MAYO CLINIC HEALTH LETTER Tools for Healthier Lives VOLUME 29 NUMBER 7 JULY 2011
Inside this issue HEALTH TIPS . . . . . . . . . . . . . 3 Buying sunglasses. NEWS AND OUR VIEWS . . . . 4 Being bilingual may delay Alzheimer’s disease. Osteoporosis drug may reduce colon cancer risk. FLUID INCREASE IN THE BRAIN . . . . . . . . . . . . . 4 Normal-pressure hydrocephalus. MALARIA . . . . . . . . . . . . . . . . . 6 Risks for travelers. NIGHTMARES . . . . . . . . . . . . . . . 7 Sometimes, an adult dilemma.
Get stronger, live better Benefits of weight training No matter how well you take care of yourself, age will take a toll on the amount and quality of muscle in your body. Weaker muscles and loss of muscle mass can contribute to many health problems, such as increased risk of falls, decreased bone strength and weight gain. With declining strength, you also may notice that things get harder to do. As a result, you may cut back on
or stop a favorite physical activity, hire someone to mow the lawn, or have to say no to grandkids who are begging you to play. But don’t give up hope and blame it all on getting old. Studies have found that only about 30 percent of the difference in strength between young adults and older adults is due to aging. That means about 70 percent of the strength people lose is related to other factors, most notably a decline in physical activity. But this 70 percent loss doesn’t have to occur — and if it has already occurred, the loss can be regained. Older adults often experience remarkable improvement in strength
SECOND OPINION . . . . . . . . 8
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Studies have found that only about 30 percent of the difference in strength between young adults and older adults is due to aging. The muscle loss depicted above is largely the result of no strength training and little physical activity.
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within weeks or months of starting a strength training program. You may be surprised at how easy it is — and how little time it takes — to maintain or get back the strength you need to improve your health and to maintain active independence.
Muscle matters
If you’re not planning to enter a bodybuilding contest or to start playing professional football any time soon, why should you bother with strength training exercises? The quick answer is that muscles are responsible for every movement that you make, and strong muscles make it easier to live a full and productive life. Strong muscles influence your health in other ways, as well. For example, strength training can: ■ Improve bone health — Strength training increases bone density and reduces your risk of osteoporosis. ■ Promote weight control and reduce body fat — Muscle is lost as a natural part of aging. Muscle burns calories, and muscle gains through strength training help you burn more calories, making it easier to reduce body fat and control your weight. Strength training initially may not result in much weight loss, because muscle weight gains may offset losses in fat weight. However, you’re still likely to be leaner and may experience reductions in measurements such as waist size. ■ Reduce your risk of injury — Strength training can contribute to better balance, coordination and agility, reducing your risk of falls and injuries. Strengthening makes joints — such as your knee joint — more stable and gives your muscles a greater role in absorbing stresses exerted on joints. ■ Alleviate back pain and arthritis pain — Strengthening lower back muscles is a proven way to
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ease back pain. Strengthening often is a critical component of alleviating joint pain, as well. ■ Promote diabetes control — Strength training helps reduce body fat, which lowers the risk of diabetes. Strength training also improves your body’s ability to process the sugar in your blood. ■ Improve cognition — A recent study found that strength training activities once or twice a week improved cognitive function in a group of older women. With no strength training and little physical activity, age-related muscle loss and weakness can quickly become a downward spiral. Declines in muscle strength, power and endurance lead to increased difficulty in handling everyday tasks, increased risk of falls and fractures, and increased fatigue and difficulty with exercise. As physical activity gets harder, you may do even less of it — which leads to further declines in strength and an increased risk of developing a disability.
groups — including your shoulders, chest, arms, back, abdominals and legs. In addition, exercise opposing muscles in a balanced way, such as exercising the chest muscles and the muscles of the upper back. Two to three strength training sessions a week lasting just 20 to 30 minutes are adequate for most people. You can do strength training at home or at a gym. Consider using: ■ Your body weight to do exercises such as push-ups, situps, leg squats, or side- or backstrengthening bridges ■ Resistance tubing, which can be found at most sporting goods stores ■ Free weights, such as barbells or dumbbells ■ Weight machines Begin by warming up with five to 10 minutes of gentle exercise
Getting started
Medical Illustration Michael King
First, get your doctor’s OK to begin a strength training program. Then consider scheduling time with a physical therapist or certified trainer who can help you design a resistance program and advise you on safety issues. This is practically a must if you’re a beginner or if you’ve been inactive or you have medical issues — such as arthritis — that may affect recommended strength training activities. When you start strength training, take it slow. It’s not about how much you can do in one day. It’s about gradual and consistent improvement over time. When you’re starting out, it’s better to err on the side of selecting weights that are too light. Aim to complete one set of exercises for each of your major muscle
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MAYO CLINIC HEALTH LETTER Managing Editor Aleta Capelle
Medical Editor Robert Sheeler, M.D.
Associate Editors Carol Gunderson Joey Keillor
Associate Medical Editor Amindra Arora, M.D.
Customer Service Manager Ann Allen
Editorial Research Deirdre Herman Proofreading Miranda Attlesey Donna Hanson Julie Maas
Administrative Assistant Jane Sultze
EDITORIAL BOARD Shreyasee Amin, M.D., Rheumatology; Amindra Arora, M.D., Gastroenterology and Hepatology; Brent Bauer, M.D., Internal Medicine; Julie Bjoraker, M.D., Internal Medicine; Lisa Buss Preszler, Pharm.D., Pharmacy; Bart Clarke, M.D., Endocrinology and Metabolism; William Cliby, M.D., Gynecologic Surgery; Clayton Cowl, M.D., Pulmonary and Critical Care; Mark Davis, M.D., Dermatology; Timothy Hobday, M.D., Oncology; Lois Krahn, M.D., Psychiatry; Suzanne Norby, M.D., Nephrology; Robert Sheeler, M.D., Family Medicine; Phillip Sheridan, D.D.S., Periodontics; Peter Southorn, M.D., Anesthesiology; Ronald Swee, M.D., Radiology; Farris Timimi, M.D., Cardiology; Matthew Tollefson, M.D., Urology; Debra Zillmer, M.D., Orthopedics; Aleta Capelle, Health Information. Ex officio: Carol Gunderson, Joey Keillor. Mayo Clinic Health Letter (ISSN 0741-6245) is published monthly by Mayo Foundation for Medical Education and Research, a subsidiary of Mayo Foundation, 200 First St. SW, Rochester, MN 55905. Subscription price is $29.55 a year, which includes a cumulative index published in December. Periodicals postage paid at Rochester, Minn., and at additional mailing offices. POSTMASTER: Send address changes to Mayo Clinic Health Letter, Subscription Services, P.O. Box 9302, Big Sandy, TX 75755-9302.
Health tips Buying sunglasses
Exercise opposing muscles in a balanced way, such as exercising the abdominal muscles with crunches, and the muscles of the lower back with two-legged bridges. Likewise, the dumbbell press exercises chest muscles, while the bench row using a dumbbell exercises the muscles of the upper back.
such as brisk walking. With a given strengthening exercise, select a weight or resistance level that feels heavy enough so that on the 12th repetition, you’re just barely able to finish with good form. If you’re a beginner, you may discover that you’re only able to lift 1 or 2 pounds, or perhaps even less than that. Don’t worry. Once your muscles, tendons and ligaments grow accustomed to strengthening exercises, you’ll be surprised at how you progress. Remember, you don’t need to do multiple sets of the same exercise. For most people, a single set of 12 repetitions with proper weight can build strength just as effectively as can two or three sets of the same exercise, and requires much less time to complete. Once you can easily do 15 repetitions of a certain exercise, gradually increase the weight or resistance.
A few more tips
When you’re strength training, keep these do’s and don’ts in mind: ■ Use proper form — Learn to do each exercise correctly. If
you’re unable to maintain good form, decrease the weight or resistance or the number of repetitions. ■ Don’t rush — Move the weight in an unhurried, controlled fashion. Taking it slow helps you isolate the muscles you want to exercise and keeps you from relying on momentum to lift the weight. ■ Don’t overdo it — Select appropriate weight or resistance levels, stop at the point of fatigue, maintain good form, and opt for only one set of a given exercise. ■ Don’t work through the pain — If an exercise causes pain, stop. Try again in a few days, try it with less weight or resistance, or ask a knowledgeable trainer if there’s something you’re doing wrong. ■ Rest — Avoid exercising the same muscles two days in a row. Remember, you don’t need to strive for the look of a bodybuilder to reap the benefits of strength training. Gains you make in strength may be felt more than seen, whether it’s being able to walk farther or faster, feeling sturdier on your feet, or having the stamina to do what you want. ❒ July 2011
Sunglasses offer your eyes protection from the sun’s damaging ultraviolet (UV) rays. Longterm exposure to UV rays can contribute to cataract formation and damage the cornea, lens and other parts vital to vision. Look for sunglasses that: ■ Offer maximum UV protection — Look for sunglasses that block 99 to 100 percent of both UVA and UVB light. Sometimes, labels say that all light below 400 nanometers is blocked. This is the same as 100 percent UV protection. Since UV coating is colorless, a dark lens doesn’t necessarily mean increased UV protection. In fact, a dark pair of sunglasses that doesn’t block 99 to 100 percent of UV light may actually increase your UV exposure. Darker glasses reduce the amount of light your eye receives. A natural response is that your pupils dilate to let in more light. As a result, the pupils also let in more UV light. ■ Wrap your eyes in protection — The more closely sunglasses fit to your face, the better. Your eyes can be damaged from UV rays that are scattered and reflected into the eye area from beyond the edges of sunglass lenses. Wraparound sunglasses give more complete protection. Regular prescription glasses also can offer UV protection with the addition of chemicals during the manufacturing of the lenses or with the addition of a UV lens coating. ❒ www.HealthLetter.MayoClinic.com
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News and our views Being bilingual may delay Alzheimer’s disease ¿Se habla Español? Parlez-vous français? Sprechen sie Deutsch? Do you also speak English? A recent study indicates that speaking two or more languages may delay development of Alzheimer’s disease. The study, published in the Nov. 9, 2010, issue of the journal Neurology, looked at 211 older adults who had been recently diagnosed with probable Alzheimer’s disease. About half were bilingual, and the rest spoke only one language. Researchers found that the study participants who were bilingual developed Alzheimer’s symptoms at an average age of 77. For those who spoke only one language, the average age of symptom development was 72. The cognitive benefits of bilingualism appeared to far surpass other factors that correlate to delayed or reduced risk of Alzheimer’s, such as higher education and occupational status. Researchers speculate that the five-year lag in Alzheimer’s symptoms for the bilingual group was due to better cognitive reserves. Essentially, the lifelong mental gymnastics necessary to learn and speak two or more languages beefs up the brain so that more brain injury is required to produce symptoms of memory loss. Mayo Clinic experts are unsure what practical implications the study may have. Because all of the bilingual speakers in the study learned their second languages in their youth, the findings support the belief that mental exercise throughout life enhances the brain’s capabilities and reserve. However, the findings don’t address whether mental activities in later life have the same beneficial effects. ❒
Osteoporosis drug may reduce colon cancer risk A recent study found that women taking bisphosphonates to prevent bone loss had a reduced risk of developing colorectal cancer. The study appeared in the Feb. 14, 2011, issue of the Journal of Clinical Oncology and involved nearly 1,900 postmenopausal women. Half were taking a bisphosphonate — primarily alendronate (Fosamax) — and half weren’t. Those who’d taken a bisphosphonate for at least a year had a 59 percent reduction in risk of colorectal cancer compared with women who weren’t taking the bone loss medication. Mayo Clinic experts say it’s too early to judge whether bisphosphonates might actually reduce the risk of some cancers. They note that other recent research has gone back and forth about the potential for bisphosphonates to wield an anti-cancer effect in breast cancer development and breast cancer recurrence. Additional data from well-conducted clinical trials are needed to more fully define the anti-cancer potential of bisphosphonates. For adults 50 and older, screening for colorectal cancer is a proven method to detect and remove precancerous growths before they progress to cancer. ❒
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Fluid increase in the brain Normal-pressure hydrocephalus A good walk is one of life’s pleasures. Lately, though, you’ve felt as if your feet aren’t in tune with your body. It’s as if they lag behind. Instead of relaxing during your walk, you find yourself thinking about picking up your feet. Your doctor suggested several tests to determine what might be causing this change. Brain scans show the problem is an abnormal fluid increase inside your brain. The medical term is normal-pressure hydrocephalus (NPH). Although NPH can occur at any age, it’s most common among older adults. Its symptoms can be similar to other conditions associated with aging, which can make NPH challenging to recognize. Once NPH is identified, treatment may help improve symptoms, although there are varying degrees of success.
Pressure points
Normally, your brain and spinal cord are cushioned in a constant bath of clear fluid called cerebrospinal fluid. This fluid also occupies four large open structures (ventricles) that reside deep inside your brain. On average, adults produce about a pint of cerebrospinal fluid every day. The fluid moves through the ventricles by way of interconnecting channels and eventually flows into spaces around the brain and spinal cord. From there, it’s absorbed into the bloodstream. With normal-pressure hydrocephalus, absorption or movement of cerebrospinal fluid is affected. Why this happens isn’t always apparent, but it results in the ven-
Treatment considerations
tricles gradually accumulating too much fluid and becoming enlarged.
Signs of trouble
Sometimes NPH develops after an injury, such as trauma to the head. It may occur as a result of other health problems. Some adults who have NPH have large heads, suggesting they may have been born with undetected hydrocephalus that produces symptoms in later life. However, in many instances, a cause can’t be determined. It’s thought that a pressure effect within the ventricles results in changes that produce certain symptoms typical of NPH. These may not occur all at once, and sometimes only one or two of the following are present: ■ Problems with walking — In the early stages of NPH, difficulty walking is often the most common symptom. Your stance may become wider, and your footsteps may become slower and closer together. ■ Mild dementia — Changes may be mild enough to go unnoticed or be accepted as part of aging. There may be short-term memory loss. You might lose interest in daily activities or become forgetful. ■ Problems with bladder control — In milder cases, urinary frequency and urgency may occur. Complete loss of bladder control (urinary incontinence) may develop in more-severe cases of NPH.
Challenging to diagnose
Identifying NPH is often a process of eliminating other possible disorders — such as Parkinson’s disease and Alzheimer’s disease — that can have symptoms resembling those of NPH. Neurologists and neurosurgeons who specialize in this area can help make the diagnosis. If NPH is suspected, brain scans — particularly magnetic resonance imaging (MRI) and computerized tomography (CT) — can help de-
Treatment of normal-pressure hydrocephalus typically involves surgery to place a drainage system in the brain’s ventricles. A shunt directs excess fluid through a thin tube into another area in the body, where it can be reabsorbed.
tect if ventricles inside the brain are enlarged, as well as evaluate cerebrospinal fluid flow and surrounding brain tissue. A key test is a lumbar tap test — sometimes called a spinal tap — which can be done under local anesthesia as an office procedure. A thin needle is positioned in the lower back into the cerebrospinal fluid space, and about 6 teaspoons of cerebrospinal fluid is withdrawn. Your doctor may make measurements of how you walk before and after the fluid removal. Improvements after fluid removal may indicate a potentially good response to NPH treatment. Some centers may admit you to the hospital to do external cerebrospinal fluid drainage. This test is a variation of the lumbar tap test, but can have more risks, including meningitis. It involves leaving a thin catheter in place to drain fluid for a few days. This allows doctors to evaluate changes in how you walk as cerebrospinal fluid levels are adjusted. July 2011
Treatment for NPH typically involves surgery to place a drainage system — called a ventricular shunt — in the brain’s ventricles. The shunt directs excess fluid through a thin tube (catheter) into another area in the body, most typically the abdomen, where it can be reabsorbed. The treatment goal with ventricular shunting is to improve walking. Results from shunt placement can’t be clearly determined ahead of time. However, NPH is more likely to respond to a shunt if walking difficulty appears first in the disorder and is the most prominent symptom. Careful discussion with your neurologist and neurosurgeon can help determine whether a shunt procedure is advisable for you. Consideration is given to your current health and to what the expected outcomes might be. Shunt placement is done under general anesthesia. After surgery, the entire shunt system is within the body. None of it is exposed to the outside. Even in an experienced surgeon’s hands, shunt complications are quite frequent. Headaches are common. Shunt blockage may occur, necessitating surgical revision. Among other possible complications are buildup of fluid or blood around the brain (subdural collection), infection within the shunt, and seizures.
A final word
Living with a shunt means being alert to any possible complications. Recurring NPH symptoms after improvements need to be evaluated for possible malfunction of the shunt itself. Shunt surgery isn’t a guaranteed “fix” for NPH. But those who have the surgery and experience reduced NPH symptoms may enjoy significant changes in quality of life. Still, as with any surgery, there are risks. ❒ www.HealthLetter.MayoClinic.com
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Malaria Risks for travelers If you’re planning to travel to tropical locations such as central South America, Haiti, sub-Saharan Africa or south Asia, discuss malariapreventing recommendations with your doctor a couple of months before you leave. Your doctor can prescribe drugs to take before, during and for some weeks after your trip to help protect you from malaria. Malaria is a parasitic disease spread by mosquitoes. It can lead to serious illness, and sometimes death. About 1,500 cases are diagnosed in the United States each year. Most occur in travelers who didn’t take preventive measures.
A vexing disease
Malaria is caused by microscopic parasites that are transmitted most commonly by mosquito bites. If an infected mosquito bites you and malaria is transmitted, the parasites travel to your liver where they lie dormant. Dormancy can last up to a year, but is usually about 10 days to four weeks. When the parasites mature, they leave the liver and infect red blood cells. This is when malaria signs and symptoms typically develop. If an uninfected mosquito bites you at this point, it will become infected and can spread malaria to others. You can also be infected from exposure to infected blood, such as through a blood transfusion. Malaria is estimated to kill about 1 million people worldwide each year. Most of these deaths are of young children in Africa. Adult residents of a malaria region still get sick from malaria, but they may be exposed to the disease so frequently that they acquire a partial immunity. This can lessen
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the severity of malaria. However, when residents of malaria regions move to an area where they’re no longer exposed to the parasite, that partial immunity can disappear.
Fevered pitch
Malaria infections are categorized as either uncomplicated or severe. Signs and symptoms of uncomplicated malaria are similar to the flu and include moderate to severe chills and shaking, high fever, profuse sweating, headaches, nausea, and vomiting. These bouts of illness may go away and recur. If uncomplicated malaria isn’t promptly treated, it can become a life-threatening medical emergency. Severe malaria may involve swelling of the brain, breathing problems as fluid accumulates in the lungs, kidney and liver failure, rupture of the spleen, severe damage to red blood cells, and dangerously low blood sugar. If you experience a high fever while traveling or living in a part of the world with malaria, talk to a doctor. In addition, talk to your own doctor promptly if you experience a high fever within a year after returning from a part of the
July 2011
world with malaria. If you have severe signs and symptoms, seek emergency care. Diagnosis of malaria is made through laboratory analysis of a blood sample. A microscopic exam may also reveal the species of malaria parasite that has infected you. Treatment of malaria involves one or more antimalarial drugs, including chloroquine (Aralen), hydroxychloroquine (Plaquenil), mefloquine (Lariam), or the combination of atovaquone and proguanil (Malarone). Drug choice and aggressiveness of treatment is determined by factors such as the malaria parasite species where you’ve traveled, your age and the severity of your disease. Drug choice is important, as some types of malaria have evolved to be resistant to certain drugs, such as chloroquine. Effective treatment can cure malaria. However, the disease can continue if it’s not treated or treated with the wrong drug. Drugs used to treat the disease are generally the same ones used to prevent it. If you’ll be traveling to a location with limited access to medical care, discuss a self-treatment plan with your doctor ahead of time. ❒
Nightmares Sometimes, an adult dilemma In recent months, you’ve been jolted out of sleep numerous times because of nightmares. Lately, the thought of sleep is sometimes crowded by worry that you may encounter another nightmare. Nightmares are common. Although they can begin at any age, nightmares typically start early in childhood and tend to decrease after about age 10. However, some people have them as teens or adults, or throughout life. Occasional nightmares generally aren’t cause for concern. But if they’re becoming more frequent, routinely disrupting your sleep or causing fear prior to sleep, talk with your doctor.
Heady dreams
Normally, you go through four to five sleep cycles a night. For the most part, nightmares occur during rapid eye movement (REM) sleep, one of the stages occurring in each of the sleep cycles. Nightmares are more likely during the latter half of your night, when the REM stages tend to last longer. While everyone has bad dreams, nightmares tend to become more disturbing as they unfold. They’re also distinguishable because you: ■ Are awakened by the dream ■ Can think clearly when awakened and often recall dream details ■ Feel fear or anxiety, anger, sadness, or disgust from your dream ■ May find it difficult to return to sleep following a nightmare
Cause and effect
What triggers an escalation in nightmares isn’t always clear. Factors may include: ■ Stress and anxiety — Stresses of daily life may trigger nightmares
for some. Major life changes, such as the death of a loved one or a move, can do the same. ■ Trauma — Nightmares are common after a traumatic event, such as an accident or injury, and they’re prominent in post-traumatic stress disorder (PTSD). Traumarelated nightmares may occur as you’re drifting off to sleep and in earlier, non-REM stages of sleep. ■ Medications — Some drugs may trigger nightmares, especially those that affect norepinephrine, serotonin and dopamine, which are chemicals in the brain called neurotransmitters. Examples include drugs that contain levodopa — such as carbidopa/levodopa (Sinemet) — and reserpine (Serpalan), as well as beta blockers and some antidepressants. Withdrawal from potentially addictive drugs, such as opioids and barbiturates, can also produce nightmares. Specific drugs, such as the antimalarial mefloquine (Lariam) and certain antibiotics may produce nightmares in some people. ■ Sleep-related breathing disorders — Breathing problems such as sleep apnea may contribute to nightmare occurrence. ■ Substance use — Substance use, including drinking alcohol, can trigger nightmares. Alcohol use — especially heavy binge drinking patterns — can lead to awakenings as alcohol’s effect wears off. Alcohol use is associated with more intense dreaming as well as more recall of dream content.
New lease on sleep
Nightmares associated with an underlying medical or mental health condition can generally be managed by treating the underlying problem. Your doctor may suggest you keep a sleep diary to track sleep patterns and daytime factors that may affect your sleep. Typical factors are caffeine and alcohol consumption, whether a heavy meal
is eaten close to bedtime, activity levels, and medications taken. If stress or anxiety seems to be a factor, your doctor may suggest stress-reduction techniques, counseling or therapy. For sleep that’s severely disrupted, an overnight sleep study may be recommended. Treatment for nightmare disorder associated with PTSD may include drug therapy with prazosin (Minipress). Studies have found this high blood pressure medication may help increase sleep time. Another treatment is cognitive behavioral therapy. When used to treat anxiety disorders, cognitive behavioral therapy helps alter and correct distorted thinking and behavior patterns. One approach is repeated exposure to the nightmare’s content with a goal of desensitization. Although studies suggest desensitization can be effective in treating nightmares in general, its effectiveness for those with PTSD-associated nightmares has yet to be evaluated. Another approach for nightmares that repeat is imagery rehearsal therapy. This involves recalling the nightmare in order to rewrite and practice a more positive storyline. For instance, you might change the ending, change the characters or create an entirely new dream sequence to displace the nightmare. The new dream can be mentally rehearsed several times a day. Studies have found imagery rehearsal therapy to be significantly helpful in relieving nightmares, whether or not they’re related to PTSD.
Prepare to sleep well
Simple relaxation techniques before bedtime may be all you need to slip into a good night’s sleep. You might treat yourself to a warm and relaxed bath or practice some deep breathing. Try shifting your focus to your breath and away from whatever’s on your mind. You also may find that meditation is helpful. ❒
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Second opinion Q: I’m bothered by heat rash. Do you have tips for preventing it? A: Heat rash — also known as prickly heat and miliaria — occurs when sweat ducts become blocked, trapping perspiration under the skin. It isn’t always clear what causes this blockage. In adults, heat rash usually develops in skin folds and places where clothing causes friction. Certain prescription drugs have been linked to heat rash. These include the bladder medication bethanechol (Urecholine), the hypertension drug clonidine (Catapres) and the chemotherapy drug doxorubicin (Adriamycin). There are different forms of heat rash. The mildest form — miliaria crystallina — produces tiny blisters on the skin’s topmost layer that aren’t itchy and usually clear up on their own. Heat rash that occurs deeper in the skin’s outer layer (epidermis) is miliaria rubra. It typically produces red bumps along with an itchy or prickly feeling in the rash area, which explains the common name of prickly heat. In general, the best treatment for any form of heat rash is to cool down, preferably in an air-conditioned building. See your doctor if heat rash lasts longer than a few days, the rash seems to be getting worse, or you experience signs and symptoms of infection — such as fever, chills or increased pain, swelling, redness, or warmth in the affected area. Copyright
© 2011 Mayo Foundation for Medical Education and Research. All rights reserved. MAYO, MAYO CLINIC, the triple-shield Mayo logo, and TOOLS FOR HEALTHIER LIVES are marks of Mayo Foundation for Medical Education and Research.
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Miliaria crystallina, left, produces tiny blisters on the skin’s topmost layer. Miliaria rubra, right, occurs deeper in the skin’s outer layer (epidermis). It typically produces red bumps.
Q: I regularly use NSAID pain medications for my arthritis pain, but I’m concerned about them increasing my risk of having a heart attack or stroke. Is there an NSAID that’s less risky from this perspective? A: A recent large study suggests that naproxen (Aleve, Naprosyn) is the safest type of commonly used nonsteroidal anti-inflammatory drug (NSAID) in terms of heart attack risk. Ibuprofen (Advil, Motrin, others) was at an intermediate level in terms of raising heart attack risk. The riskiest NSAID drugs in terms of heart attack appear to be diclofenac (Cataflam, Voltaren) and celecoxib (Celebrex). All of these drugs — including naproxen — raised stroke risk. With diclofenac, celecoxib and ibuprofen, heart attack and stroke risks generally increase if you’re taking higher daily doses. In addition, ibuprofen appears to interfere with the ability of noncoated, low-
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dose aspirin to prevent heart attack or stroke. If you take both, take the ibuprofen at least 30 minutes after or eight hours before taking aspirin. This study supports past research that has found similar results, and it highlights the need for caution as you seek ways to manage your pain. Work closely with your doctor to explore medication options that offer relief with the lowest possible risks to your health. Often, appropriate doses of acetaminophen (Tylenol) are considered the safest option for pain relief. There are many other painrelieving drugs that may be helpful, depending on your circumstances. In addition, some of the most powerful pain-relieving tools include physical therapy, counseling, stress management, treatment for depression, good sleep, physical activity, and complementary therapies such as acupuncture and massage. ❒
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