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The contents of this website are for informational purposes only and are not intended to be used for medical advice. You should consult your physician or health care provider on a regular basis. You should consult your physician immediately with any problem about which you are concerned.
Teens and Calcium
Q. How much milk should a teenage girl drink? Does calcium matter at that age?
A. Teenage boys and girls need 1,300 milligrams a day, according to recently revised guidelines from the National Academy of Sciences. It is vital that they have enough calcium and participate in weight-bearing exercise at this age. This provides bone strength that helps protect against osteoporosis in later years. According to a 1996 study published in the Journal of Adolescent Health, only two percent of 15- to 18-year-old American girls get the calcium they need--meaning 98 percent eat calcium-deficient diets. This can have disastrous consequences down the road.
According to the National Osteoporosis Foundation, 10 million Americans have osteoporosis and another 18 million have low bone mass; 1 out of 2 women and 1 in 8 men over the age of 50 will have osteoporotic fractures at some point in their lives. Caucasian and Asian women are at higher risk than African-American women. About a quarter of hip fracture patients over the age of 50 die within a year following their fracture from complications such as pneumonia. Low-fat milk can provide an important source, with about 300 milligrams per 8-ounce glass, as can yogurt (200-415 mg per serving) and dark leafy vegetables.
The National Osteoporosis Foundation offers in depth information on prevention and treatment. Call 1-800-223-9994.
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Kids' Ear Infections
Q. My daughter has ear infections all the time. I've heard it's not a good idea to give children antibiotics for this, but she suffers so much.
A. Ear infections are caused by bacteria, which are sensitive to antibiotics, so that is the most common way to treat acute ear infections, according to George M. Lazarus, M.D., Associate Clinical Professor of Pediatrics at Columbia University and a pediatrician in private practice in New York City. "Without question a child in pain should be treated with antibiotics," he says. "And since it may take two to three days before a child feels better from the antibiotic, you may also want to treat the pain with ear drops and/or OTC painkillers." With repeated ear infections, sometimes fluid will persist in the middle ear after treatment. The best approach is to wait to see if the fluid dries up on its own. Have your doctor check it periodically; if fluid lasts longer than three to six months, you may need to have tubes placed in your child's ear to drain fluid and equalize pressure. If fluid is left indefinitely, it can become thick and gluey and cause ear damage, including hearing loss. Only if a child has persistent ear infections that are left untreated is language development likely to be hampered. The younger the first ear infection, the more likely a child is to get recurrent infections. Even the most severe ear infection problems tend to go away by the time a child is four or five years old.
George M. Lazarus, M.D., is Associate Clinical Professor of Pediatrics at Columbia University and a pediatrician in private practice in New York City.
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Colon Cancer Check Ups
Q. At what age does a man have to start having a regular checkup for colon cancer? A woman?
A. Men and women 50 or older should have a fecal occult blood test every year and a sigmoidoscopy every three to five years, which is the current American Cancer Society recommendation. Lewis Schneider, M.D., a gastroenterologist in private practice in New York City, suggests people go for a colonoscopy at age 50 to 55, with no need for further screening beyond the annual fecal occult blood test unless they have symptoms, such as rectal bleeding or a change in bowel habits. "That may well become the American Cancer Society guidelines," he conjectures. However, people in a high-risk group for this cancer--such as those with inflammatory bowel disease, colitis, a family/personal history of polyps and colorectal cancer, or any gynecological cancer--should talk with their physician about earlier and more frequent screenings.
Lewis Schneider, M.D., is Assistant Professor of Clinical Medicine at Columbia University and a gastroenterologist in private practice in New York City.
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Yeast Infections in Men
Q. I seem to get yeast infections fairly frequently, while my husband doesn't ever have any symptoms. Do men get yeast infections?
A. "Many fungal infections, such as oral, nail, esophageal and others, affect both men and women," says obstetrician/gynecologist Lauri Romanzi, M.D., a New York-based doctor who specializes in female urinary tract problems. "Your question, however, suggests yeast infections of the male genitalia, similar to vaginal infections in women. In fact, yeast is a common cause of balanitis, an infection of the tip (glans) of the penis." Symptoms include itching or burning of the glans or foreskin and a red rash. Balanitis is most common in men who have not been circumcised or who have diabetes or are HIV positive. Topical antifungal medications, such as Myconazole, Clotrimazole or Nystatin (which are also used to treat women) may be needed to clear up the infection. "While some people also suggest that soaking in a bath containing five drops of tea tree oil twice a day for five to seven days will clear up a fungal infection, be aware that no studies have been done confirming this," Dr. Romanzi notes. "Men can certainly try it--if their jock itch clears up, that means the tea tree treatment worked. If the problem continues despite standard established medical therapy, and they are uncircumcised, adult circumcision may be advised. Good hygiene helps prevent repeat infections. Furthermore, it's possible for both women and men to have yeast infections with no symptoms or almost undetectable ones. In cases such as yours, in which there is somewhat frequent infection, it may be necessary to treat both you and your husband.
Lauri Romanzi, M.D., a New York-based doctor who specializes in female urinary tract problems, is Clinical Assistant Professor of Obstetrics and Gynecology, College of Medicine, Cornell University, Ithaca NY.
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Out of Breath
Q. When I walk up stairs, I get so winded. I'm only 35 and not overweight. It worries me.
A. If you smoke, quit. If you don't, consult your doctor to determine if you have a respiratory allergy or some other problem. With your doctor's guidance and clearance, you may also want to begin a daily regimen of walking and low-impact aerobics to build your stamina. Low-intensity and low-impact exercises such as swimming and biking are the most joint friendly. Doing muscle-toning and -building exercises, such as stair climbing, is also a good idea. "Exercise is important and should be part of your normal daily routine," notes Renato Grammatica, physical therapist and director of Westchester (NY) Sports Physical Therapy. "I'm a big advocate of health clubs, with knowledgeable people available to give guidance. And having a place to go, with a variety of activities, helps reduce boredom--it's too easy to fall out of a routine when you're home alone. Try to set a regular time to exercise, so it becomes part of your lifestyle. Everyone, men and women, should have their own individual program, geared to their abilities and goals."
The Partnership for Women's Health urges anyone who is going to work with a physical trainer at a local gym to talk to his or her doctor first and get a recommendation or referral to someone who is well-trained and knowledgeable about physiotherapy. Unschooled trainers can cause you injury, especially if they haven't spoken with your physician about what you need to become more fit and about any particular vulnerabilities or injuries (old or recent) you may have which require special consideration.
Renato Grammatica is a licensed physical therapist and director of Westchester Sports Physical Therapy, in Scarsdale, New York.
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How Trauma Affects Boys and Girls
Q. Six years ago, my son, then aged 14, and my daughter, 12, were in a terrible car accident that resulted in the death of a cousin their age. All these years later, my son seems fine. In fact, he claims to barely remember the accident, while my daughter still has nightmares, phobias and other problems. Why might that be?
A. "It sounds like your daughter is suffering from post-traumatic stress disorder (PTSD), which occurs after (sometimes years after) a person has experienced or witnessed an event that involved serious injury to oneself or to others," says Patricio Paez, M.D., Assistant Professor of Psychiatry at Columbia University. "People with PTSD may have anxiety, panicky fears, nightmares, eating or sleep disorders, phobias and/or avoidance of people, places and things associated with the event." It may be no coincidence that your daughter is having a tougher time coping than her brother. According to a recent survey of 1,007 young adults, although the chance of experiencing a traumatic event was not gender-linked, the females who were exposed were more likely to experience PTSD. "What makes a person more vulnerable is the presence of preexisting mood or anxiety disorders," notes Dr. Paez. "These people have a higher incidence of PTSD than people with a similar trauma but no depression." Since anxiety and depressive disorders affect females more than males, it makes sense that females would experience PTSD at higher rates than males. Researchers observed that the sex difference was noticeably greater if the trauma occurred in childhood (under age 15). Treatment is similar to other anxiety disorders, with psychotherapy and anti-anxiety medications such as Prozac.
Patricio Paez, M.D., is Assistant Professor of Psychiatry at Columbia University and a psychiatrist in private practice in New York City.
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Serving Up Healthy Portions
Q. My husband and I are trying to improve our diets by eating a wide variety from all the food groups on the USDA food pyramid chart. Three things confuse us. How much is a serving; is it the same for fruit, vegetables, dairy and other foods; and are a man and a woman supposed to be eating the same amount of food?
A. It's easy to get confused by what is meant as a serving. "In general, half a cup—roughly speaking, an amount the size of your fist—is a serving of any type of food for most people," says Evelyn Tribole, a registered dietitian in Beverly Hills, California. "A dish can be made up of several servings of the same food. For example, a normal plateful of spaghetti that you eat for a meal may actually be two or more servings of grains and breads."
The official USDA recommendations give a range of servings per day to accommodate individual requirements. While all men and women need to eat daily from all the food groups, each person requires a unique amount depending on his or her activity level and weight. Men can generally eat more than women, but women need more (low-fat) dairy for the calcium.
The chart below may help you determine what constitutes a serving:
| Grains |
6 - 11 servings; one serving equals 1 slice bread or 1/2 cup cooked cereal, rice or pasta |
| Vegetables |
3 - 5 servings; one serving equals 1-2 cups cooked, 1 cup raw leafy. |
| Fruits |
2 - 4 servings; one serving equals 1 medium apple or banana, _ cup juice |
| Dairy |
2 - 3 servings, 1 cup per serving |
| Protein |
2 - 3 servings of meat, poultry, dry beans, eggs or nuts, 2-3 oz. per serving |
Evelyn Tribole, M.S., R.D., former nutritional expert on ABC's "Good Morning America," is the author of Healthy Homestyle Cooking, Rodale Press, 1994; and Healthy Homestyle Desserts, Viking Press, 1996. For the past seven years she has authored Shape magazine's Recipe Makeover column.
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Skin Cancer Awareness
Q: My 40-year-old brother died of melanoma and I'm terrified of getting it too. Is it hereditary? What should I watch out for? I'm a 44-year-old woman.
A. While there is some genetic connection, for the most part skin cancer is caused by exposure to the sun. It hits fair-skinned people hardest. It is one of the most common and fast-rising cancers, but the prognosis is excellent when caught early. "Existing evidence suggests a link between female sex hormones and melanoma; however this requires further clarification," says Mary Gail Mercurio, M.D., a dermatologist on the faculty of the University of Rochester, NY.
There are three types of skin cancers:
- Basal cell carcinoma is the most common malignant skin tumor; signs include a waxy bump on the face, ear or neck, or a scar-like lesion on the chest or back. While basal cell cancer rarely spreads, it can be very disfiguring.
- Squamous cancer cells are flat and scaly; squamous cell cancer is more aggressive than basal cell and can uncommonly spread to the lymph nodes and internal organs.
- Malignant melanoma is the most serious form of skin cancer but the least common; look for irregular red, white, blue or black spots on the trunk or limbs or changes in preexisting moles. Melanomas often develop on women's lower legs and men's upper backs; men have higher mortality rates. A number of characteristics have been associated with elevated risk for melanoma: blond or red hair, light skin, blue or green eyes, prominent freckling and relatives with melanoma.
Self-examination is crucial in controlling skin cancers; inspect your moles monthly, using a mirror or your spouse for hard-to-see areas and see a dermatologist if any existing mole bleeds or changes size or shape, or if you have a new mole after age 30. Treatment for both sexes is the same: surgical excision and sometimes chemotherapy.
Mary Gail Mercurio, M.D., is Clinical Assistant Professor of Dermatology at University of Rochester Medical School, Rochester, NY.
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Side Effects of HRT
Q: I am a 70-year-old woman who is taking Hormone Replacement Therapy (estrogen and progestin) to help boost my energy level and ease chest pains. It seems to do the trick, but I spot every two weeks and have breast pain as a result. How can I stay on HRT and minimize the side effects?
A: Hormone Replacement Therapy (HRT) is given to women to replace estrogen and progesterone--which are produced naturally by the body--when the production falls off precipitously after menopause. (Progestin is synthetic progesterone.) HRT is especially beneficial to women who experience early surgical menopause or severe menopausal symptoms, or who are at risk for osteoporosis and cardiovascular disease. HRT is not recommended for women who are pregnant, have a family or personal history of uterine, ovarian and possibly breast cancer, have large fibroids or benign uterine tumors, have blood clotting problems or gall bladder or liver disease.
The proper quantities of replacement hormones are complicated to determine, and it may take a fair amount of fine-tuning before you get the right dose, according to Philip Sarrel, M.D., Professor of Psychiatry and Obstetrics/Gynecology at Yale University. The usual way to reduce or eliminate spotting is to change the way you take progestin, either the dose or the way it's combined with estrogen. "If the progestin is being taken every day, there's the probably cause of the spotting," says Dr. Sarrel. Research is underway that should suggest better ways to control this side effect.
"As for breast tenderness or swelling, that may be due to the combined treatment. Modifying the dosage of the hormones and the way you take them might well reduce the problem," he says. Furthermore, it is not surprising that taking HRT eased your chest pains; estrogen promotes dilatation of coronary arteries in women.
Philip Sarrel, M.D., is Professor of Psychiatry and Obstetrics/Gynecology at Yale University.
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Controlling Hives
Q: I have severe hives that seem to spring up whenever I touch almost anything. I can't wear blue jeans or I get a rash on my waist, can't sit on wooden chairs or I break out wherever there is contact or pressure against my body. The hives last for days. It is really torture. After years of trying every known medication and elimination diet, they are still here. My doctors say the true cause may never be known and they are doing all that can be done. What do you know about this kind of allergy and is there a link to female hormones? I begin to think there may be.
A: Urticaria, or hives, are common (slightly more so in women) and may have many causes, including an allergic reaction to a number of foods (common are shellfish, berries, citrus and nuts), heat, water, the sun, the cold, certain drugs, pollen, insect bites, penicillin, aspirin and more, including, as in your situation, simple pressure. A related condition is called dermographia, in which wheals (raised lumps) form after stroking the skin even lightly.
Hives from any cause tend to be worse at pressure points. Pressure urticaria is, however, a distinct diagnosis, in which hives occur ONLY at pressure points. "Hives sometime flare up on a monthly cyclic basis," notes Marjorie Slankard, M.D., Associate Professor of Clinical Medicine at Columbia University and a board-certified specialist in allergy and immunology. "When hives occur only at those times, there is a possibility that an allergy to the woman's own progesterone may be the cause. Some people also think there may be an allergy to estrogen, but this is less well documented. With pregnancy, hives improve in one third of women and get worse in a third--so there is a hormonal connection but no consistent pattern. Also, allergies in general have a genetic predisposition. "I recommend evaluation by an allergist or dermatologist if you have chronic hives, because 20 to 30 percent of the time a cause is found. There are a number of systemic diseases or medical conditions associated with hives."
Treatment for mild hives is often antihistamine drugs. A tepid bath or calamine lotion can be soothing. Corticosteroid drugs are prescribed for more severe cases. One hopeful fact, according to Dr. Slankard: "Even when hives are chronic (occurring for more than 6 to 8 weeks), 70 percent of the time they disappear for unknown reasons."
Marjorie Slankard, M.D., is Associate Professor of Clinical Medicine at Columbia University and a board-certified specialist in allergy and immunology with a practice in New York City and Ridgewood, NJ.
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