulatory system, since it typically involves aerobic-type activities. Cross training produces increased cardiac output, blood volume and a greater number of red blood cells, which ultimately enhances the body’s ability to transport oxygenated blood to the exercising muscles.

However, oxygen delivery is only part of the process, since the muscles utilized in performing a particular physical activity must be able to extract oxygen from the blood, and then use it to produce the energy needed to power human movement.

In response to engaging in aerobic-type cross training on a regular basis, several significant changes take place within the muscle cells:

* The number and size of mitochondria (organelles in the muscle cells that product ATP for energy) increase.

* Concentration of important enzymes (within the mitochondria that are involved in the production of ATP) increases.

* The amount of glycogen (carbohydrate) stored in the muscle increases.

* The amount of triglycerides (fat) stored in the muscle increases.

* The ability to oxidize fat from primarily muscle-fat stores, but also from adipose tissue stores, increases. This enhanced ability to use stored fat results in less glycogen depletion, less lactic acid accumulation and, concomitantly, less muscular fatigue and better endurance.

These changes, called peripheral adaptations, help the muscles contract repeatedly and more efficiently during exercise. Peripheral adaptations are activity-specific. For example, trained distance runners cannot transfer their high level of endurance for running to swimming because the peripheral muscular adaptations required for optimal performance are different for swimming.

The combined effect of peripheral and central adaptations determines the quality of performance. Improving one without the other, however, produces limited improvements in sport-specific performance. Accordingly, while cross training may offer certain advantages for the typical fitness enthusiast, it may also have a few limitations for competitive athletes. As a result, individuals who know exactly what they want from their exercise efforts are better able to decide whether to engage in cross training.

A: “Hitting the wall” is a term used to describe the point during an activity of relatively long duration when individuals are forced to significantly reduce the pace or intensity of their exercise to the point of stopping because they literally (and figuratively) run out of “gas.” Some individuals who are running a marathon will, for example, be slowed to a walk during the latter stages of a race.

The primary physiological factor responsible for this phenomenon is the depletion of glycogen (i.e., stored carbohydrates) within the active muscle cells. Under normal conditions, the muscles utilize both carbohydrate and fat.

When the muscle cells are forced to use predominantly fat as an energy source, the level of readily available energy is very limited. As a result, the ability of an individual’s muscles to generate force is significantly reduced.

Once an individual reaches this point, recovery requires the replenishment of glycogen through carbohydrate ingestion — a replenishment process that can take more than 24 hours.

Asthma should not be an excuse for missing school, but it may take some effort on parents’ part to make sure that the child, the teachers and the school nurse all work together to keep asthma symptoms under control.

Since taking cheap medications at the right time and often enough to control symptoms is so important, the school and parents need to make sure that children do not skip doses. Some children resent having to go to the nurse’s office and fear being regarded as sick by other children. It might work best to see if your child, with the approval of his or her physician, can carry a metered-dose inhaler during the day and use it when needed. Many children are able to manage this even in the early grades, as long as they have received careful instruction in using the inhaler.

What can parents do?
Make sure the school is aware of your child’s asthma.

Inform the school nurse about your child’s medications and their potential side effects.

Work with teachers and the school nurse to insure your child takes the necessary medications without a fuss being made, which could embarrass the child and lead to fights over taking the drugs.

Side Effects of Medication
The vast majority of children can be treated with few side effects. From time to time, however, some children may complain of headaches, hand tremors and stomach aches, which can affect the child’s ability to learn. Occasionally, medications will undermine concentration. Teachers who are aware that a child has asthma and is taking medication are in a better position to cope with problems that may occur. Parents may be able to alleviate problems in the classroom by asking their child’s doctor to adjust the medication schedule or experiment with different types of drugs.

Physical Education and Sports
Participating in physical-education classes and in organized sports can cause asthma attacks. But with medication, the frequency and severity of attacks can be reduced. Make sure the school understands the importance of maintaining a normal and stable routine at school, including physical activity. Sometimes children with asthma are reluctant to go to the nurse’s or secretary’s office to use their inhalers before exercise. Allowing children to carry their inhalers with them avoids this problem and increases the likelihood that the medication will be taken and that symptoms will be avoided.

Cold dry air, smog, increased levels of allergens and upper respiratory illness can increase the risk of an asthma attack during exercise. Familiarize your child’s teacher or coach with the schedule of medications your child is taking. It is best if the child’s doctor provides specific information about exercise-induced asthma, prevention techniques and warning signals of an impending attack. Ask your doctor to explain your child’s asthma management program to school officials.

Other Potential Problems
Children with asthma or allergies may have other problems at school. Pets in the classroom — hamsters, guinea pigs, mice and rabbits — have been known to cause problems. Parents may have to ask the school to remove the pets. Good ventilation in the classroom is essential, especially when children are working with chemicals for art or science projects.

Some children with asthma and allergies have sensitivities to food and food preservatives. Parents should discuss these problems with the school, to make sure that appropriate alternatives are available on the school lunch menu. If not, have your child carry a bag lunch. Remember: A team effort can create a positive and healthy school environment and minimize the number of days lost to asthma.

My real problem is horrible regurgitation. I always spit up my food after I have completely chewed and swallowed it. Is this something that’s related to my diagnosed conditions, or could I have another problem that has not been diagnosed?

Karla

A. It is not clear from your question how the diagnosis of these three conditions were made. While we occasionally see patients with peptic ulcer and gastroesophageal reflux (GERD) together, it is unusual for the symptoms not to respond at all to drugs like Prilosec.

Regurgitation as you have described may be a symptom of GERD, but it may also reflect another problem — perhaps an abnormality in the emptying of your stomach. A careful evaluation should help clarify the problem. See your doctor about having a complete evaluation that includes endoscopy (a visual examination of your esophagus, stomach and upper small intestine), stomach-emptying studies, and assessment of acid reflux over 24 hours.

a.Who can master this method of healing a person? I am glad you asked, the answer is a well trained physician.

b.What is a well trained physician? One who has a bachelor’s degree, plus a medical degree has completed a successful internship and residency training, and has a medical license–Must have compassion and sensitivity.

c.Where does a well trained physician reside? Usually, one can be found in private practice, group practice, clinics and hospitals– you know where one is needed and respected.

d.When may a well trained physician be reached? Between hospitals rounds, at scheduled appointments and on the 18th hole– Sorry, about the golfing reference, Go Tiger!

Thank You:
To all physicians who spend countless hours and effort caring for the sick. Our warmest regard and appreciation.
“For where there is the love of man, there is the love of the Art”-Hippocrates