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Get Headaches? Smart Ways to Deal
Headache Triggers
By Winnie Yu Scherer
Sometimes you know exactly what's causing that pounding in your skull. Other times, you're blindsided. Headaches—whether debilitating migraines or less-painful-but-still-annoying tension headaches—are often set off or made worse by a key trigger, says Brian Grosberg, MD, director of the Inpatient Headache Program at Montefiore Headache Center in New York City.
Here, the seven most common pain provokers, and how to head off the hurt. (See your doctor if these DIY fixes don't do the trick; for those plagued by headaches, prescription meds may help.)
Invasive Dentistry May Raise Short-Term Heart, Stroke Risk
MONDAY, Oct. 18 (HealthDay News) — Invasive dental procedures designed to treat gum inflammation may raise the risk for heart attack and stroke, researchers say.
But the increase appears to be slight and short-term, the study team noted.
“I don’t want to downplay this entirely, because we saw a genuine rise in cardiovascular risk in the period just after dental work was done among patients undergoing invasive treatment,” said study co-author Liam Smeeth, a professor of clinical epidemiology at the London School of Hygiene and Tropical Medicine in England. “But the overall risk is quite small and endures for only a very brief period.”
Smeeth and his colleagues published their findings in the Oct. 19 issue of the Annals of Internal Medicine.
Previous research has linked common and chronic low-grade dental infections to inflammatory processes that elevate the risk for strokes and heart attacks, the authors pointed out.
But whether treatment for those infections raises a similar risk had not been explored, said the authors who set out to study the potential link between the two.
The team analyzed U.S. Medicaid records for nearly 1,200 patients who had undergone invasive dental treatments and had also experienced a stroke or a heart attack between 2002 and 2006.
The patients’ median age was 67, and invasive dental procedures were characterized as those with the potential to cause an inflammatory response, such as periodontal therapy and tooth extractions.
Nearly three-quarters of the patients had undergone a single dental procedure, nearly all of them (89 percent) tooth extractions. About one-quarter had had two to four dental treatments, with 57 days, on average, between each procedure.
About 4 percent of the patients died during hospitalization.
Even after taking into consideration a history of diabetes, high blood pressure and/or coronary heart disease, the team observed a significant but slight increase in heart-related events during the month following a dental treatment, primarily because of an apparent short-term rise in heart attack risk. Stroke risk appeared to rise less significantly than heart attack risk.
However, no patient suffered a cardiovascular event on the day of treatment, and the apparent increased risk for heart problems dissipated within six months, the researchers noted.
Such “transient” cardiovascular concerns are generally minimal, do not outweigh the long-term cardiovascular benefits of invasive dental treatment, and should not deter patients from getting the dental care they need, the authors concluded.
In an editorial in the same journal, Dr. Howard Weitz of the Jefferson Heart Institute and Dr. Geno Merli of the Jefferson Vascular Center, both in Philadelphia, noted that it is too early to say that routine dental care should be altered in any way based on the current findings.
For one thing, they said the jury is still out on how clear a connection actually exists between periodontal disease and cardiovascular illness in the first place. And they theorized that much of the observed treatment-related risk might actually stem from a common pre-procedure practice, namely that patients who routinely take aspirin to lower their heart risk stop taking the medication before undergoing dental surgery.
With millions of Americans on an ongoing aspirin regimen, Weitz and Merli said this angle requires further exploration.
Anthony Iacopino a prosthodontist and dean of the University of Manitoba’s school of dentistry in Canada, said he was not surprised that dental treatment may entail some cardiovascular risk. But he agreed that the benefits of treatment far exceed the risks.
“Periodontal disease is an infection, and bacteria gets into the bloodstream as a result,” he noted. “This happens at a low level at rest, and even more so when a person eats and chews, and perhaps even more so when he or she has dental treatment.
“But there is a very big difference between a temporarily high level of bacterial exposure during one or two treatment sessions and years and years of walking around with untreated periodontal disease,” stressed Iacopino. “Clearly, whatever exposure a patient goes through during dental treatment, it’s worth it in the long run.”
More information
For more on periodontal disease, visit the American Academy of Periodontology.
SOURCE: Liam Smeeth, Ph.D., M.D., professor of clinical epidemiology, department of epidemiology and population health, London School of Hygiene and Tropical Medicine, London; Anthony Iacopino, D.M.D., Ph.D., prosthodontist, and dean, University of Manitoba, school of dentistry, and director, International Center of Oral-Systemic Health, Manitoba, Canada; Oct. 19, 2010, Annals of Internal Medicine
TUESDAY, Jan. 4 (HealthDay News) — Elderly people who lose their teeth may be at increased risk for dementia, researchers have found.
The new study included more than 4,000 Japanese participants, 65 and older, who underwent a dental examination and a psychiatric assessment. Compared with participants who still had many of their natural teeth, those with fewer or no teeth were much more likely to have experienced some memory loss or have early-stage Alzheimer’s disease.
The findings were published online Dec. 31 in Behavioral and Brain Functions.
Participants with symptoms of memory loss tended to report that they had visited the dentist rarely, if at all. Dr. Nozomi Okamoto, the study’s principal investigator, said that this may be one explanation for the study’s findings but suggested that there may be other links between tooth loss and memory problems.
“Infections in the gums that can lead to tooth loss may release inflammatory substances, which in turn will enhance the brain inflammation that cause neuronal death and hasten memory loss,” she said in a news release from the journal’s publisher. “The loss of sensory receptors around the teeth is linked to some of the dying neurons.”
This may lead to a vicious cycle, Okamoto explained. The loss of these brain connections can cause more teeth to fall out, further contributing to cognitive decline.
More information
The U.S. National Institute of Neurological Disorders and Stroke has more about dementia.
– Robert Preidt
U.S. Officials Recommend Reduced Fluoride Levels in Water
FRIDAY, Jan. 7 (HealthDay News) — U.S. government officials said Friday that the amount of fluoride in the nation’s drinking water should now be set at the lowest recommended level.
Although fluoride is a significant help in preventing cavities and tooth decay, too much of it can cause unattractive spotting on children’s teeth. About two out of five teens have white spots and streaks on their teeth due to too much fluoride, according to a recent government study.
To prevent this problem, the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency are recommending that the fluoride level in drinking water be set at 0.7 milligrams per liter of water, replacing the current recommended range of 0.7 to 1.2 milligrams.
“One of water fluoridation’s biggest advantages is that it benefits all residents of a community — at home, work, school, or play,” HHS Assistant Secretary for Health Dr. Howard K. Koh said in a statement. “Today’s announcement is part of our ongoing support of appropriate fluoridation for community water systems, and its effectiveness in preventing tooth decay throughout one’s lifetime.”
One reason for the new recommendation is that over the years the sources of fluoride have increased from water to include toothpastes, mouth wash, fluoride supplements and fluoride applied by dentists, EPA and HHS officials noted.
According to the agencies, this new recommendation allows the maximum prevention of tooth decay through fluoridation, while reducing the possibility of children getting too much fluoride.
Overexposure to fluoride results in a condition known as fluorosis, which can damage children’s developing teeth.
In the United States fluorosis is usually mild, seen as barely visible lacy white markings or spots on the enamel. The severe form of fluorosis, which causes staining and pitting of the tooth surface, is rare here, but is more common in places like China where the water has naturally occurring levels of fluoride.
A spokesman for the American Dental Association, Dr. Matthew Messina, said these government agencies are doing their job in recommending what community water supplies are supposed to do.
“They have just refined from a range and provided a more exact direction,” Messina said. “We are excited that they continue to advocate the safety and effectiveness of fluoride and its value as a public health measure in preventing dental decay.”
Messina noted that fluoride occurs naturally in water and different places have different levels of fluoride. Some towns may not have to add any fluoride and others only a little to reach the recommended level, he said.
“Fluoride is one of the best returns on investment as far as the small amount of money spent on fluoridating water relative to the tremendous reduction in the cost of having cavities,” Messina said.
Dr. Leo Dorado, an assistant professor of oral surgery at the University of Miami, said that each locality needs to tailor adding fluoride to water to achieve the right level.
Dorado is concerned that too much fluoride can cause fluorosis in young children. “I don’t think the standard has been enforced state by state,” he said. “It’s not just an easy fix. It is something that has to be regulated according to government standards, but state by state,” he said.
More information
For more information on fluoride, visit the American Dental Association.
SOURCES: Matthew Messina, D.D.S., spokesman, American Dental Association; Leo Dorado, D.D.S., assistant professor of oral surgery, University of Miami; U.S. Department of Health and Human Services, news release, Jan. 7, 2011
Fish Oil Might Help Fight Gum Disease
TUESDAY, Oct. 26 (HealthDay News) — Eating even moderate amounts of omega-3 fatty acids, typically found in foods such as salmon and other fatty fish, may help ward off gum disease, new research suggests.
Researchers divided nearly 9,200 adults aged 20 and up participating in the National Health and Nutrition Examination Survey between 1999 and 2004 into three groups based on their consumption of omega-3 fatty acids. Consumption was assessed by asking participants to recall exactly what they’d eaten during the prior 24 hours.
Dental exams showed participants in the middle and upper third for omega-3 fatty acid consumption were between 23 percent and 30 percent less likely to have gum disease than those who consumed the least amount of omega-3 fatty acids.
Specifically, the researchers found that the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were associated with less gum disease. The association with linolenic acid (LNA) was not statistically significant.
“Eating a very feasible amount of fatty fish seems to have a lot of benefit,” said senior study author Dr. Kenneth Mukamal, an associate professor of medicine at Harvard Medical School. “But we found no benefits to eating tons of this stuff.”
Since the study was a snapshot of a single day’s diet, Mukamal said researchers could not determine exactly how much fish oil people should consume regularly. But following guidelines from major organizations such as the American Heart Association, which recommends eating fatty fish at least twice a week, is probably a good idea, not just for gum disease but for overall health, they noted.
“There are a lot of benefits of omega-3 fatty acids. We have good evidence they prevent sudden death caused by heart rhythm disturbances. We have some evidence omega-3 fatty acids can reduce the risk of heart attacks and stroke,” Mukamal said. “This is a great example of another potential benefit.”
In the study, researchers took into account other factors that could affect the likelihood of having gum disease, such as age, income, education and other health and socioeconomic factors.
The study is published in the November issue of the Journal of the American Dietetic Association.
Periodontitis is a chronic inflammation of the gums caused by bacteria that accumulate around the gum line, according to background information in the study. Over time, the gum tissue can recede and separate from teeth, leading to “periodontal pockets,” or spaces between the gums and the teeth, and loss of the bone that provides the supporting structure for the teeth.
About 54 percent of men and 46 percent of women over age 30 in the United States experience gingival bleeding, the earliest sign of periodontal disease, according to background information in an accompanying editorial.
In the general population, about 11 percent of adults aged 50 to 64 have moderate or severe periodontitis, rising to 20 percent of those over age 75. In the study, about 8.2 percent of participants had periodontitis.
The usual treatment of periodontitis is good dental hygiene, including manually removing bacteria during dental appointments and applying local antibiotics to kill the bacteria, though there is disagreement among dentists about how well local antibiotics work.
In an accompanying commentary, Elizabeth Krall Kaye, a professor in the department of health policy and health services research at Boston University Henry M. Goldman School of Dental Medicine, said the study supports incorporating fatty fish into one’s diet, but not necessarily fish oil supplements.
“The study is interesting in that they studied a large population, and they saw some benefit just from consuming moderate amounts of omega-3 fatty acids,” Kaye said.
Other sources of omega-3 fatty acids include sardines, mackerel and swordfish, along with some nuts and seeds such as walnuts and flax seed.
More information
The American Heart Association has more on omega-3 fatty acids.
SOURCES: Kenneth Mukamal, M.D., M.P.H., associate professor, medicine, Harvard Medical School, Boston; Elizabeth Krall Kaye, Ph.D., M.P.H., professor, Henry M. Goldman School of Dental Medicine, Boston University, Boston; November 2010, Journal of the American Dietetic Association
FDA Panel Calls for Safety Review of Mercury in Dental Fillings
FDA Panel Calls for Safety Review of Mercury in Dental Fillings
WEDNESDAY, Dec. 15 (HealthDay News) — U.S. Food and Drug Administration advisers urged the agency to take a new look at data that may indicate potential safety problems with dental fillings that include mercury.
The FDA had ruled in 2009 that mercury used in so-called amalgam dental fillings is safe.
“We need to see where the science is and if there are gaps,” said the panel’s chairwoman, Dr. Marjorie Jeffcoat, a dentist and researcher with the University of Pennsylvania, CNN reported.
The advisory panel noted that the FDA’s 2009 decision was solid, based on scientific findings available at the time. The panel also stressed that more studies need to be done on the fillings, especially in children, CNN said.
The FDA advisory panel met in response to challenges from consumer and dental groups that contended the FDA relied on flawed data when it set the guidelines for mercury safety levels. Critics of fillings that use mercury as a component contend that they can pose neurotoxic health risks, especially to fetuses and young children.
In July 2009, the FDA placed tighter safety controls on the use of mercury dental fillings, but said they were safe for most people.
Since that time, the agency has categorized the fillings as Class II devices, which puts them into the middle range of risk. Class II devices usually carry some kind of precautions regarding their use.
But FDA officials said at the time of the 2009 vote that the fillings pose no real harm to most people.
“Patients are not at risk for long-term, mercury-related adverse health events,” Dr. Susan Runner, of the FDA’s Division of Anesthesiology, General Hospital, Infection Control and Dental Devices, said during a July 28, 2009, news conference. “There have only been 141 adverse event reports over 20 years. None resulted in death.”
The FDA did recommend in 2009 the following labeling changes: a warning against the use of these fillings in patients with mercury allergy; a warning that dental professionals use adequate ventilation when handling the material for the fillings; and a statement discussing the scientific evidence on the benefits and risks of dental amalgam.
“We’re not contraindicating dental amalgam in any patient group [other than those who have allergies],” Runner said at the news conference.
The 2009 ruling brought an angry reaction from the consumer organization Consumers for Dental Choice.
“I’m outraged. FDA broke its word,” Charles Brown, the group’s national counsel, said at the time of the 2009 vote. “They put a warning a year ago on the Web site and promised to keep those warnings on the Web site that warned of neurological damage to children and unborn children. Bowing to the dental products industry, FDA has, for the first time in memory, withdrawn a warning about neurological harm to children and the unborn. It’s a contemptuous attitude toward lower income and minority children because they’re the ones that get amalgam. The rich get resin.”
The agency decision followed a lengthy debate on the supposed dangers of these fillings, which included a lawsuit filed in 2006 against the FDA by several consumer groups, including Moms Against Mercury and Consumers for Dental Choice.
As part of that settlement, the FDA agreed to classify mercury fillings, also known as dental amalgam, by July 28, 2009, and posted a notice on its Web site that said: “Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses.”
Dental amalgam contains elemental mercury combined with other metals such as silver, copper, tin and zinc. The fillings, about 50 percent mercury, have been used for generations to stabilize decaying teeth. Dental experts contend that when mercury is bound to the other metals, it’s “encapsulated” and doesn’t pose a health risk. Consumer groups, however, contend that mercury, a known neurotoxin, does leak out in the form of mercury vapor and then gets into the bloodstream.
According to the American Dental Association, the use of amalgam is declining. In 1990, dental amalgams made up 67.6 percent of all dental restorations, but by 1999 it was 45.3 percent and, in 2003, an estimated 30 percent. Cavities that previously would have been treated with dental amalgam are now mostly filled with a resin composite.
Several countries have already either banned or advised against the use of mercury fillings.
More information
The U.S. Centers for Disease Control and Prevention has more on amalgam fillings.
SOURCES: CNN; July 28, 2009, news conference with Susan Runner, division of anesthesiology, General Hospital, Infection Control and Dental Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration; Charles Brown, national counsel, Consumers for Dental Choice; July 28, 2009, prepared statement, American Dental Association
WEDNESDAY, Dec. 15 (HealthDay News) — U.S. Food and Drug Administration advisers urged the agency to take a new look at data that may indicate potential safety problems with dental fillings that include mercury.
The FDA had ruled in 2009 that mercury used in so-called amalgam dental fillings is safe.
“We need to see where the science is and if there are gaps,” said the panel’s chairwoman, Dr. Marjorie Jeffcoat, a dentist and researcher with the University of Pennsylvania, CNN reported.
The advisory panel noted that the FDA’s 2009 decision was solid, based on scientific findings available at the time. The panel also stressed that more studies need to be done on the fillings, especially in children, CNN said.
The FDA advisory panel met in response to challenges from consumer and dental groups that contended the FDA relied on flawed data when it set the guidelines for mercury safety levels. Critics of fillings that use mercury as a component contend that they can pose neurotoxic health risks, especially to fetuses and young children.
In July 2009, the FDA placed tighter safety controls on the use of mercury dental fillings, but said they were safe for most people.
Since that time, the agency has categorized the fillings as Class II devices, which puts them into the middle range of risk. Class II devices usually carry some kind of precautions regarding their use.
But FDA officials said at the time of the 2009 vote that the fillings pose no real harm to most people.
“Patients are not at risk for long-term, mercury-related adverse health events,” Dr. Susan Runner, of the FDA’s Division of Anesthesiology, General Hospital, Infection Control and Dental Devices, said during a July 28, 2009, news conference. “There have only been 141 adverse event reports over 20 years. None resulted in death.”
The FDA did recommend in 2009 the following labeling changes: a warning against the use of these fillings in patients with mercury allergy; a warning that dental professionals use adequate ventilation when handling the material for the fillings; and a statement discussing the scientific evidence on the benefits and risks of dental amalgam.
“We’re not contraindicating dental amalgam in any patient group [other than those who have allergies],” Runner said at the news conference.
The 2009 ruling brought an angry reaction from the consumer organization Consumers for Dental Choice.
“I’m outraged. FDA broke its word,” Charles Brown, the group’s national counsel, said at the time of the 2009 vote. “They put a warning a year ago on the Web site and promised to keep those warnings on the Web site that warned of neurological damage to children and unborn children. Bowing to the dental products industry, FDA has, for the first time in memory, withdrawn a warning about neurological harm to children and the unborn. It’s a contemptuous attitude toward lower income and minority children because they’re the ones that get amalgam. The rich get resin.”
The agency decision followed a lengthy debate on the supposed dangers of these fillings, which included a lawsuit filed in 2006 against the FDA by several consumer groups, including Moms Against Mercury and Consumers for Dental Choice.
As part of that settlement, the FDA agreed to classify mercury fillings, also known as dental amalgam, by July 28, 2009, and posted a notice on its Web site that said: “Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses.”
Dental amalgam contains elemental mercury combined with other metals such as silver, copper, tin and zinc. The fillings, about 50 percent mercury, have been used for generations to stabilize decaying teeth. Dental experts contend that when mercury is bound to the other metals, it’s “encapsulated” and doesn’t pose a health risk. Consumer groups, however, contend that mercury, a known neurotoxin, does leak out in the form of mercury vapor and then gets into the bloodstream.
According to the American Dental Association, the use of amalgam is declining. In 1990, dental amalgams made up 67.6 percent of all dental restorations, but by 1999 it was 45.3 percent and, in 2003, an estimated 30 percent. Cavities that previously would have been treated with dental amalgam are now mostly filled with a resin composite.
Several countries have already either banned or advised against the use of mercury fillings.
More information
The U.S. Centers for Disease Control and Prevention has more on amalgam fillings.
SOURCES: CNN; July 28, 2009, news conference with Susan Runner, division of anesthesiology, General Hospital, Infection Control and Dental Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration; Charles Brown, national counsel, Consumers for Dental Choice; July 28, 2009, prepared statement, American Dental Association
Dental Care
Dental health is about more than just pretty white teeth. Poor dental health—in particular gum disease—is linked to a greater risk of heart disease and early labor in pregnancy. The first step to having healthy teetand gums is to floss and brush your teeth regularly.
Do Not Panic! Breathing Techniques Can Help You Exercise
http://img2.timeinc.net/health/images/journeys/copd/breathing-exercise-150.jpg
If you've got chronic obstructive pulmonary disease (COPD), it's more important than ever to get some exercise—it can save your lung function and slow down the progression of COPD. The problem? The shortness of breath that comes with exertion can make it tempting to move less than you did before. This sets up a vicious cycle: shortness of breath leads to inactivity, which leads to a decline in fitness, which leads to further shortness of breath and inactivity.
To get out of the rut, Michael Berry, PhD, chair of the department of health and exercise science at Wake Forest University, in Winston-Salem, N.C., recommends walking, stationary biking, and elliptical training. They work well for people with COPD, but strength and resistance training are playing an increasing role in patients’ regimens.
As we age, people—particularly those over the age of 60—lose muscle fibers, according to Berry. Healthy people lose fast-twitch muscles, which are used for short bursts of energy. But individuals with COPD tend to lose slow-twitch muscles, which are used for endurance activities as well.
Weight training helps to improve skeletal muscle function so patients can remain active longer. Exercise of the lower legs—frequently walking or cycling—is the main focus of any organized exercise program for COPD, says Gail Weinmann, MD, the deputy director of the National Heart, Lung and Blood Institute’s Division of Lung Diseases, but exercising the upper arms through resistance training is also helpful. (Like anyone starting an exercise program, a person with COPD should be cleared for exercise by a health care provider, Dr. Weinmann cautions.)
If you have COPD, another advantage of exercising the respiratory system is to learn how to cope with the panic that can occur with shortness of breath.
“I have heard it described as when someone is hit in the stomach and can’t get their breath,” Berry says. “Exercise teaches people how to deal with that sensation, to work through it. They know they are going to get up the steps, and they will get short of breath, but now they know, ‘I’m not going to keel over and die.’”
Breathing techniques can fight panicky feelings
Mike McBride, a COPD patient from Arvada, Colo., who racewalks with oxygen in tow, says the first time he walked around his neighborhood for exercise, he thought he was going to have to call someone to pick him up. Over the years he has had setbacks and has learned his limits, but he continues to exercise at the gym and walks at least three times a week.
“Learning to deal with the panic is the first thing to get past,” McBride says.
Respiratory therapists offer two common breathing techniques: pursed lip and diaphragm breathing. Pursed lip breathing is performed by inhaling through the nose and then exhaling through pursed lips (as if one is going to whistle). The exhale should be longer than the inhale, but air should not be forced out. This breathing helps people relax and reduces the amount of air trapped in the lungs. Diaphragm breathing helps to strengthen this important muscle and is accomplished by lying on one’s back with knees bent and making the stomach, rather than the chest, move out while inhaling and in while exhaling.
Patients are typically introduced to breathing exercises only when they visit a respiratory therapist or participate in a pulmonary rehabilitation program, Berry says, mainly because time-crunched primary care physicians focus on exercise and smoking cessation.
McBride’s insurance would not pay for respiratory therapy, so he utilized breathing techniques he learned during Lamaze classes years ago. He visualizes wringing out a towel when he starts to panic and concentrates on breathing out twice as long as he breathes in.
“A lot of people don’t want to do anything because they are afraid of getting short of breath," he says. "It doesn’t scare me anymore because I have had enough experience with the distress part.”
If you've got chronic obstructive pulmonary disease (COPD), it's more important than ever to get some exercise—it can save your lung function and slow down the progression of COPD. The problem? The shortness of breath that comes with exertion can make it tempting to move less than you did before. This sets up a vicious cycle: shortness of breath leads to inactivity, which leads to a decline in fitness, which leads to further shortness of breath and inactivity.
To get out of the rut, Michael Berry, PhD, chair of the department of health and exercise science at Wake Forest University, in Winston-Salem, N.C., recommends walking, stationary biking, and elliptical training. They work well for people with COPD, but strength and resistance training are playing an increasing role in patients’ regimens.
As we age, people—particularly those over the age of 60—lose muscle fibers, according to Berry. Healthy people lose fast-twitch muscles, which are used for short bursts of energy. But individuals with COPD tend to lose slow-twitch muscles, which are used for endurance activities as well.
Weight training helps to improve skeletal muscle function so patients can remain active longer. Exercise of the lower legs—frequently walking or cycling—is the main focus of any organized exercise program for COPD, says Gail Weinmann, MD, the deputy director of the National Heart, Lung and Blood Institute’s Division of Lung Diseases, but exercising the upper arms through resistance training is also helpful. (Like anyone starting an exercise program, a person with COPD should be cleared for exercise by a health care provider, Dr. Weinmann cautions.)
If you have COPD, another advantage of exercising the respiratory system is to learn how to cope with the panic that can occur with shortness of breath.
“I have heard it described as when someone is hit in the stomach and can’t get their breath,” Berry says. “Exercise teaches people how to deal with that sensation, to work through it. They know they are going to get up the steps, and they will get short of breath, but now they know, ‘I’m not going to keel over and die.’”
Breathing techniques can fight panicky feelings
Mike McBride, a COPD patient from Arvada, Colo., who racewalks with oxygen in tow, says the first time he walked around his neighborhood for exercise, he thought he was going to have to call someone to pick him up. Over the years he has had setbacks and has learned his limits, but he continues to exercise at the gym and walks at least three times a week.
“Learning to deal with the panic is the first thing to get past,” McBride says.
Respiratory therapists offer two common breathing techniques: pursed lip and diaphragm breathing. Pursed lip breathing is performed by inhaling through the nose and then exhaling through pursed lips (as if one is going to whistle). The exhale should be longer than the inhale, but air should not be forced out. This breathing helps people relax and reduces the amount of air trapped in the lungs. Diaphragm breathing helps to strengthen this important muscle and is accomplished by lying on one’s back with knees bent and making the stomach, rather than the chest, move out while inhaling and in while exhaling.
Patients are typically introduced to breathing exercises only when they visit a respiratory therapist or participate in a pulmonary rehabilitation program, Berry says, mainly because time-crunched primary care physicians focus on exercise and smoking cessation.
McBride’s insurance would not pay for respiratory therapy, so he utilized breathing techniques he learned during Lamaze classes years ago. He visualizes wringing out a towel when he starts to panic and concentrates on breathing out twice as long as he breathes in.
“A lot of people don’t want to do anything because they are afraid of getting short of breath," he says. "It doesn’t scare me anymore because I have had enough experience with the distress part.”
Health Precautions
Health Precautions
General Cautions
Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary.
Drink only bottled beverages (including water) or beverages made with boiled water. Do not use ice cubes or eat raw seafood, rare meat or dairy products. Eat well-cooked foods while they are still hot and fruits that can be peeled without contamination. Avoid roadside stands and street vendors.
Swim only in well-maintained, chlorinated pools or ocean water known to be free from pollution; avoid freshwater lakes, streams and rivers. Wear clothing which reduces exposed skin and apply repellents containing DEET to remaining areas.
Sleep in well-screened accommodations. Carry anti-diarrhea medication. Reduce problems related to sun exposure by using sunglasses, wide-brimmed hats, sunscreen lotions and lip protection.
Specific Concerns
AIDS occurs. Blood supply may not be adequately screened and/or single-use, disposable needles and syringes may be unavailable. When possible, travelers should defer medical treatment until reaching a facility where safety can be assured.
The large number of tropical plants and pollution levels inurban areas may cause children and adults with asthma problems severe discomfort.
Immunizations
These recommendations are not absolute and should not be construed to apply to all travelers. A final decision regarding immunizations will be based on the traveler's medical history, proposed itinerary, duration of stay and purpose for traveling.
Hepatitis A
Consider active immunization with hepatitis A vaccine or passive immunization with immune globulin (IG) for all susceptible travelers. Especially consider choosing active immunization for persons planning to reside for a long period or for persons who take frequent short-term trips to risk areas. The importance of protection against hepatitis A increases as length of stay increases. It is particularly important for persons who will be living in or visiting rural areas, eating or drinking in settings of poor or uncertain sanitation, or who will have close contact with local persons (especially young children) in settings with poor sanitary conditions.
Hepatitis B
Vaccination is advised for health care workers, persons anticipating direct contact with blood from or sexual contact with inhabitants, and persons planning extended stays of 6 months or greater (especially those who anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population).
Japanese encephalitis
Consider vaccination if staying a month or more on Bali, Irian Jaya, Java, Kalimantan, Lombok, Mollucas, Nusa Tenggara or Sulawesi, especially if travel includes rural areas. Also consider if staying less than 30 days and at high risk (in case of epidemic outbreak or extensive outdoor
exposure in rural areas). While transmission likely occurs all year and varies by island, peak risk is generally from November to March, although it is June to July in some years. Human cases have historically been reported only on Bali and Java.
one-time booster dose is recommended for travelers who have previously completed a standard course of polio immunization. Refer to CDC guidelines for vaccinating unimmunized or incompletely immunized persons. Pregnancy is a relative contraindication to vaccination; however, if protection is needed, either IPV or OPV may be used, depending on preference and time available.
Rabies
Preexposure vaccination should be considered for travel to Java, Kalimantan, Sumatra or Sulawesi for persons staying longer than 30 days who are expected to be at risk to bites from domestic and/or wild animals (particularly dogs), or for persons engaged in high risk activities such as spelunking or animal handling. Need for vaccination is more important if potential exposure is in rural areas and if adequate postexposure care is not readily available.
Typhoid
Vaccination should be considered for persons staying longer than 3 weeks, adventurous eaters, and those who will venture off the usual tourist routes into small cities, villages and rural areas. Importance of vaccination increases as access to reasonable medical care becomes limited.
Contraindications depend on vaccine type.
All routine vaccines (such as DTP or Td, Hib, MMR, polio, varicella, influenza and pneumococcal) should be kept up-to-date as a matter of good health practice unrelated to travel.
Disease Risk Summary
The general level of community sanitation and public health awareness is low throughout Indonesia.
Insect-borne illness: considered an important cause of disease in this area.
Encephalitis (Japanese type) - occurs (risk may extend to resort areas, including those on Bali)
Filariasis - prevalent in rural areas
Malaria - common
Typhus (mite-borne) - occurs in deforested areas
Food-borne and water-borne illness: these diseases are common.
Cholera - occurs
Dysentery (amoebic and bacillary) - occurs
Fasciolopsiasis (giant intestinal fluke) - occurs
Hepatitis - occurs
Melioidosis - occurs
Schistosomiasis - occurs on the island of Sulawesi
Other hazards:
Diseases such as measles and diphtheria are commonly reported, and cases of polio still occur regularly.
Influenza risk extends throughout the year.
Rabies - occurs on Java, Kalimantan, Sumatra and Sulawesi
Trachoma - occurs
Yellow fever
A yellow fever vaccination certificate is required from
travelers coming from infected areas. A certificate is also required from
travelers arriving from countries in the endemic zones.
Malaria Information
General Cautions
Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary.
Drink only bottled beverages (including water) or beverages made with boiled water. Do not use ice cubes or eat raw seafood, rare meat or dairy products. Eat well-cooked foods while they are still hot and fruits that can be peeled without contamination. Avoid roadside stands and street vendors.
Swim only in well-maintained, chlorinated pools or ocean water known to be free from pollution; avoid freshwater lakes, streams and rivers. Wear clothing which reduces exposed skin and apply repellents containing DEET to remaining areas.
Sleep in well-screened accommodations. Carry anti-diarrhea medication. Reduce problems related to sun exposure by using sunglasses, wide-brimmed hats, sunscreen lotions and lip protection.
Specific Concerns
AIDS occurs. Blood supply may not be adequately screened and/or single-use, disposable needles and syringes may be unavailable. When possible, travelers should defer medical treatment until reaching a facility where safety can be assured.
The large number of tropical plants and pollution levels inurban areas may cause children and adults with asthma problems severe discomfort.
Immunizations
These recommendations are not absolute and should not be construed to apply to all travelers. A final decision regarding immunizations will be based on the traveler's medical history, proposed itinerary, duration of stay and purpose for traveling.
Hepatitis A
Consider active immunization with hepatitis A vaccine or passive immunization with immune globulin (IG) for all susceptible travelers. Especially consider choosing active immunization for persons planning to reside for a long period or for persons who take frequent short-term trips to risk areas. The importance of protection against hepatitis A increases as length of stay increases. It is particularly important for persons who will be living in or visiting rural areas, eating or drinking in settings of poor or uncertain sanitation, or who will have close contact with local persons (especially young children) in settings with poor sanitary conditions.
Hepatitis B
Vaccination is advised for health care workers, persons anticipating direct contact with blood from or sexual contact with inhabitants, and persons planning extended stays of 6 months or greater (especially those who anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population).
Japanese encephalitis
Consider vaccination if staying a month or more on Bali, Irian Jaya, Java, Kalimantan, Lombok, Mollucas, Nusa Tenggara or Sulawesi, especially if travel includes rural areas. Also consider if staying less than 30 days and at high risk (in case of epidemic outbreak or extensive outdoor
exposure in rural areas). While transmission likely occurs all year and varies by island, peak risk is generally from November to March, although it is June to July in some years. Human cases have historically been reported only on Bali and Java.
one-time booster dose is recommended for travelers who have previously completed a standard course of polio immunization. Refer to CDC guidelines for vaccinating unimmunized or incompletely immunized persons. Pregnancy is a relative contraindication to vaccination; however, if protection is needed, either IPV or OPV may be used, depending on preference and time available.
Rabies
Preexposure vaccination should be considered for travel to Java, Kalimantan, Sumatra or Sulawesi for persons staying longer than 30 days who are expected to be at risk to bites from domestic and/or wild animals (particularly dogs), or for persons engaged in high risk activities such as spelunking or animal handling. Need for vaccination is more important if potential exposure is in rural areas and if adequate postexposure care is not readily available.
Typhoid
Vaccination should be considered for persons staying longer than 3 weeks, adventurous eaters, and those who will venture off the usual tourist routes into small cities, villages and rural areas. Importance of vaccination increases as access to reasonable medical care becomes limited.
Contraindications depend on vaccine type.
All routine vaccines (such as DTP or Td, Hib, MMR, polio, varicella, influenza and pneumococcal) should be kept up-to-date as a matter of good health practice unrelated to travel.
Disease Risk Summary
The general level of community sanitation and public health awareness is low throughout Indonesia.
Insect-borne illness: considered an important cause of disease in this area.
Encephalitis (Japanese type) - occurs (risk may extend to resort areas, including those on Bali)
Filariasis - prevalent in rural areas
Malaria - common
Typhus (mite-borne) - occurs in deforested areas
Food-borne and water-borne illness: these diseases are common.
Cholera - occurs
Dysentery (amoebic and bacillary) - occurs
Fasciolopsiasis (giant intestinal fluke) - occurs
Hepatitis - occurs
Melioidosis - occurs
Schistosomiasis - occurs on the island of Sulawesi
Other hazards:
Diseases such as measles and diphtheria are commonly reported, and cases of polio still occur regularly.
Influenza risk extends throughout the year.
Rabies - occurs on Java, Kalimantan, Sumatra and Sulawesi
Trachoma - occurs
Yellow fever
A yellow fever vaccination certificate is required from
travelers coming from infected areas. A certificate is also required from
travelers arriving from countries in the endemic zones.
Malaria Information
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