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What do doctors do when they get sick? The editors of Prevention Magazine Health Books asked more than 500 of the nations top specialists to recommend their best doctor-tested and easy-to-follow remedies for 138 illnesses and maladies. This complete, practical guide contains the distilled experience of health professionals who offer more than 2300 accessible healing tips for the most common medical complaints. In this handy reference you will find curative techniques and symptom-relieving treatments for bladder infections, depression, emphysema, headaches, premenstrual syndrome, toothaches, and much more. Here are invaluable at-home solutions for annoying afflictions such as canker sores, dandruff, and snoring as well as methods for coping with more serious health problems such as high cholesterol, ulcers, and backaches. The Doctors Book Of Home Remedies is like having a doctor on call 24 hours a day. So treat yourself to this prescription for health and stay well.
Year:
2010
Publisher:
Rodale Books
Language:
english
Pages:
704
ISBN 10:
1605291609
ISBN 13:
9781605291604
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EPUB, 1.04 MB
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The DOCTORS BOOK of HOME REMEDIES®


QUICK FIXES, CLEVER TECHNIQUES,

AND UNCOMMON CURES TO GET YOU

FEELING BETTER FAST

BY THE EDITORS OF Prevention®





This book is intended as a reference volume only, not as a medical manual. The information given here is designed to help you make informed decisions about your health. It is not intended as a substitute for any treatment that may have been prescribed by your doctor. If you suspect that you have a medical problem, we urge you to seek competent medical care.



Mention of specific companies, organizations, or authorities in this book does not imply endorsement by the author or publisher, nor does mention of specific companies, organizations, or authorities imply their endorsement of this book, its author, or the publisher.



Internet addresses and telephone numbers given in this book were accurate at the time it went to press.





Contents




INTRODUCTION

A

ACNE

15 Remedies for Smoother Skin

ADDICTION

11 Ways to Conquer Unhealthy Behaviors

AGE SPOTS

9 Ways to Out the Spots

ALLERGIES

15 Ways to Alleviate the

Symptoms

ANAL FISSURES AND ITCHING

17 Soothing Solutions

ANGINA

10 Long-Life Strategies to

Protect the Heart

ANXIETY

19 Ways to Control Excessive

Worrying

ASTHMA

29 Steps to Better Breathing

ATHLETE’S FOOT

18 Ways to Get Rid of It

B

BACKACHE

22 Pain-Free Ideas

BAD BREATH

15 Ways to Overcome It

BED-WETTING

6 Options for Sleep-Through Nights

BELCHING

11 Steps to Banish the Burps

BITES, SCRATCHES, AND STINGS

28 Hints to Relieve the Pain

BLACK EYE

10 Ways to Clear Up the Bruise

BLISTERS

20 Hints to Stop the Hurt

BODY ODOR

12 Ways to Feel Fresh and Clean

BOILS

14 Tips to Stop an Infection

BREAST DISCOMFORT

19 Ways to Reduce Soreness

BREASTFEEDING

22 Problem-Free Nursing Ideas

BRONCHITIS

10 Tips to Stop the Cough

BRUISES

10 Healing Ideas

BURNOUT

25 Paths to Renewal

BURNS

15 Treatments for Minor Accidents

BURSITIS

15 Ways to Ease Your Pain

C

CALLUSES AND CORNS

17 Ways to Smooth and Soothe

CANKER S; ORES

17 Ways to Ease the Sting

CARPAL TUNNEL SYNDROME

17 Coping Techniques

CHAFING

12 Ways to Rub It Out

CHAPPED HANDS

23 Soothing Tips

CHAPPED LIPS

14 Tips to Stop the Dryness

COLDS

32 Remedies to Win the Battle

COLD SORES

20 Tips to Halt Herpes Simplex

COLIC

12 Ideas to Quiet the Cries

CONJUNCTIVITIS

10 Remedies for Pinkeye

CONSTIPATION

20 Solutions to a Common

Problem

COUGH

21 Throat-Soothing Strategies

CUTS AND SCRAPES

22 Ways to Soothe a Sore

D

DANDRUFF

18 Tips to Stop Flaking

DENTURE TROUBLES

20 Ideas for a More Secure Smile

DEPRESSION

34 Mood Lifters

DERMATITIS AND ECZEMA

29 Clear-Skin Remedies

DIABETES

55 Ways to Steady Blood Sugar

DIAPER RASH

9 Easy Solutions

DIARRHEA

27 Strategies to Deal with It

DIVERTICULOSIS

17 Self-Care Techniques

DIZZINESS

18 Tips to Stop the Spinning

DRY EYES

14 Moistening Ideas

DRY MOUTH

16 Mouthwatering Solutions

DRY SKIN AND WINTER ITCH

10 Cold-Weather Options

E

EARACHE AND EAR INFECTION

25 Ways to Stop the Pain

EARWAX

4 Steps to Clean Ears

EMPHYSEMA

22 Tips for Easy Breathing

ERECTILE DYSFUNCTION

12 Secrets for Success

EYESTRAIN

10 Tips to Avoid It

F

FATIGUE

30 Hints for a High-Energy Life

FEVER

10 Cooling Tactics

FLATULENCE

8 Gas-Reducing Ideas

FLU

20 Remedies to Beat the Bug

FOOD POISONING

26 Solutions for Food Flu

FOOT ACHES

16 Feet Treats

FOOT ODOR

15 Deodorizing Secrets

FROSTBITE

19 Safeguards against the Cold

G

GENITAL HERPES

19 Managing Strategies

GINGIVITIS

23 Ways to Stop Gum Disease

GOUT

18 Coping Ideas

H

HAIR PROBLEMS

22 “Bad Hair Day” Fixes

HANGOVER

19 Ways to Deal with the Day After

HEADACHES

32 Hints to Head Off the Pain

HEARTBURN

26 Ways to Put Out the Fire

HEAT EXHAUSTION

24 Tactics to Stave Off Trouble

HEMORRHOIDS

20 Tips to Find Relief

HICCUPS

18 Home-Tested Cures

HIGH BLOOD PRESSURE

26 Pressure-Lowering

Strategies

HIGH CHOLESTEROL

31 Steps to Total Control

HIVES

10 Ways to Stop the Itch

HOSTILITY

11 Soothers for Seethers

HOT FLASHES

13 Ways to Put Out the Fire

I

INCONTINENCE

18 Tips to Gain Control

INFERTILITY

16 Ways to Get a Baby on Board

INGROWN HAIR

11 Ways to Get a Clean Shave

INGROWN NAILS

7 Feet-Treating Methods

INSOMNIA

23 Steps to a Good Night’s Sleep

IRRITABLE BOWEL SYNDROME

19 Coping Suggestions

J

JET LAG

17 Hints for Arriving Alert

K

KNEE PAIN

18 Ways to Handle the Hurt

L

LACTOSE INTOLERANCE

9 Soothing Ideas

LARYNGITIS

13 Ways to Make It Easier to Swallow

LEG PAIN

8 Tips to Ease the Pain

M

MARINE BITES AND STINGS

11 Soothing Strategies

MEMORY PROBLEMS

21 Ways to Forget Less

MENOPAUSE

16 Ways to Embrace the Change

MORNING SICKNESS

13 Ways to Counteract Queasiness

MOTION SICKNESS

19 Quick-Action Cures

MUSCLE PAIN

37 Ways to Relief

N

NAIL BRITTLENESS

14 Strengthening Secrets

NAIL DISCOLORATION

12 Nail Remedies

NAIL RIDGES

7 Ridge Reducers

NAUSEA AND VOMITING

15 Stomach-Soothing Solutions

NECK PAIN

29 Ways to Get the Kinks Out

NIGHT BLINDNESS

10 Ways to Deal with the Dark

NOSEBLEED

15 Hints to Stop the Flow

O

OILY HAIR

15 Neutralizing Solutions

OILY SKIN

7 Restoratives for a

Shine-Free Face

OSTEOARTHRITIS

25 Ways to End the Ache

OSTEOPOROSIS

19 Ways to Preserve Bone Strength

P

PHLEBITIS

14 Remedies to Keep It at Bay

PHOBIAS AND FEARS

11 Coping Measures

PIZZA BURN

6 Cooling Treatments

POISON PLANT RASHES

15 Itch Relievers

PREMENSTRUAL SYNDROME

26 Ways to Treat the Symptoms

PROSTATE PROBLEMS

18 Gland Helpers

PSORIASIS

21 Skin-Soothing Remedies

R

RASHES

15 Skin-Salving Solutions

RAYNAUD’S PHENOMENON

27 Toasty Tips

RESTLESS LEGS SYNDROME

20 Calming Techniques

ROAD RAGE

15 Tips for a More Pleasant Drive

ROSACEA

12 Face-Saving Steps

S

SCARRING

14 Ways to Decrease the Damage

SCIATICA

17 Strategies to Knock Out

Nerve Pain

SEASONAL AFFECTIVE DISORDER

12 Steps to a Brighter Outlook

SHINGLES

15 Tips to Combat the Pain

SHINSPLINTS

11 Ways to Soothe Sore Legs

SIDE STITCHES

6 Ways to Avoid the Nuisance

SINUSITIS

13 Infection Fighters

SNORING

13 Tips for a Silent Night

SORE THROAT

14 Ways to Put Out the Fire

SPLINTERS

7 Ways to Get Them Out

SPRAINS

17 Self-Care Strategies

STRESS

23 Tips to Ease Tension

SUNBURN

24 Cooling Treatments

T

TACHYCARDIA

13 Ways to Calm a Rapid

Heartbeat

TEETHING

9 Ways to Soothe the Pain

TEMPOROMANDIBULAR DISORDERS

21 Ideas to Ease the

Discomfort

TENDINITIS

10 Soothing Remedies

TINNITUS

19 Ways to Cope with the Din

TOOTHACHE

11 Tips for Pain Relief

TOOTH STAINS

11 Brightening Ideas

U

ULCERS

12 Tips for Quick Relief

URINARY TRACT INFECTIONS

19 Germ-Fighting Strategies

V

VARICOSE VEINS

16 Helpers and Healers

W

WARTS

20 Healing Secrets

WEIGHT PROBLEMS

34 Ways to Win the Battle of the Bulge

WRINKLES

17 Age-Defying Secrets

Appendix A FIRST AID FOR MEDICAL EMERGENCIES

Appendix B A HOME REMEDY FIRST-AID KIT

Appendix C HOME REMEDIES FOR DOGS AND CATS

INDEX





Introduction




	 We can’t pinpoint the exact moment in human history when home remedies came to be, but we imagine a scenario something like this: A crude hammer, fashioned from a stone, landed on an unfortunately placed finger. Throbbing pain ensued, perhaps accompanied by the muttering of a prehistoric blue streak. Our handyman ancestor may not have had access to a gel pack, but he would have instinctively sought relief in another way—by plunging his hand into a nearby cool stream, for example, or simply rubbing his finger until it felt better. Not very sophisticated, by today’s standards, but it did the trick!

Whatever their origin, home remedies have stood the test of time. They grew from necessity, when formal medical care either didn’t exist or wasn’t widely available to everyone. Our forebears made do by using whatever they had on hand to treat their various ills, then sharing what worked through word of mouth.

The amazing thing about home remedies is that they have not just survived but thrived through the evolution of modern medicine. Despite all of the marvelous advances that have transformed how we treat illness and injury, home remedies tend to be our go-to choice for all but the most severe conditions. It’s easy to understand why: They’re inexpensive (even free!), they’re convenient, and most important, they work.

For this book, we’ve defined a home remedy as one that you can use on your own, with materials that you’re likely to have at your disposal. You’ve got hundreds of tips and techniques to choose from, as you’ll see in the pages that follow. The vast majority of the remedies come from interviews with M.D.s and other health professionals, all experts in their respective fields. They’ve helped us to separate the proverbial wheat from the chaff in creating the definitive home remedy resource for your bookshelf.

As our expert panelists would tell you, while certain remedies have been validated by clinical research, for many others the proof comes from the laboratory of real life. In other words, we don’t know why they’re effective; they just are. Indeed, a good number of them have found their way into our doctors’ clinical practices.

The remedies presented here address a wide range of health concerns, from the mildly annoying to the more serious. Generally, any chronic condition—like asthma or diabetes, for example—requires proper medical care. In this case, home remedies can be helpful for easing symptoms and preventing flare-ups or complications, as long as your doctor okays them. Likewise, never stop taking a medication or otherwise change your treatment plan without consulting your doctor first.

Nearly all of the health concerns covered in this book are accompanied by a “When to Call a Doctor” box. Please read this information carefully and take it to heart. Sometimes professional medical attention is critical to getting a proper diagnosis and treatment. Time is of the essence, and spending it by trying one home remedy after another may not pay off in the long run.

Fortunately, such urgent situations are more the exception than the rule. You can use home remedies for the vast majority of common health concerns—and, in the process, continue the time-honored tradition of selfcare that took root millennia ago. Let this book be your guide to your best health!



—The Editors of Prevention





A





Acne


		 15 Remedies for Smoother Skin



	 Acne is considered a natural rite of passage. In fact, about 85 percent of teenagers have pimples, half of them severely enough to require a physician’s treatment. Adolescents develop acne when hormones called androgens, which increase the amount of oil the skin produces, circulate at higher levels in their blood.





WHEN TO CALL A DOCTOR


Acne is classified in four grades, the first being a mild bout, with a few whiteheads and blackheads. At the other end of the spectrum, grade four cases are often accompanied by severe inflammation that becomes red or purple. Consider it a flashing light to see a dermatologist. “If you’re getting a lot of pimples on your face or you have cystic acne (meaning big, painful boils under or on the skin), it’s definitely time to see a doctor,” says Francesca Fusco, M.D. Severe acne can result in permanent scarring if it isn’t treated properly. A dermatologist can offer prescription medications that will help clear even severe acne. For example, topical creams, gels, and lotions with vitamin A or benzoyl peroxide can help unblock pores and reduce bacteria.



Yet teenagers aren’t the only ones plagued by nasty skin eruptions. Acne can also beleaguer women undergoing hormone changes triggered by menstruation, birth control pills, pregnancy, even early menopause.

“Acne may begin and end in the teen years for men,” says Laurie J. Polis, M.D., “but women can experience blemishes, pimples, and outbreaks from puberty through menopause and beyond.”

Acne is really a catchall term for a variety of symptoms, including pimples, whiteheads, blackheads, and skin cysts. It’s a condition that causes the pores of the skin to become clogged, causing inflamed and noninflamed lesions.

Contrary to popular misconception, neither dirty hair nor chocolate contributes to acne. However, some evidence links the standard American diet of greasy hamburgers and fries to chronic breakouts. A study published in the American Journal of Clinical Nutrition, for example, found that young men who consumed a low glycemic index diet—meaning a diet relatively void of junk food—developed significantly fewer acne lesions than those who munched on high GI fare.

Nevertheless, experts agree that genetics is the major risk factor for chronic acne. So if both of your parents had acne as adults, there’s a very good chance that you will, too. But being at risk for acne and actually experiencing it are two different things. Usually it takes some other factor to trigger a breakout, explains Francesca Fusco, M.D. That something can be hormonal fluctuations, stress, sun exposure, or seasonal changes. Certain types of makeup, as well as oral contraceptives, also can cause pimples to appear.

So what can you do to keep your skin smooth and clear? Start with these tips.

CHANGE YOUR MAKEUP. “Oil-based makeup is a big problem,” says Dr. Fusco. “The pigments in foundation, rouge, cleansing cream, and night moisturizer aren’t the problem, and neither is the water in the products. It’s just the oil.” The oil is usually a derivative of fatty acids, which are intended to keep skin soft and supple. In some people, though, they can cause breakouts.

“Use a non-oil-based makeup if you are prone to acne, and avoid layering mineral makeup throughout the day,” says Dr. Fusco. “There’s some preliminary evidence suggesting that mineral powder makeup contributes to inflammatory acne, which looks like little red bumps.”

READ THE LABELS. The most important thing to look for on a label is the term “non-comedogenic,” says Dr. Fusco. Beyond that, avoid cosmetic products that contain lanolins, isopropyl myristate, sodium lauryl sulfate, laureth-4, and D & C red dyes. Like oil, these ingredients are too rich for the skin.

LATHER UP. “Wash your makeup off thoroughly every night,” says Dr. Fusco. Use a mild soap twice a day and wash away any soap film left behind. Rinsing well will help remove any debris, dead skin cells, and all traces of cleanser. Splashing the face five to ten times with fresh water should do it, says Dr. Fusco.

BLAME IT ON THE PILL. Research suggests that certain birth control pills, such as Ovral (norgestrel and ethinyl estradiol), Loestrin (norethindrone acetate and ethinyl estradiol), and Norinyl (norethindrone and ethinyl estradiol) can aggravate acne. If you’re on the Pill and have an acne problem, discuss it with your doctor. She may be able to switch you to another brand or prescribe a different birth control method.

“Several brands of oral contraceptives can help reduce moderate acne and promote clearer, more healthful looking skin,” says Dr. Polis. “Ask your dermatologist or ob-gyn for recommendations. Just remember that it might take a month or two before you’ll see an improvement in your skin.”

Other medications, including lithium (for mood disorders), steroids (such as prednisone), and thyroid medications, also can contribute to acne, says Dr. Fusco. Talk to your doctor about potential outbreaks.

Otherwise, there isn’t much you can do to a pimple to make it go away faster.





How Hollywood Hides Blemishes


Don’t celebrities ever break out? “You bet they do,” says Hollywood makeup artist Maurice Stein. “The difference is, they can’t let their pimples or any other blemish show.”

Stein has been a makeup artist for more than 30 years, touching up famous faces in such movies as M*A*S*H, Funny Girl, and the original Planet of the Apes films.

Guerrilla warfare is the only way to fight the pimple that always sprouts at the wrong time. So here are two combat tips from the trenches in Hollywood. Stein says that he has used these on “some of the most expensive faces in the world.”

Put makeup to the test. The right makeup will totally block out the discoloration, whether it’s pink, red, or purple. While you can’t really tell the pigment level of a product by looking at it, you can tell by sampling it. “Take a drop and rub it on your skin,” suggests Stein. “If it’s so solid in color that you can’t see your own skin underneath, then you know it has a high pigment level and will cover your blemish well.”

Try a layered look. “When I cover a pimple on an entertainer’s face, I use two thin layers of foundation with a layer of loose translucent powder between each layer,” Stein says. This helps set each layer.



ATTACK BLACKHEADS. The black part of a blackhead is not dirt. In fact, dermatologists aren’t sure what it is, but they do know that squeezing won’t result in a pimple. “If you suffer from a lot of clogged pores or blackheads, try using topical treatments containing retinoic acid (retinol, Retin-A, Tazorac, and others),” says Dr. Polis. “Those medications loosen the sticky cells and facilitate removal.” You should also have a properly trained aesthetician steam open the pores and clean them periodically, she says, or use pore-cleaning strips such as Biore.

USE OTCS TO KNOCK OUT ACNE. You can fight back an acne attack with over-the-counter products like salicylic acid, benzoyl peroxide, or sulfur. “My first choice is salicylic acid,” says Dr. Fusco. “It unclogs already clogged pores and exfoliates the top layer of skin. Plus, not many people are allergic to salicylic acid.” Her second choice is benzoyl peroxide. It unclogs the pores and it’s also bacteriostatic, meaning it may reduce the amount and strength of bacteria on the skin so they’re less likely to multiply in the pores. Sulfur helps reduce redness of the skin and dries out the area.

OTC acne products come in various forms, such as gels, liquids, lotions, and creams. They come in a range of concentrations, too—and the stronger they are, the more likely they are to irritate the skin. Dry skin, in particular, can be sensitive to benzoyl peroxide.

No matter what sort of OTC acne product you choose, experts recommend starting with a lower-strength concentration and then increasing slowly. For benzoyl peroxide, a low strength would be about 2.5 percent; for salicy-clic acid and sulfur, more like 0.5 to 3 percent. “In cases of sensitivity, it’s a good idea to spot-test a small patch of skin—on the side of the face, for example—for a few days before applying a new product all over,” Dr. Polis advises.

“Be sure to clean your skin thoroughly before applying any over-the-counter acne medication,” Dr. Fusco adds. “And if you have sensitive skin, wait a bit after cleansing before treatment.”

You may notice some redness at first, which is normal. But if the redness doesn’t clear or it develops into a rash, stop using the product altogether.

GET A PEEL. Both glycolic acid and salicylic peels (and products) can help combat acne, but salicylic acid components provide a more prolonged effect against pimples and clogged pores, says Dr. Polis.

STAY OUT OF THE SUN. Acne medications may cause adverse reactions after sun exposure, so you should minimize time in sunlight and under infrared heat lamps until you know how you will react. Even more important, cautions Dr. Polis, is to know that sunlight aggravates acne. “Most people think it helps clear the skin, but this is a temporary reaction and sun exposure can actually cause a flare-up of acne 2 to 4 weeks after exposure,” she says.





What the Doctor Does


Laurie Polis, M.D., avoids touching her face. “It’s not so much what you eat, but how you eat that affects your skin,” she says. “If you washed your hands after touching greasy french fries it would not affect your skin, but most of us touch greasy food and then unconsciously touch our faces. Depositing grease on the skin feeds bacteria and contributes to acne.” Dr. Polis also tries to stay hydrated, which helps keep her skin healthy.



USE ONE REMEDY AT A TIME. Be careful not to mix treatments. If you use an OTC acne product, stop using it if you get prescription medication for your acne. Slowly introduce products so you can see how your skin reacts, says Dr. Fusco. Benzoyl peroxide, for example, is a close cousin to tretinoin (Retin-A) and other products containing vitamin A derivatives, so don’t use both at the same time.

TREAT IT WITH TEA. Research shows that using a 2 percent tea lotion significantly reduces acne flare-ups. If a pimple is red or inflamed, soak a chamomile tea bag in cold water and then apply it to your skin for 30 seconds or so, suggests Dr. Polis. Chamomile is a natural anti-inflammatory and will calm an angry pimple.

DON’T TOUCH YOUR FACE. “Frequently touching or rubbing your face, which we all do without thinking, can aggravate acne,” says Dr. Polis. In fact, rubbing from a cell phone is a common culprit of acne along the jaw line or chin.

LEAVE WELL ENOUGH ALONE. Don’t squeeze pimples or whiteheads. A pimple is an inflammation, and squeezing it could increase the redness and even cause an infection. Squeezing a whitehead could burst the wall of the skin pore and spill the contents onto the skin, ending in a pimple. The one exception is a pimple with a head of yellow pus. Gentle pressure will usually pop the head, and once the pus is out, the pimple will heal more quickly.





PANEL OF ADVISORS




* * *



FRANCESCA FUSCO, M.D., IS A CLINICAL ASSISTANT PROFESSOR OF DERMATOLOGY AT MOUNT SINAI MEDICAL CENTER IN NEW YORK CITY.

LAURIE J. POLIS, M.D., IS A BOARD-CERTIFIED COSMETIC DERMATOLOGIST AT SOHO SKIN AND LASER DERMATOLOGY IN NEW YORK CITY.

MAURICE STEIN IS A COSMETOLOGIST AND HOLLYWOOD MAKEUP ARTIST. HE IS THE OWNER OF CINEMA SECRETS, A FULL-SERVICE BEAUTY SUPPLIER FOR THE PUBLIC AND A THEATRICAL BEAUTY SUPPLIER FOR THE ENTERTAINMENT INDUSTRY IN BURBANK, CALIFORNIA.





Addiction


11 Ways to Conquer Unhealthy Behaviors



Imagine a man who knocks back a few stiff drinks after work. Is he a “pleasure” drinker or an alcoholic? What about the woman who raids the refrigerator when she’s tired or depressed, or the millions of Americans who spend hours sitting in front of the TV or surfing the Internet?





WHEN TO CALL A DOCTOR


Denial is one of the hall-marks of addiction. People with drug, alcohol, or other addictions often insist that their behavior is normal, even when the destruction is all around them.

Are friends, family members, or coworkers gently suggesting that you may have a problem? Listen to them. Look at your recent behavior. Ask yourself if they’re seeing something that you don’t.

“Try to solve the problems on your own,” advises Tom Horvath, Ph.D. “Try cutting back or quitting entirely—and get the support of the people around you. If you’ve made one or several attempts that don’t seem to be going far or fast enough, then it’s time to get professional help.”



Harmless diversions—or addictions?

Most people have compulsive behaviors that they’d like to change. They find something they like that makes them feel good, and they use it again and again as a kind of coping mechanism, says Tom Horvath, Ph.D.

We tend to think of addictions in their most severe forms: the drug abuser who steals for the next fix, for example, or the compulsive gambler who empties the family bank account into slot machines. But many Americans have milder addictions. They crave substances or experiences that make them feel good temporarily, but that often have harmful long-term consequences.

If you suspect that you have an addiction—to alcohol, cigarettes, gambling, food, the Internet, or anything else—ask yourself this question: Has the behavior caused enough problems for you to consider stopping or cutting back? “In some cases, it’s not clear whether a person’s substance use reflects abuse or a more serious addiction,” says Peter A. DeMaria Jr., M.D. The following techniques might help you determine whether your problem is a compulsive behavior that you can curb on your own, or a more serious addiction that requires professional help.

START BY LISTING PROS AND CONS. It’s difficult for most people to recognize that they have an addiction. One way to find out is to list the pros and cons of the behavior that’s troubling you.

First, write down all the things that you like about the substance or activity. If you drink, for example, the list might include things such as “It helps me unwind” or “I like the feeling of euphoria it gives me.”

Second, write down the benefits of quitting: “I’d be more productive if I didn’t drink” or “I’d have fewer Friday night fights with my spouse.”

Now, compare the lists. Does it appear that the costs of your behavior outweigh the benefits? You’ve just recognized that you have some problems—the first step toward making the necessary changes, says Dr. Horvath.

Dr. DeMaria also suggests asking friends and family members how the substance or activity affects your life and if they see negative consequences to your behaviors. If they answer yes, you need to decide for yourself what steps you’re willing to take to curb some of your behaviors. You’re never cured of a true addiction, he adds, but you can bring your addictions under control.

TAPER OFF—OR STOP COMPLETELY. Some people wean themselves from addictions by initially smoking 10 fewer cigarettes each day, for example, or gambling once a week instead of every night. Others find it easier to stop the behavior cold turkey.

Both approaches can be effective. “With weaning, people are generally less scared, so they’re more motivated,” says Dr. Horvath. Going cold turkey is harder initially, but the process is faster. “You pay more up front, but it’s easier to maintain because there is a shorter transition period,” he explains.

DISTANCE YOURSELF FROM CRAVINGS. Anyone who curtails addictive substances or behaviors will go through a withdrawal period. The desire—for one more cigarette, one more drink, one more day at the track—can be unbearably intense.

“I advise people to keep their cravings at a distance,” says Dr. Horvath. Distract yourself by calling a friend, walk around the block, washing the dishes. Do whatever you can to take your mind off the craving.

In other words, acknowledge how you’re feeling. Admit to yourself your discomfort. But don’t give in. “Just because you have an itch doesn’t mean you have to scratch,” Dr. Horvath adds. Be strong. Individual cravings will disappear in minutes or even seconds, and the entire urge will often leave in a month or two.

STAY BUSY. “A lot of people who make the commitment to quit an addiction find themselves sitting at home all the time,” says Dr. DeMaria. If you don’t keep busy—with exercise, hobbies, or other activities that keep your mind and body active—you’ll find yourself focusing more and more on the addiction.

“Exercise can be especially helpful, because it’s a way of reconnecting to things that are healthy,” Dr. DeMaria adds.

GET YOUR MIND RACING. One way to distract yourself from cravings is to think about something—anything—at high speed. Count ceiling tiles as quickly as you can. Try reading book titles backward. Do repetitious math problems in your head—such as subtracting 7 from 1,000, 7 from 993, and so on.

“When you do these sorts of things quickly, they take up your entire mind, which will help you get past the desire,” says Dr. Horvath.

AVOID BEHAVIOR TRIGGERS. If you’ve just quit smoking, the last thing you need is an evening at a smoke-filled party. If you’ve been obsessed with the Internet, it’s probably a good idea to avoid shopping for Christmas gifts online.

Alcoholics Anonymous (AA), SMART Recovery, and other self-help programs teach members to steer clear of people, places, or things that are associated with their addictions. “Some people will alter their walking or driving routes to avoid parts of the city where they used to buy drugs or to stay away from people that were a bad influence,” says Dr. DeMaria. “With smoking, talking on the phone may be a trigger. You have to recognize your triggers and figure out how to respond when you’re confronted.”

As time goes by, you’ll find that addiction triggers will lose some of their pull.

SUBSTITUTE GOOD BEHAVIORS FOR BAD ONES. Avoidance is helpful in the early stages of fighting addictions, but no one can avoid all sources of temptation indefinitely. You can, however, develop substitute habits or ways to manage your cravings, says Dr. DeMaria. When you crave a cigarette, for example, chew gum. In some cases, the substitute may be temporary—you probably don’t want to be eating celery for the rest of your life every time you feel hungry—but some substitutes may become healthful habits that you can sustain for life. After a while, your new habits will take the place of the old ones.

MAKE IT HARDER TO INDULGE. Addictions are grounded in habits, which means people sometimes indulge without thinking about what they’re doing. Smokers, for example, may puff on a cigarette that they don’t remember lighting. People with eating problems may raid the refrigerator and be unaware that they left the living room.

One way to break unconscious habits is to make them harder to practice. A smoker, for example, might put a pack of cigarettes inside a box and wrap the whole thing with rubber bands. You still may smoke, but at least you won’t be doing it automatically.

The same approach works with other addictions. Turn off the computer when you sign off the Internet—and maybe crawl under the desk to pull the plug. Clear the house of alcohol, pornography, or other “forbidden” things. Putting obstacles between you and your addiction will force you to think about what you’re doing, which in turn will make the addiction easier to overcome, says Dr. Horvath.

FIND NEW WAYS TO BE FULFILLED. It’s not enough merely to give up unhealthy behaviors. If you’re going to be successful, you need to replace addictions with something positive.

“In order to develop new habits, you need to gradually change the sources of satisfaction in your life,” says Dr. Horvath. This could be as simple as creating a healthier lifestyle. Instead of spending the night in front of the television, for example, go to bed early and get more rest. You might focus more of your energy on eating healthful foods, exercising regularly, or even donating several hours a week to a charity. Spending time with friends is a good idea, too, because studies show that the more social support the less likelihood for relapse.

JOIN A SUPPORT GROUP. There are thousands of self-help groups for overcoming every sort of addiction—to alcohol, drugs, sex, overeating, and the Internet, to name a few. These groups are free, don’t require insurance, and can be very effective, either by themselves or in combination with therapy, says Dr. DeMaria.

In a support group, you spend time with people in various stages of recovery, says Dr. DeMaria. “They’ve been through it all before, and they can act as role models and mentors.”

Every group has a different mix of messages and personalities. If you find yourself in a gathering that doesn’t feel right, don’t give up on the idea. “I usually advise people to go to at least six different meetings in order to find one they like,” he says.

Keep in mind, too, that different groups offer different approaches to recovery. Besides the traditional Alcoholics Anonymous (AA) model, options include SMART Recovery, Moderation Management, Women for Sobriety, LifeRing Secular Recovery, and Secular Organizations for Sobriety. Even if you can’t find a meeting in your locality, most offer free online support in various formats.

LEARN FROM SETBACKS. Nearly everyone who struggles with addictions reverts on occasion. Expect it, says Dr. Horvath. Don’t get discouraged, and don’t give up.

“When slips happen, ask yourself why they happened. Then learn from them,” says Dr. Horvath. “Persistence is the most important virtue. Everyone who keeps going will be successful. Eventually, you run out of ways to make mistakes and you will build a life that eliminates addiction problems and is also filled with satisfactions and pleasures that would not have been possible while you were engaged in an addictive behavior.”





PANEL OF ADVISORS


PETER A. DEMARIA JR., M.D., IS A CLINICAL ASSOCIATE PROFESSOR OF PSYCHIATRY AND BEHAVIORAL SCIENCE AT TEMPLE UNIVERSITY SCHOOL OF MEDICINE IN PHILADELPHIA.

TOM HORVATH, PH.D., IS PRESIDENT OF PRACTICAL RECOVERY SERVICES, AN ADDICTION TREATMENT CENTER IN LA JOLLA, CALIFORNIA, AND PRESIDENT OF SMART RECOVERY, AN ABSTINENCE-ORIENTED SUPPORT GROUP FOR THOSE WITH ADDICTIVE BEHAVIORS.





Age Spots


9 Ways to Out the Spots



The term age spots is a misnomer. These flat, circular, brown areas that commonly appear on the backs of hands as well as on necks, faces, and shoulders are actually large, sun-induced freckles with no relation to age, says Audrey Kunin, M.D.





WHEN TO CALL A DOCTOR


If your age spots don’t respond to home remedies, or if you have an age spot that bleeds, itches, tingles, or changes in size or color, it’s time to see your doctor. Some skin cancers, such as melanoma, can look like age spots.



“The reason they’re called age spots is because they usually occur from sun exposure over time—which means that for a lot of people they won’t show up on their skin until they get a little older,” she says.

While age spots are common during the fifth decade of life and beyond, they can appear on someone who’s had significant sun exposure as early as the late twenties or thirties. Sunlight contains ultraviolet (UV) rays that cause suntans and sunburns. As time goes by, this sun damage causes excess pigment to deposit in the skin, which eventually leads to the flat, brown, skin freckles known as age spots, liver spots, or sun spots.

No matter what they’re called, they’re unsightly. And, if they change in size, they may indicate skin cancer, which is why it’s a good idea to have a dermatologist examine your skin at least once a year.

Assuming they are indeed age spots, here are some tips on concealing and fading them (as well as preventing more).

LIGHTEN UP. If your age spots aren’t too big or too dark, over-the-counter bleaching agents could help fade them, Dr. Kunin says. Look for products such as Porcelana and Palmer’s Skin Success Cream, which contain 2 percent hydroquinone, the best-known active ingredient used in many types of bleaching agents. Hydroquinone lightens age spots until they become less noticeable or even disappear. It works best with a glycolic acid moisturizer, like Neutrogena Pore Refining Cream or Alpha Hydrox Enhanced Creme, which smooths the skin.





Prescription-Strength Help to Fade Spots


For especially stubborn age spots that have been given the all-clear by your dermatologist, a prescription-strength fade cream with 4 percent hydroquinone could be your first course of action. “Rub it on twice a day for 21 to 28 days, and you may see marked improvement,” says C. Ralph Daniel III, M.D. For a stronger, quicker bleaching effect, some doctors prescribe vitamin A creams such as tretinoin (Retin-A and Renova) along with prescription-strength hydroquinone. Some studies involving laboratory animals have raised questions about the safety of hydroquinone—specifically, whether it might contribute to cancer. To date, no such link has been identified in humans, and doctors continue to prescribe hydroquinone to patients. Still, you should talk with your doctor about the benefits and risks, based on your own health history.

If creams fail to do the trick, your doctor has several treatment options at his disposal to make age spots disappear, says Dr. Daniel. For instance, your doctor can freeze them with liquid nitrogen. After a few weeks, the spots peel off. “This is a highly effective procedure for many benign age spots,” he says.

A second treatment procedure is a chemical peel—done with trichloroacetic acid (TCA) or glycolic acid. These treatments can be quite effective for all body areas but may cause scarring and whitening of the skin if not done properly. The upper layer of affected skin takes 2 to 3 days to peel from your face or 5 to 7 days from your arms and chest.

A third, and much more expensive, procedure (average cost ranges between $2,000 and $6,000, depending on how large an area is treated) is laser resurfacing. During this procedure, the doctor uses pulses of laser light to fade the spots. The laser resurfacing procedure can take a half hour to an hour to perform and 2 to 6 weeks to heal.

“A much less expensive and quicker procedure than lasers is a relatively new technique known as Collagen Induction Therapy (CIT) or more simply microneedling,” says Nelson Lee Novick, M.D. “The procedure takes only about 5 minutes to perform and has little or no downtime; most people return to work or social activities immediately afterward.” Two to four treatments, spaced at 4 to 6 week intervals, are generally required for optimal lightening. Treatment costs may range between $350 and $450 per session, depending upon the number and location of the age spots.



Apply the bleaching agent twice a day to your sun spots, carefully following the manufacturer’s directions. Dab the cream directly onto the age spots with a cotton swab so that you don’t bleach the pigment in unaffected areas.

“Be patient,” says Dr. Kunin. “You won’t see results overnight. These lightening agents often take 6 to 12 months to do the job.” Stop the treatment when the age spots disappear, or the affected area may become lighter than your normal skin tone.

Want a more natural approach? Some plant extracts, such as aloe, flavonoids, licorice, yeast derivatives, and polyphenols can lighten the skin when applied topically.

SLATHER ON THE SUNSCREEN BEFORE HEADING OUTDOORS. Even if you already have age spots, sunscreen keeps existing ones from darkening and helps prevent more from popping up, says Dr. Kunin.

Buy a broad-spectrum sunblock (which protects you from both the UVA and UVB rays of the sun) with a sun protection factor (SPF) of at least 30. Apply it to exposed skin 10 to 15 minutes before you go outside, says C. Ralph Daniel III, M.D. Tests show that SPF 30 sunblock protects the skin against about 93 percent of the sun’s UV rays, he says.





Cures from the Kitchen


Cut a few lemon slices and place them directly onto your age spots for 10 to 15 minutes once a day, suggests Audrey Kunin, M.D. “The acid in the fresh lemon juice helps lighten the age spots in some cases.” It won’t happen overnight, though. Dr. Kunin says that you’ll notice a difference in 6 to 12 weeks. Watch carefully. Overuse may cause the upper layer of skin to peel.



Be sure to use sunblock whenever you’re planning to be outdoors for more than 10 to 15 minutes, whether you’ll be on the golf course, tennis court, or ski slope. It’s especially important if you spend a lot of time on a boat or at the beach, because the sun’s rays reflect off the water.

Remember, too, to reapply sunscreen frequently, because perspiration and water can wash it off. Experts suggest using enough sunscreen to fill a shot glass every time you slather up. Dr. Daniel recommends Neutrogena #70. “It’s water resistant and not greasy,” he says.

COVER YOUR HEAD. Whether you’re heading to the beach or spending extended time in the midday sun, wear a hat with at least a 4-inch-wide brim to keep the sun off your face and neck. Dr. Daniel’s favorite: Tilley Hats (www.tilley.com).

Baseball caps, assuming they’re worn with the bill in front, don’t protect your ears, the back of your neck, or even most of your face from full sun, says Dr. Kunin. Straw hats don’t usually offer much protection either. If the hats are unlined and loosely woven, the sun shines directly through them.

“Choose a hat with an extra-long bill and sun-protective cloth inside,” says Dr. Kunin. “It will give you more protection and help limit your chances of developing age spots.”

PROTECT YOUR LIPS. Most people don’t think about their lips when it comes to sun protection. But age spots can show up there, too. Many women believe that their lipstick will protect them. The sun, however, can penetrate many lighter shades, and lipstick typically wears off throughout the day, leaving the lips naked and unprotected.





What the Doctor Does


There is a wart-remover product called Wart Stick that contains 40 percent salicylic acid, which is also the beta hydroxy acid that doctors use to treat wrinkles. “Because the stick allows you to concentrate on one specific spot or area to treat, I got the idea to use the Wart Stick for people who have brown spots, dark circles, and roughened areas of the skin,” explains Nelson Lee Novick, M.D. “It’s convenient, it doesn’t run, and it works.” He recommends applying it at bedtime. It may take 8 to 12 months to see results. Wart Stick is available at some drugstores, at mass merchandisers, and online.



Apply either a lip balm or lipstick with an SPF of 15 to 30 before you head outside. Dr. Kunin recommends DERMAdoctor Climate Control Lip Balm SPF 15 (available online) or Neutrogena Lip Moisturizer SPF 15 (available in drug stores). If you still want to wear your favorite non-SPF lipstick, apply it over a layer of the protective balm.

SHUN THE SUN. Since these brown blotches are caused by the sun’s UV rays, limiting sun exposure is an important first step in the battle against age spots. “Avoid the sun as much as possible during peak hours (10:00 a.m. to 4:00 p.m. during spring, summer, and fall or 10:00 a.m. to 2:00 p.m. during winter), when the ultraviolet radiation is the strongest,” says Dr. Kunin. If you have to do outdoor chores like gardening, perform them early in the morning or in the evening. And remember that sunblock is needed even during winter months and on cloudy days.

TAKE A BREAK IN THE SHADE. Excessive sun exposure causes age spots, so periodically retreat to a shady place on sunny days. At the beach or a backyard barbecue, park yourself under a big umbrella. “It sounds simple, but protecting yourself with sunblock and staying out of the sun are the two best ways to keep new age spots from forming,” says Dr. Kunin. Also, whenever you’re in the sun, wear tightly woven, light-colored clothing if it’s not too hot outside. It helps keep UV rays from penetrating your skin. Dr. Daniel recommends a line of clothing called Sun Precaution. “It provides an SPF of 30 and keeps you relatively cool,” he says.

COVER UP THE SPOT. If the other at-home remedies don’t do the trick and you don’t want to spend the money on a dermatologist-administered chemical peel or a laser resurfacing treatment, you can always reach into your cosmetics bag. “Brown age spots can be hidden by applying a cream-based or water-based concealer,” says Dr. Kunin. Pick a lighter version of your skin tone to best hide age spots.





PANEL OF ADVISORS


C. RALPH DANIEL III, M.D., IS A CLINICAL PROFESSOR OF DERMATOLOGY AT THE UNIVERSITY OF MISSISSIPPI MEDICAL CENTER AND CLINICAL ASSOCIATE PROFESSOR OF DERMATOLOGY AT THE UNIVERSITY OF ALABAMA IN BIRMINGHAM.

AUDREY KUNIN, M.D., IS A COSMETIC DERMATOLOGIST IN KANSAS CITY, MISSOURI, THE FOUNDER OF THE DERMATOLOGY EDUCATIONAL WEB SITE WWW.DERMADOCTOR.COM, AND AUTHOR OF THE DERMADOCTOR SKINSTRUCTION MANUAL.

NELSON LEE NOVICK, M.D., IS A CLINICAL PROFESSOR OF DERMATOLOGY AT MOUNT SINAI SCHOOL OF MEDICINE IN NEW YORK CITY.





Allergies


15 Ways to Alleviate the Symptoms



Allergies are the result of an immune system run amok. They develop when your immune system overreacts to a normally harmless substance, such as pollen, cat dander, or dust. About one in five Americans are plagued by sneezing, coughing, wheezing, chest tightness, difficulty breathing, itchy eyes, hives, and rashes, which are all hall-marks of allergy symptoms.





WHEN TO CALL A DOCTOR


If you have a known allergy and you notice any of the following symptoms, you should see your doctor.

Welts that spring up in response to exposure to an allergen, also known as hives. They may indicate the onset of anaphylactic shock, an allergic reaction severe enough to kill. Seek medical attention promptly.

Wheezing—a whistling sound when you breathe

Asthma—congestion of the chest severe enough to make breathing difficult, often accompanied by wheezing

An allergy attack that doesn’t respond to over-the-counter medications within a week

“If your allergy symptoms are preventing you from doing the things you want to do, or you’re missing work or school, you should see a doctor,” says David Lang, M.D.



How can you tell the difference between a cold and an allergy? David Lang, M.D., offers this rule of thumb: If you have nasal symptoms and it feels like you have a cold but it’s with more itching and sneezing, and it lasts for more than 2 weeks, you probably have an allergy.

Allergies come in almost infinite variety. But most triggers, called allergens, stimulate the immune system through four basic routes: ingestion (eating peanuts or shrimp, for example), injection (such as getting a penicillin shot), absorption through the skin (touching poison ivy), and inhalation (breathing in cat dander).

For food and drug allergies, avoidance is the only option. To prevent or treat contact allergies caused by poison plants, see Poison Plant Rashes on page 486 But when you want relief from inhalant allergies, the answer is probably right under your nose, because house dust, pollen, pet dander, and mold are the most common triggers.

“You find a bit of everything in house dust,” says Thomas Platts-Mills, M.D. “Different people are allergic to different things—pieces of cockroach are pretty potent, actually—but the single biggest cause of problems is the dust mite.”

The dust mite is an almost microscopic relative of ticks and spiders. But living mites are not the problem. People react, instead, to the fecal material that mites expel on carpets, bedding, and upholstered furniture. The bodies of dead mites also trigger allergies.

Dust mites have been isolated in dust samples from the five major continents of the world, and are frequently a big allergen for those with allergies and asthma. Because dust mites require heat and humidity to survive, and can live only below an altitude of 1500 meters, they are not found in areas of the United States such as Denver, Vail, Santa Fe, and Lake Tahoe.

The other common trigger, the cockroach, is pervasive. “Although most species of cockroaches live in the tropics, they are also found in North America, particularly in homes in large cities,” says Dr. Lang. Not surprisingly, cockroach allergen is most abundant in kitchen areas where there is food debris.

Airborne allergens are hard to escape. Pollen fills the air in almost every region with seasonal regularity. Mold grows wherever it’s dark and humid—under carpets, in dank basements, and in leaky garages and storage sheds. And with millions of dogs and cats in America, it’s not easy to escape pet dander. If you’re sensitive to any of these allergens—most likely because you’ve inherited the tendency—contact with them will trigger a sneezing, wheezing, itchy reaction.

Fortunately, there’s much you can do to help minimize the misery. The following doctor-tested and recommended tips will help plant you firmly on the wellness path to easy breathing and dry eyes.

TREAT YOUR SYMPTOMS. A certain amount of exposure to whatever bothers you is unavoidable. Allergy shots, available from your doctor, are a great way to make sure that your forays into the outside world are pleasant instead of painful. But you don’t have to rely on them. Over-the-counter, nonsedating antihistamines, available from your local pharmacy, work wonders on drippy noses and red, itchy eyes, and are well tolerated. However, according to the Joint Council of Allergy, Asthma, and Immunology, the most effective medication for the treatment of nasal allergies is an intranasal steroid spray, which is available only by prescription.

AIR-CONDITION YOUR HOUSE (AND CAR). This is probably the single most important thing you can do to alleviate pollen problems, and it can help with two other chief inhalants: mold and dust mites.

The basic idea is to create an oasis of sorts,” says Richard Podell, M.D. “You want your home to be a place of sanctuary, a place you can count on to provide escape.”

Air conditioners help in two ways. They keep humidity low, which discourages mites and mold, and they can filter the air in the course of cooling it—if you also install an air cleaner. But it’s the sealing of the house that provides the real benefit, Dr. Podell says. If you have the windows open, the inside of the house is essentially the same environment as the outside of the house—full of pollen.

If walking outside makes you start wheezing and sneezing, imagine what tearing through all those pollen clouds at 55 miles per hour is going to do. Be sensible and remember to use the air conditioner in your car, too.

INSTALL AN AIR FILTER. Keeping the air clean in your home can bring relief from pollen, mold, and pet dander. HEPA (high-energy particulate-arresting) filters are most efficient. When you use an air filter in your room, remember to keep the door closed to reduce the overall volume of air that the machine is trying to clean.

Air filters, however, aren’t much use against dust mites. The dead mites float in the air for only a few minutes before falling, not long enough for the filter to draw them in.

BUY A DEHUMIDIFIER. Keeping the air in your home dry will help put a stop to dust mite problems.

Dust mites don’t thrive in low humidity, below about 45 percent, says Dr. Platts-Mills. “Generally, the drier, the better.”

Remember to empty the unit’s water often and clean it regularly, according to the manufacturer’s instructions, to prevent mold. If your dehumidifier creates a problem for a child or someone else sensitive to dry air, try using a small room humidifier in the bedroom.

KEEP IT CLEAN, BUT NOT TOO CLEAN. People with allergies fare better when dust and grime are kept to a minimum. But your home will need more than a dusting with a dry cloth, which just propels allergens into the air. Instead, wipe down hard surfaces and floors with a slightly damp cloth. Try not to use aerosol sprays or products containing harsh chemicals or odors that may irritate airways.

In humid areas, use a bleach solution. Bleach kills mold, and, unlike some other exotic (and potentially dangerous) chemicals, you can get it at the grocery store. Wipe down surfaces in your bathroom as needed. The label on a bottle of bleach suggests that you clean floors, vinyl, tile, and your kitchen sink with a solution of ¾ cup of bleach per gallon of water. Let it stand for 5 minutes and then rinse. Use a regular fungicide for tough locations such as the basement. Of course, if you use bleach on fabrics they’ll lose their color.

If you’re allergic to house dust, pet dander, or another common household allergen, hire someone else to clean that carpet, such as a professional cleaning service or carpet cleaner. The cost of hiring a helper is a small price to pay to avoid an allergic reaction.

All of that said, some researchers believe that our excessively sanitized Western lifestyle keeps our immune systems confused, off bal-ance, and unable to distinguish friend from foe. In fact, increasing evidence shows that a baby’s immature immune system can develop properly only if it’s exposed to some bacteria.





How the Home Became a Dust Mite Haven


In the 1940s, American homeowners welcomed the vacuum cleaner with enthusiasm. Before long, no homemaker could live without one.

But the same technology that made our lives easier has indirectly contributed heavily to one common medical problem: allergies to dust mites.

“The vacuum cleaner made carpeting more attractive than throw rugs,” says David Lang, M.D. With central heating, homes tended to stay warm year-round. Add well-insulated homes and cold-water washes to the mix (courtesy of the energy crisis), and you end up with a perfect environment for dust mites.



ISOLATE YOUR PETS. The furry friends that occupy America’s homes can worsen allergies. Cat dander usually causes the most problems, but dogs, birds, rabbits, horses, and other pets with hair or fur also stir up allergic reactions. “One walk a week through a room is all it takes for a pet to keep a dander allergy going,” Dr. Podell says.

“Unfortunately, no secondary measure can rival the benefit that will occur with elimination of a pet from the home,” says Dr. Lang. “If a cat or dog is removed from the home, however, clinically relevant levels of pet allergen may persist in ‘reservoirs’ like upholstered couches and chairs, wallpaper, and other areas for several months.” So be patient.

If you can’t bear to part with your pet (and most pet owners can’t), make your bedroom a haven, sealed off from the rest of the house and absolutely forbidden territory for critters. There’s evidence to suggest that washing a cat or dog frequently will reduce its level of allergens.

WEAR A FACE MASK. Don a mask when doing anything that’s likely to expose you to a problem allergen. A simple chore like vacuuming can throw huge quantities of dust and contaminants into the air, where it will hang for several minutes, says Dr. Lang. Similarly, gardening can expose you to huge volumes of pollen. A small mask that covers your nose and mouth, known professionally as a dust and mist respirator, can keep the pollen from reaching your lungs. The 3M Company makes an effective, inexpensive version that can be found in most hardware stores.

ENFORCE A NO-SMOKING POLICY. Tobacco smoke is a significant irritant for not only the smoker but also anyone else nearby. Smoke can worsen allergies, so if you wish to breathe easier if you keep your home, office, and car smoke-free.





Don’t Buy into the Allergen-Free Cat Claims


You may have heard the buzz about “allergen-free” cats. Most of these animals cost several thousand dollars, but the experts claim they offer more hype than hope. “I have yet to see any quantitative data to show that these animals lack Feld 1, the main cat allergen,” cautions Scott P. Commins, M.D., Ph.D. Before you buy one of these animals, he suggests waiting for some solid research indicating they are, indeed, allergen-free.



MAKE YOUR BED A MITE-FREE ZONE. Encase your pillows, mattress, and box spring in allergen-proof covers. These covers provide a barrier between you and any allergens found inside them. Look for a fabric weave of 10 microns, which is tight enough to keep out dust mite allergens. These products are available from companies such as American Allergy Supply, National Allergy Supply, Allergy Control Products, and at www.stopallergy.com.

CHOOSE THE HOT CYCLE ON LAUNDRY DAY. Linens should be washed in water that is at least 130°F to rid them of dust mites and their wastes. To test your water temperature, stop the washer once it’s filled and dip a meat thermometer into the water. (This works only for top-loading machines, of course!) If you’re worried about scalding people by setting your water heater that high, consider taking your bedding to a professional laundry service where you’re assured that the bedding will be washed at a sufficiently high temperature.

THROW OUT YOUR CARPETS. Carpets may look nice, but they make an almost perfect home for dust mites and mold. Plus, tightly woven carpets very effectively attract and hold pollen and pet dander. Even steam cleaning may not help.

“It’s not hot enough to kill the mites,” says Dr. Platts-Mills. All steam cleaning really does is make it warmer and wetter underneath—an ideal climate for both mites and mold.

BUY THROW RUGS. Replace your carpets with throw rugs to achieve two major benefits. First, you’ll eliminate your home’s biggest collector of dust, pollen, pet dander, and mold. Second, you’ll make keeping your home allergen-free much easier. Rugs can be washed at temperatures hot enough to kill dust mites. Also, the floors underneath—courtesy of a rug’s loose weave—stay cooler and drier, conditions distinctly hostile to mold and mites.

“Mites can’t survive on a dry, polished floor,” Dr. Platts-Mills says. “That kind of floor dries in seconds versus days for a steam-cleaned carpet.”

BUY SYNTHETIC PILLOWS. Dust mites like synthetic (Hollofil and Dacron) pillows just as much as those made from down and foam, however, synthetic pillows do have one major advantage: You can wash them in hot water and kill the dust mites.

REDUCE CLUTTER. Dried flowers, books, stuffed animals, and other homey touches collect dust and allergens. So keep knickknacks to a minimum, or get rid of them entirely.

MAKE AT LEAST ONE ROOM A SANCTUARY. If you can’t afford central air and don’t want to rip the wall-to-wall carpeting out of every room in your house, there’s still hope. Make just one room a sanctuary.

“Most people spend the largest part of their time at home in the bedroom,” Dr. Platts-Mills says. Making just that one room an allergen-free area can help a great deal to alleviate your allergy symptoms.

Do it by air-conditioning the room in summer, sealing it from the rest of the house (by keeping the door closed), replacing carpets with throw rugs, encasing linens in allergen-proof cases, and keeping it dust-free.





PANEL OF ADVISORS


SCOTT P. COMMINS, M.D., PH.D., IS AN ALLERGY AND IMMUNOLOGY FELLOW IN THE ASTHMA AND ALLERGIC DISEASE CENTER AT THE UNIVERSITY OF VIRGINIA CHARLOTTESVILLE.

DAVID LANG, M.D., IS THE HEAD OF ALLERGY AND IMMUNOLOGY IN THE RESPIRATORY INSTITUTE AT CLEVELAND CLINIC IN OHIO.

THOMAS PLATTS-MILLS, M.D., PH.D., IS A PROFESSOR OF MEDICINE AND HEAD OF THE DIVISION OF ALLERGY AND IMMUNOLOGY AT THE UNIVERSITY OF VIRGINIA MEDICAL CENTER IN CHARLOTTESVILLE.

RICHARD PODELL, M.D., IS A CLINICAL PROFESSOR IN THE DEPARTMENT OF FAMILY MEDICINE AT THE UNIVERSITY OF MEDICINE AND DENTISTRY OF NEW JERSEY–ROBERT WOOD JOHNSON MEDICAL SCHOOL IN PISCATAWAY.





Anal Fissures and Itching


17 Soothing Solutions



Even though the symptoms are comparable—pain, bleeding, and itching—the similarities between anal fissures and hemorrhoids are largely superficial. Hemorrhoids are generally swollen veins. In contrast, fissures are ulcers, or breaks in the skin, which just happen to occur in the same general area.





WHEN TO CALL A DOCTOR


Fissures don’t require special medical attention, unless they persist.

The real caution with fissures is not to put them off forever—an ulcer that doesn’t heal may be cancer.

If you have fissures that don’t heal within 4 to 8 weeks, get them evaluated. A sore that will not heal is one of the seven classic warning signs of cancer. In addition, if you notice a mucus discharge from your anus, have it checked out by a doctor. The possibility of perirectal/perianal abscess formation should be considered if there’s any persistent pain or discharge, says Judy Gerken, M.N., F.N.P.-B.C. Abscesses can be very serious in that area.



“Fissures are tears or ulcers in the lining of the anal canal most often caused by trauma, the most common being a hard bowel movement,” says Edmund Leff, M.D.

New research points to anatomical problems that can contribute to chronic anal fissures, as opposed to isolated problems with the painful lesions. Increased pressure in the internal anal sphincter muscle and reduced blood flow to the area in which fissures occur may make you more prone to chronic problems.

If you have fissures, you know these little sores can make your life—at least your sitting life—miserable. Take comfort in the fact that about 60 percent of anal fissures heal within a few weeks. In severe, chronic cases, surgery may be required, but it carries considerable risks, including the possibility of fecal incontinence if the anal sphincter is injured. But according to Dr. Leff, some fissures will respond to Botox injections, eliminating the need for surgery. And a number of nonsurgical remedies exist to help fissures heal. Here’s what our experts suggest.

ELIMINATE HARD STOOLS WITH FIBER AND FLUID. The anal opening was never meant to accommodate large, hard stools. Generally a by-product of a Western diet lacking in fiber, rock-hard stools tug and tear at the anal canal, which can result in anal fissures and hemorrhoids.

The solution? Adapt yourself to a diet high in fiber and fluids that produce soft bowel movements. Eating more fruit, vegetables, and whole grains, and drinking six to eight glasses of water a day are the best remedies and preventive measures you can use for anal fissures, says Dr. Leff. Once your stool is soft and pliable, your anal fissures should begin to heal on their own.

TRY THE PETROLEUM SOLUTION. Eating more fiber will soften your stool, but you can also protect your anal canal by lubricating it before each bowel movement. A dab of petroleum jelly inserted about a ½ inch into the rectum may help the stool pass without causing any further damage, says Dr. Leff.

BUFF YOURSELF WITH BABY POWDER. Following each shower or bowel movement, sprinkle on baby powder. This helps keep the area dry, which can help to reduce friction throughout the day. If the area is actively inflamed, skip this step, cautions Wal Baraza, M.B. CH.B., M.R.C.S., because it can worsen anal itching. And steer clear of the powders with perfumes, which may be irritating, adds Judy Gerken, M.N., F.N.P.-B.C. “People generally like to search for things that make them smell like a flower, but sometimes that can do more harm than good.”

WATCH THE WIPES. Over-the-counter “wipes” are widely available, but many of them contain alcohol, which is the last thing you want to use if you have a fissure, says Gerken.

AVOID DIARRHEA. It may seem odd that not only can hard, constipated stools worsen anal fissures—but so can diarrhea. Watery stools can soften the tissues around them, and they also contain acid that can burn the raw anal area. “If you tend toward loose stools and have a fissure, taking fiber supplements with a minimum of water can firm up your stools,” says Dr. Leff.

DON’T SCRATCH. Anal fissures may be itchy as well as painful, but using sharp fingernails on your tender anus can further abrade the skin and lead to a vicious cycle in terms of itching, says Dr. Baraza.

SHED THOSE EXCESS POUNDS. The more weight you carry, the more likely you are to sweat. Perspiration in your anal area irritates the skin and slows the healing of fissures, says Dr. Leff.

MINIMIZE SWELLING WITH HYDROCORTISONE. Nonprescription topical creams containing hydrocortisone can help reduce the inflammation that often comes with anal itching, says Dr. Baraza.

TRY A VITAMIN SOLUTION. Nonprescription ointments containing vitamins A and D, as well as aloe, may be particularly helpful for soothing pain and helping fissures heal.

SOAK IN A HOT TUB. Whether you fill your bathtub with hot water or slip into an outdoor hot tub, warm water helps relax the muscles of the anal sphincter, increases blood flow, and reduces much of the discomfort of fissures, says Dr. Leff.

STEER CLEAR OF CERTAIN FOODS. While no food directly causes fissures, some foods may irritate the tissues of the anal canal. “Hot, spicy foods, as well as caffeine, are irritating,” says Dr. Leff. “Excess caffeine is probably the major cause of anal itching.”

AVOID ANAL ENTRY. Anal intercourse can be a source of tears, says Gerken. The best treatment is prevention, so use adequate lubrication, she says.

BUY YOURSELF A SPECIAL PILLOW. Alleviate the pain associated with the anal area by sitting on a soft or gel-filled pillow. “But avoid doughnut-shaped pillows,” cautions Gerken, “because they may restrict blood flow to the area.”

DON’T READ ON THE TOILET. “People shouldn’t be reading their morning paper or a novel while they’re sitting on the toilet,” says Gerken. “The seat has a constricting effect, and prolonged sitting causes engorgement of the blood vessels.”

WIPE GENTLY. Rough toilet paper and overzealous wiping slows healing of your fissures. Use only white, unscented, top-quality toilet paper. Perfumes and dyes can irritate the anus. You can soften toilet paper by moistening it with water before wiping. Make sure you dab after a bath, don’t wipe, says Dr. Baraza. Applying petroleum jelly after a bath can help soothe itching, too.

SUBSTITUTE FACIAL TISSUE. The very best toilet paper isn’t a toilet paper at all. Facial tissues coated with moisturizing lotion offer the least amount of friction.

USE A BIDET, IF YOU HAVE ONE. There are portable bidets available, which divert water from your bathroom faucet to underneath your toilet seat. A narrow stream of water, aimed right where you need it most, does all your “wiping” for you. There’s no need for toilet paper, except for one or two sheets to pat yourself dry. This is the best way to cleanse the area, says Dr. Leff.





PANEL OF ADVISORS


WAL BARAZA, M.B.CH.B., M.R.C.S., IS A SPECIALIST REGISTRAR IN GENERAL SURGERY AT SHEFFIELD TEACHING HOSPITALS IN SHEFFIELD, UK.

JUDY GERKEN, M.N., F.N.P.-B.C., IS A NURSE PRACTITIONER AND THE HIV PROGRAM COORDINATOR AT THE VA LONG BEACH HEALTH CARE SYSTEM IN LONG BEACH, CALIFORNIA.

EDMUND LEFF, M.D., IS A COLON AND RECTAL SURGEON IN PHOENIX AND SCOTTSDALE, ARIZONA.





Angina


10 Long-Life Strategies to Protect the Heart



More than a few people confuse the symptoms of angina with those of a heart attack. Angina isn’t quite that serious, but it’s close. Think of it as a warning sign that your heart needs some tender loving care.





WHEN TO CALL A DOCTOR


Most people with angina have a form called chronic stable angina. This means that it occurs in predictable ways—during exercise, for example, or at times of emotional stress—with the pain lasting 5 minutes or less. Most chronic stable angina can easily be managed with medications and lifestyle changes.

Unstable angina, on the other hand, is much more serious. The discomfort can occur out of the blue and may last 20 minutes or more.

“If there’s any change in your usual pattern of angina—if pain or shortness of breath get more intense—head to an emergency room right away,” says David M. Capuzzi, M.D., Ph.D.

While you’re en route, chew two aspirin tablets. “Aspirin thins the blood and can help dissolve blood clots that may be blocking circulation to the heart.” says Dr. Capuzzi.



Angina (the full name is angina pectoris) occurs when the heart gets insufficient blood and oxygen, which may result in temporary nausea, dizziness, or a burning or squeezing pain in the chest. Angina itself isn’t a disease. It’s a symptom of underlying problems, usually coronary artery disease.

“When you have chronic worsening angina (meaning your episodes become more frequent or occur with less activity), you’re at a much higher risk of having a sudden ‘cardiac event,’ such as a heart attack or sudden cardiac arrest,” says David M. Capuzzi, M.D., Ph.D. “Unfortunately, up to 50 percent of people who experience heart attack do not have prior angina as a warning.”

Anything that increases the heart’s demand for oxygen, such as exercise or emotional stress, can trigger bouts of angina. This is especially likely if the heart’s supply of blood is decreased by a narrowing of one or more of the heart’s blood vessels. The attacks normally last fewer than 5 minutes and are unlikely to cause permanent damage to the heart. The underlying problems, however, can be life-threatening.

The discomfort of angina can be relieved with nitroglyc-erine, beta-blockers, or other medications that dilate arteries or fulfill the heart’s demand for oxygen. In addition, it’s essential to make some lifestyle changes to reduce angina episodes and prevent the problem from getting worse.

KEEP CHOLESTEROL AND TRIGLYCERIDES UNDER CONTROL. Along with other fatty substances in the blood, cholesterol slowly accumulates on the linings of arteries and restricts blood flow to the heart. If you’re having episodes of angina, it probably means fatty buildups have reached dangerous levels, says Howard Weitz, M.D.

Keep your total cholesterol below 200. In addition, levels of low-density lipoproteins (LDL, or “bad” cholesterol) should ideally be below 100. “Apart from the use of medications, reducing the amount of saturated fat in your diet and increasing the fiber from whole grains are two of the most effective ways to control cholesterol,” says Christine Gerbstadt, M.D., R.D.

Saturated fat is mainly found in fatty meats, whole-fat dairy (such as whole milk, cheeses, butter, cream, and ice cream), rich desserts, and snack foods. If you have high cholesterol, limit red meat to lean cuts no more than twice a week, and avoid snack foods that are made with butter or other fats, suggests Dr. Gerbstadt.

INCREASE THE FIBER IN YOUR DIET. Found in whole grains, legumes, fruits, and other plant foods, fiber helps prevent cholesterol from passing through the intestinal wall into the bloodstream. High-fiber foods are also filling, which means you’ll naturally eat smaller amounts of other, fattier foods.

LOAD UP ON FRUITS AND VEGETABLES. A low-fat, meat-free diet isn’t for everyone, but it’s an ideal way for those with angina to partially control the underlying coronary artery disease. Most vegetarian diets tend to be lower in fat and also provide a bounty of antioxidants. These chemical compounds help prevent cholesterol from sticking to artery walls.

“Diet alone can lower cholesterol by up to 20 percent,” says Dr. Weitz. “At the same time, it decreases your risk of heart attack by as much as 25 percent if you can lower LDL levels to 100 or less, which makes arterial plaques more stable and less likely to rupture and form clots. Patients frequently require both diet and cholesterol-lowering medication to help them achieve this goal.

GET MOVING. “Exercise is a major lifestyle component to prevent coronary disease, although we usually make sure people also take the appropriate medication,” says Dr. Weitz. Strive to perform moderate to intense exercise such as brisk walking for 30 minutes a day, 7 days a week. If you haven’t exercised in a while, start with as little as 5 minutes a day, suggests Dr. Gerbstadt, and build up from there.

If you’ve experienced angina, be sure to talk to your doctor before starting an exercise plan. You’ll be advised to build up your fitness gradually—by starting with short walks or water-resistance walking (in a pool), for example, and increasing the exertion over a period of weeks or months. “Swimming may be added once a baseline test of a few months shows no signs of angina during the activity,” says Dr. Gerbstadt.

EXERCISE LATER IN THE DAY. Morning can be a risky time for people with angina because fight-or-flight hormones, such as cor-tisol and norepinephrine, rise overnight and peak in the morning, says Dr. Gerbstadt. The levels stay elevated until about noon, and intensive morning exercise is probably not a good idea for most patients with angina.

“Don’t sprint in the morning or do any heavy lifting or other stressful exercises,” Dr. Gerbstadt says. “Ease into the morning and follow your doctor’s advice. Some people with angina should never do heavy weight or strength training that requires bearing down, because this impedes blood return from the body to the heart, which can cause angina.”

AVOID EXERCISE FOLLOWING A MEAL. Large meals, especially those containing saturated fats from fatty meats or fried foods, are a common angina trigger, because blood diverted to the intestine during digestion is not available to the heart, Dr. Weitz says.

STAY AT A HEALTHFUL WEIGHT. Those extra pounds that tend to accumulate over the years put an incredible load on the heart. For one, the heart has to work harder to supply blood to all that extra body tissue. What’s more, being overweight can result in elevated levels of cholesterol, which makes it harder for blood to circulate.

STAY AWAY FROM SMOKE. Whether you smoke yourself or are exposed to secondhand smoke on a regular basis, now’s the time to clear the air. Smoking even one cigarette temporarily reduces your heart’s supply of oxygen, which can trigger painful angina.





What the Doctor Does


For years author and cardiologist Ralph Felder, M.D., Ph.D., has been eating what he calls the seven bonus-years foods every day—red wine (5 ounces daily), dark chocolate (2 ounces daily), fruits and vegetables (4 cups daily), fish (three 5-ounce servings a week), garlic (one clove daily), and nuts (2 ounces daily). “Eat these seven foods every day in the recommended doses and you’ll add an average of 5 to 6 years to your life,” he says. In fact, a study published in the British Medical Journal suggests that people who eat these foods regularly can reduce their risk of heart disease by more than 75 percent. “The dark chocolate and fruits and vegetables lower your blood pressure. Garlic and nuts lower LDL (bad) cholesterol. Fish helps protect against cardiac arrhythmias, blood clotting, and inflammation,” says Dr. Felder. “Together these foods help protect the endothelium (the Teflon-like coating around your blood vessels) and reduce the risk of heart disease.”



TAKE ASPIRIN. If your stomach can handle it, experts generally agree that taking one 81-milligram aspirin daily is good protection. It won’t stop the pain of angina, but it does reduce the risk of blood clots that can lead to heart attacks. In fact, taking an aspirin each day can reduce the risk of coronary heart disease by 28 percent. “Previously, doctors may have recommended higher doses (up to 325 milligrams), but with the higher dose there is generally an increased chance of bleeding, says Ralph Felder, M.D., and it is probably not worth the risk.

GET SOME CALM IN YOUR LIFE. Emotional stress is an inevitable part of daily life, but when tension and anxiety soar, the body’s demand for blood and oxygen increases, which can result in angina. Regular exercise is an excellent way to reduce stress. Some people meditate. Others practice yoga or deep breathing. Experiment to find what works best for you.





PANEL OF ADVISORS


DAVID M. CAPUZZI, M.D., PH.D., IS A PROFESSOR OF MEDICINE, BIOCHEMISTRY, AND MOLECULAR PHARMACOLOGY AND DIRECTOR OF THE CARDIOVASCULAR DISEASE PREVENTION CENTER AT THOMAS JEFFERSON UNIVERSITY HOSPITAL IN PHILADELPHIA.

RALPH FELDER, M.D., PH.D., IS A CARDIOLOGIST AND THE AUTHOR OF THE BONUS YEARS DIET.

CHRISTINE GERBSTADT, M.D., R.D., IS A NATIONAL SPOKESPERSON FOR THE AMERICAN DIETETIC ASSOCIATION AND PRESIDENT OF NUTRONICS HEALTH.

HOWARD WEITZ, M.D., IS DIRECTOR OF THE JEFFERSON HEART INSTITUTE OF THOMAS JEFFERSON UNIVERSITY HOSPITAL AND SENIOR VICE CHAIR OF THE DEPARTMENT OF MEDICINE AT JEFFERSON MEDICAL COLLEGE, BOTH IN PHILADELPHIA.





Anxiety


		 19 Ways to Control Excessive Worrying



	 Anxiety is a natural reaction to some of life’s most challenging situations. In small, occasional doses, it can be a good thing—motivating you to meet a deadline, pass a test, or deliver a well-crafted presentation. As part of what’s known as the fight-or-flight response, anxiety triggers the physiological changes that allow you to deal with stressors large and small. Your heart rate speeds up, you breathe faster, and your muscles tense, so you can take action if you need to.





WHEN TO CALL A DOCTOR


The line between normal worrying and an anxiety disorder can be hard to discern. “If your life is restricted by anxiety, get medical attention,” advises Bernard Vittone, M.D. Also see a doctor if you:

Experience more than one panic attack a month

Are nervous or anxious most of the time, particularly if your worry is attached to situations that would not make other people anxious

Have frequent insomnia, shakiness, poor concentration, tight muscles, or heart palpitations

Feel nervous in or avoid facing particular situations, such as crossing bridges or tunnels

Take refuge from fear or worry by using drugs, including alcohol, or overeating

Obsess or ruminate about the past or the future

Fear you might harm yourself or others



A little bit of anxiety can be good. It helps motivate you to meet a deadline, pass a test, or deliver a well-crafted presentation at work. It also keeps you from meeting danger head-on. As part of the fight-or-flight response, anxiety causes your heart rate to increase and your muscles to tense should you need to act.

If your anxiety becomes so severe that it takes over your thinking and undermines your ability to function, then you may have an anxiety disorder. About 25 million Americans experience these disorders, which include panic attacks, generalized anxiety disorder, phobias, post-traumatic stress disorder, and obsessive-compulsive disorder. Anxiety disorders require medical attention and sometimes medication.

Millions of people fall somewhere in between these two extremes. They worry too much but don’t have an actual disorder. Chronic worriers are able to function from day to day, but the anxiety eats away at their emotional and physical health. Edward M. Hallowell, M.D., calls this “persistent toxic worry.”

“We virtually train ourselves to worry, which only reinforces the habit,” Dr. Hallowell says. “Worriers often feel vulnerable if they’re not worrying.”

But they have good reason to stop. Excessive worry, or anxiety, is associated with increased risk for depression, heart disease, and other medical conditions.

Here are some tips for getting a handle on excessive worry.

TAKE SLOW, DEEP BREATHS. When you’re anxious, you tend to hold your breath or breathe too rapidly or shallowly, and that makes you feel more anxious. “Regulating your breathing is a surprisingly effective antianxiety measure,” says Bernard Vittone, M.D. He recommends inhaling slowly through your nose holding one nostril, then holding your breath for about 10 seconds, and finally slowly exhaling through your mouth. Then repeat the process holding the other nostril. To make sure you’re breathing correctly, place your hand on your diaphragm, just below your rib cage. Feel it rise with each inhalation and fall with each exhalation. Practice this technique regularly throughout the day for about a minute at a time, or any time you’re feeling anxious.





Cures from the Kitchen


To calm yourself before bedtime, reach for a glass of warm milk. “The old wives’ tale of having warm milk really does help,” says Bernard Vittone, M.D. Milk contains the amino acid tryptophan, which can cause a certain amount of relaxation. Chamomile tea is another folk remedy for anxiety—and there’s evidence from test tube studies that the herb contains compounds that have a calming action. Experts recommend drinking one cup of tea at least three times a day.



MAKE CONTACT. The more isolated you feel, the more likely you are to worry, says Dr. Hallowell, who recommends daily doses of human contact. Go to a restaurant, a supermarket, or a library and start a conversation with someone. Call a friend or relative. Feeling connected reduces anxiety, Dr. Hallowell says.

BE SURE TO MEDITATE. Do some sort of meditative activity for at least 15 minutes, three or four times each day. Research shows that meditation can significantly lower anxiety. Find a quiet environment, clear your mind, and actively relax, says Dr. Vittone. “Focus on a mantra or make your mind a blank slate, whatever works for you.”

STAY IN THE PRESENT. Pay attention to what’s happening now, not to the past or the future. Take 1 day, 1 hour, or even 1 minute at a time, says Dr. Vittone.

PASS UP PASSIVITY. Don’t be a passive victim, says Dr. Hallowell. If you’re worried about your job, health, or finances, for example, create a plan to solve potential problems. Start a savings account or schedule a work evaluation with your boss. Taking action reduces anxiety.





How to Choose a Therapist


Edward M. Hallowell, M.D., offers these tips for choosing a mental-health professional, such as a licensed clinical social worker, psychologist, or psychiatrist. To start, consult two or three licensed professionals with good reputations in your community. Keep these questions in mind as you talk with each of them.

Does she have a pleasant disposition and a sense of humor?

Do you feel at ease with her?

Is she sincere about trying to understand and help you?

Does she treat you with dignity and respect?

Is she honest, nondefensive, and kind?

Is she willing to explain her approach, including strategies, goals, and length of treatment?

Does she make you feel accepted?

Can she understand your background and cultural heritage, if relevant?

Does she treat you like an equal—or as though you are flawed or defective?

Do you leave the sessions feeling more hopeful and empowered most of the time?

Do you feel that she understands your pain?

Do you feel safe disclosing your innermost feelings and that they are held in confidence?

Does she give you homework assignments between sessions?

As you talk with potential therapists, keep in mind that research shows that the therapist’s personal style, such as empathy, is more important in determining therapeutic success than is a therapist’s theoretical persuasion or choice of techniques, says Dr. Hallowell.

These tips also apply if you’re seeking help for depression, the symptoms of which are often intertwined with those of anxiety or other serious mental disorders. (For more information on depression, see page 173.)



GET REAL. Or, at least, get the facts, says Dr. Hallowell. Exaggerated worry often stems from a lack of information. If your CEO snubs you in the hall, you may worry that you’re not doing a good job. But the CEO may have been pondering a personal matter, not even aware of your presence.

STOP THE STIMULUS. People who are too anxious need to decrease stimulation, says Dr. Vittone. Eliminate some of the racket vying for your attention. Turn off the car radio, don’t answer the telephone at home, take a lunch break away from your office—and away from your cell phone.

TAKE A “NEWS FAST.” Turn off the TV. Leave the morning paper on the porch. Taking a break from the news for a few days may decrease feelings of anxiety and lessen personal worries.

ENVISION THE WORST. Ask yourself, “What’s the worst that could happen?” “How bad would it be?” “What’s the likelihood of it happening?”

The worst thing that can happen usually isn’t that bad, Dr. Vittone says. What’s more, it seldom happens. Later, you may even wonder why you worried at all.

WRITE IT DOWN. Journaling or writing your worries down can help to put them in perspective and free you to think of solutions, says Dr. Vittone.

PREPARE TO SLEEP. At night, that is. “Give yourself time to unwind and relax,” says Dr. Vittone. Take 30 to 50 minutes to do something quiet and nonstressful before bed. Read a light novel, watch a TV comedy, or take a warm bath. Avoid active tasks such as housework.

LAUGH AT YOURSELF. Take another view of your worries. Ask yourself: “What’s funny about this situation?” “When I think about this 2 years from now, will I laugh?”

If we can f ind humor in a situation, we immediately defuse the danger, Dr. Vittone says.

SHARE YOUR WORRY. Never worry alone. “When we talk about our worries, the toxicity dissipates,” says Dr. Hallowell. Talking it through helps us find solutions and realize that our concerns aren’t so overwhelming.





What the Doctor Does


Bernard Vittone, M.D., who considers himself “more anxious than the average individual,” banishes worry by exercising for 30 to 40 minutes every day after work. He also tries to view his anxiety as energy to help him perform his job better and more efficiently—and he takes short breaks to meditate and clear his mind.

If you experience anxiety, he suggests exercising for at least a half hour each day. Try running, cycling, walking, or swimming laps. The repetitive action of these activities produces the same calming effect as meditation. Of course, yoga and stretching are good choices, too. The more vigorous the exercise, the more anxiety you’ll eliminate from your system.



LET IT GO. Chronic worriers have a tough time letting go. You may hold on to worry as though it will fix the problem, Dr. Hallowell says. It won’t. So train yourself to let go. He suggests meditation or visualization using your own technique. One patient “sees” worries in the palm of her hand and blows them away. Another takes a shower and “watches” worries go down the drain. “Don’t feel like a failure if you can’t do it at first,” he says. Keep practicing.





Put a Cap on Caffeine


Nothing is worse for anxiety than caffeine, says Bernard Vittone, M.D. Found in beverages such as coffee, tea, and cola, and medications like Excedrin, caffeine affects neurotransmitters in the brain, which causes anxiety. Research shows that people who are predisposed to anxiety and those with panic disorders are especially sensitive to caffeine’s effects.

Caffeine is deceptive, says Dr. Vittone. When you drink a cup of coffee, for example, you’re likely to feel more vivacious for up to an hour afterward. Two to 12 hours after that, caffeine’s anxiety-producing effects kick in. Because of this delayed reaction, people rarely connect anxiety to their morning java.

If you consume a lot of caffeine, try this test: Abstain from coffee and other caffeine-containing foods for 2 weeks. Then, drink three cups in one sitting and see how you feel. You’re likely to notice a tightening of muscles, worry, nervousness, or apprehension several hours later.

“I really advocate trying to cut out caffeine completely,” Dr. Vittone says. If that’s asking too much, then limit coffee, tea, or cola to one cup a day.



HANDLE WITH LESS CARE. Stop treating yourself as fragile. If you believe that you’re fragile, it becomes a self-fulfilling prophecy. Instead, learn to make anxiety a stimulus, not a hindrance. If you’re about to give a speech, for example, imagine it as a thrill instead of a threat.

FIND YOUR CHALLENGE. Anxiety often arises when people are juggling too many responsibilities. Instead of viewing your busyness as negative, think of life as action-filled, rich, or challenging. If you’re raising a family, for example, consider how one day you will miss your children’s presence at home. The way you interpret things makes all the difference in the world, Dr. Vittone says.

AVOID ALCOHOL. Beer, wine, and other alcoholic beverages can exacerbate anxiety. “Alcohol reduces the anxiety when you first take it in,” says Dr. Vittone. “But when it wears off, it has the opposite effect.” People are often more anxious the day after a night of heavy drinking, he says. Avoid alcohol, or limit consumption to one or two drinks a day.





PANEL OF ADVISORS


EDWARD M. HALLOWELL, M.D., IS A PSYCHIATRIST AND FOUNDER OF THE HALLOWELL CENTER FOR COGNITIVE AND EMOTIONAL HEALTH IN SUDBURY, MASSACHUSETTS, AND NEW YORK CITY. HE IS THE AUTHOR OF WORRY: HOPE AND HELP FOR A COMMON CONDITION AND CONNECT: 12 VITAL TIES THAT OPEN YOUR HEART, LENGTHEN YOUR LIFE, AND DEEPEN YOUR SOUL.

BERNARD VITTONE, M.D., IS A PSYCHIATRIST AND FOUNDER OF THE NATIONAL CENTER FOR THE TREATMENT OF PHOBIAS, ANXIETY, AND DEPRESSION IN WASHINGTON, D.C.





Asthma


		 29 Steps to Better Breathing



	 You may think of asthma as a childhood illness, not one that’s much of a problem for adults. Yet of the 22 million Americans who have asthma, only 9 million are children. Every day in America, 5,000 people visit the emergency room, 1,000 are admitted to the hospital, and 11 die due to asthma.





WHEN TO CALL A DOCTOR


The symptoms of asthma are often subtle at first, but they can get much worse in a hurry. Report any changes in your usual breathing patterns to your doctor.

You also should see a doctor if your wheeze, cough, or shortness of breath worsens after you take your rescue medication. It means the asthma isn’t well controlled, and you have a higher risk for a flare-up, which may be serious.



Of course, asthma doesn’t always require hospitalization. It may cause only occasional and short-lived symptoms, such as breathlessness, coughing, or wheezing. But unless your asthma is well controlled, it may subtly interfere with normal activity and get out of hand quickly. In fact, a person with “mild asthma” can have a fatal attack.

Asthma occurs when the main air passages in the lungs, called bronchioles, become inflamed and overly sensitive to “triggers.” During attacks, the lungs produce extra mucus and the bronchiole walls narrow, making breathing difficult.

No cure exists yet, but nearly everyone can dramatically reduce—and maybe even eliminate—symptoms. Even if you currently use medications to treat your asthma, you may be able to reduce the dose or frequency by more than 50 percent if you practice good lifestyle control, says Thomas F. Plaut, M.D.

Here are some doctor-recommended approaches.

LOOK INTO ALLERGIES. More than 70 percent of adults with asthma have allergies that set off or worsen symptoms. “Everyone who takes medications daily for asthma needs to find out if they have allergies,” says Dr. Plaut. Think about when your symptoms occur and what you are doing at the time. Any patterns may help indicate if you have an allergy. You might want to keep an asthma journal. A board certified allergist can identify your allergens by taking a careful history and performing skin testing for inhalant allergens, including pollen (tree, grass, weed), mold, dust mites, cockroaches, and pet dander, says David Lang, M.D.

WATCH THE SULFITES. Food allergies are commonly suspected as relevant for asthma, but rarely confirmed, says Dr. Lang. Generally allergies influencing your asthma symptoms are those that are inhaled. That said, an estimated 5 to 10 percent of asthmatics suffer from a sensitivity to sulfites, which are often added to wine, beer, dried fruit, and frozen food.

AVOID PLANT POLLEN. It’s a main asthma trigger. Plants pollinate at specific times of the year, so once you know those that are your triggers, take steps to avoid them. Stay indoors between 5:00 a.m. and 10:00 a.m. and on dry, hot, windy days, when pollen counts tend to be highest. During the warm months, keep your windows closed and air-condition your house. Doing these two things can cut down on the indoor pollen count by 90 percent or more, says Dr. Lang. Air conditioning also eliminates the high indoor humidity that promotes mold and dust mites.

Ragweed is the most common pollen allergen for Americans. This plant’s season runs from August to November, usually peaking in early to mid-September. Check your local TV or newspaper for daily pollen counts to determine when it’s best to stay inside.

SWITCH ON THE BATHROOM FAN. Mold is a common asthma trigger, and it thrives in bathrooms and other high-moisture areas, so good ventilation is essential. Use the bathroom fan every time you bathe or shower to reduce the moisture that mold needs to thrive.

Using a squeegee to wipe water off the bathroom tiles is a terrific strategy for preventing mold—and takes only about 30 seconds, says Dr. Plaut.

WASH YOUR PETS WEEKLY. Dogs and cats are loaded with dander—a combination of skin cells and allergy-causing proteins that can provoke asthma attacks. Some pet owners with asthma may find they are allergic to dander, and the only solution is remove animals from the home. At the very least, wash your pets weekly—with or without shampoo—to reduce dander. And keep your bedroom pet-free, says Dr. Lang.

OPEN WINDOWS WHEN YOU COOK. Strong food odors—from a smoking frying pan, for example, or the pungent oils in onions and garlic—can irritate airways and trigger asthma attacks. Open the windows during low-pollen months or use an exhaust fan when you cook to help vent the odors outside.

FREQUENTLY CHANGE FURNACE FILTERS. During the cold months, central heating systems circulate dust all over the house. Installing electronic air cleaners in place of the standard furnace filters is one of the best ways to control this spread, Dr. Plaut says. These devices, available from heating contractors, act almost like dust magnets.

REDUCE EXPOSURE TO DUST MITES. Despite the name, these microscopic creatures live on the dead skin cells in your home. When they die, their bodies dry up and are ground into dust. They’re a potent asthma trigger—and because people shed millions of skin cells every day, dust mites are hard to eliminate. They can, however, be reduced.

Wash sheets, pillowcases, and bathroom towels at least once a week in water 130°F or hotter to kill adult mites as well as the eggs, says Dr. Plaut.

“It’s also important to encase pillows, mattresses, and box springs in covers made specifically to act as a barrier against dust mites. These covers are available at allergy supply stores,” he adds. These products are available from companies such as American Allergy Supply, National Allergy Supply, and Allergy Control Products.

INVEST IN A GOOD AIR FILTER. A good air purifier, ideally with a HEPA filter, can really help clear indoor air of allergens, says Elson Haas, M.D.

KEEP YOUR HOUSE PEST-FREE. Studies have shown that cockroaches—which thrive in the same areas as humans—can trigger asthma. Like dust mites, their dry, dead bodies and feces turn into dust and can trigger an asthma episode, says Dr. Plaut.

Cockroaches are difficult to get rid of, even if your house is always squeaky-clean. One of the safest ways to control roaches is to sprinkle boric acid in areas where they congregate—around drainpipes, for example, or along kitchen and bathroom baseboards.

“Don’t have an exterminator spray the house if you can help it,” says Dr. Plaut. The fumes can irritate the airways for days, making asthma symptoms much worse. Many asthmatics are very sensitive to chemical exposures at home and work, adds Dr. Haas.

MAKE YOUR HOUSE A SMOKE-FREE ZONE. Cigarette smoke is extremely irritating. It not only triggers asthma attacks but also can increase the risk of asthma in children. If you smoke, take advantage of nicotine patches, prescription medications, or smoking-cessation programs. Let others know that smoking in the house is verboten.

LOAD YOUR DIET WITH FLAVONOIDS. Fight the inflammation that accompanies asthma by eating foods loaded with flavonoids—tiny crystals found in onions, apples, blueberries, and grapes that give them their blue, yellow, or reddish hues. Flavonoids not only strengthen the capillary walls, but they are also antioxidants, and so they help protect the membranes in the airways from being damaged by pollution. Eat a couple of servings of flavonoid-rich foods every day.

TAKE FISH OIL. Preliminary research shows that diets containing the fatty acids gamma linolenic acid (GLA) and eicosapentaenoic acid (EPA)—found in such fatty fish as salmon, sardines, tuna, and mackerel—may improve the quality of life in people with asthma and decrease their reliance on rescue medication. Plus, studies show that fish oil partially reduces reactions to allergens that can trigger attacks in some asthmatics. Other studies suggest fish oil supplements may prevent exercise-induced asthma attacks. “The best natural sources of omega-3s are fish, particularly salmon or other cold-water fish,” says Dr. Plaut. Fish oil capsules are a good alternative, but they can cause “fish burps.” “This can usually be avoided if the capsules are taken frozen right before a meal,” he adds.





Cures from the Kitchen


If you or anyone in your family has asthma, put fish on the menu at least twice a week. Fatty fish such as tuna, salmon, and mackerel contain beneficial fats called omega-3 fatty acids. Asthma is an inflammatory disease, and the omega-3s help to damp down many of the body’s processes that create inflammation.



TAKE MAGNESIUM. Magnesium levels are frequently low in asthmatics. Research shows that taking a supplement may improve lung function and reduce reaction of the bronchial passages. Extra magnesium may help to decrease muscle tension and airway spasms, explains Kendall Gerdes, M.D. But high doses of magnesium (350 milligrams or more) can cause cramps, gas, or diarrhea for some people, so take what your gut will allow. Dr. Gerdes suggests starting with 100 milligrams twice a day and increasing it gradually until you experience some of these side effects. Then cut back the dosage a level at a time until problems subside, and then hold that dose. Make sure you’re taking a form of magnesium that can be easily absorbed by the body, says Dr. Gerdes. Magnesium citrate, magnesium chloride, and magnesium glycinate are all good options.

Note: If you have heart or kidney problems, be sure to talk to your doctor before taking supplemental magnesium.

SUPPLEMENT WITH QUERCETIN. This flavonoid is extracted from certain fruits and vegetables, such as apples, onions, and the white rinds of citrus, and helps reduce the histamine reactions that can lead to asthma. Quercetin can also be taken as a supplement, says Dr. Haas, who recommends 250 to 300 milligrams twice or three times a day along with 500 to 1,000 milligrams of vitamin C. At higher intakes, vitamin C has a mild antihistamine, antiallergy effect. Because asthma is a serious, individualized condition, it’s a good idea to talk with your doctor before making any changes to your treatment plan, he adds.

STAY ACTIVE. An active lifestyle can help control asthma much better than a sedentary one. Physical activity helps improve lung capacity and may enable people to use lower doses of medications or to use them less often. All asthma patients should discuss a fitness program with their physicians. It is important to first warm up by either stretching, jogging, or sprinting for 20 to 30 minutes before exercising.

AVOID EXERCISING IN COLD AIR. Cold air may irritate the airways and trigger an asthma episode. It is important, however, to exercise throughout the year. If you enjoy skiing or skating, make sure you wear a mask to create a reservoir of warm air, advises Dr. Plaut. If you notice that you’re having more asthma episodes during the cold months, consider shifting to warm-weather activities. Swimming is especially good because the moist air soothes the airways and reduces the risk of attacks.

CHANGE YOUR BREATHING STYLE. Most people breathe using only their chest muscles. This makes it difficult to empty air from the lungs completely. For those with asthma, it’s important to use the diaphragm as well. This large muscle between the chest and abdomen adds power to your breathing and helps remove “used” air from the lungs, which can reduce feelings of breathlessness, explains Dr. Plaut.

It takes practice to develop the habit of diaphragmatic breathing (also called abdominal, or belly, breathing). Several times a day, lie on your back with one hand on your belly and the other on your chest. As you breathe in, the hand on your belly should rise slightly, while the hand on your chest should barely move.

TAKE UP A WIND INSTRUMENT. Playing a reed instrument, like the oboe, saxophone, or trumpet, requires diaphragmatic breathing, Dr. Plaut says. Even if you aren’t especially musical, playing the instrument is great practice for your breathing muscles.

PRACTICE STRESS CONTROL. Yoga, selfhypnosis, deep breathing, and other techniques for reducing stress are good techniques for dealing with asthma because they help the airways open more fully, says Dr. Plaut.

WASH YOUR HANDS OFTEN. Asthma episodes surge in the autumn and winter, when colds are more common. Even a mild case of the sniffles can make asthma harder to control. A viral infection is a common trigger of an asthma attack.

Cold viruses can survive for hours on doorknobs, handrails, and even money. Washing your hands often—at least every few hours—will flush away the viruses before they have a chance to take hold. Some people have infectious asthma, meaning they wheeze only when they have a cold or flu, says Dr. Haas.

THINK TWICE ABOUT ASPIRIN. Close to 5 percent of those with asthma are sensitive to aspirin, ibuprofen, and related pain relievers, known as nonsteroidal anti-inflammatory drugs (NSAIDs). For those who are sensitive, an asthma attack or other respiratory problems can begin within 3 hours of taking the drugs. If you have asthma and chronic sinusitis with nasal polyps, your chances of developing a sensitivity to aspirin (known as “aspirin exacerbated respiratory disease”) is about one in three, says Dr. Lang.

If you need long-term pain relief—from arthritis, for example—your doctor may advise you to switch to acetaminophen or other analgesics that are less likely to trigger asthma attacks. Because acetaminophen may also “cross-react” in those sensitive to aspirin, you should take regular rather than extra-strength acetaminophen, and always avoid not only aspirin but also medications otherwise known as NSAIDs, including ibuprofen, naproxen, and others, says Dr. Lang. If you have aspirin sensitivity, the reaction to it and these other drugs can be serious or even life-threatening.

DON’T PUT UP WITH HEARTBURN. The upward surge of stomach acids that cause the telltale pain of heartburn can also trigger asthma attacks. One of the best ways to prevent heartburn is to eat four or more small meals daily, instead of two or three large meals, says Dr. Plaut. Also, don’t eat 2 hours before bedtime. To help prevent stomach acid from going “upstream,” create an incline by raising the head of your bed 4 to 6 inches by putting blocks under the top legs.

You can also treat heartburn with over-the-counter antacids or acid-suppressing drugs, such as cimetidine (Tagamet) and ranitidine (Zantac), or proton pump inhibitors (Prilosec).

FLUSH YOUR SINUSES. Millions of Americans get sinus infections every year, and the inflammation and mucus drainage can make asthma worse. Sinusitis often requires treatment with antibiotics, but you may be able to prevent infections by flushing your sinuses at home, says Dr. Plaut.

Mix ½ teaspoon of salt in 1 cup of warm water. Put the solution into a plastic squeeze bot