“Balance exercises help strengthen arms, legs, and core muscles, allowing more efficient movement while also reducing fall risk,” says Michelle Tan, PT, DPT, UCLA Department of Rehabilitation Services.

According to the Centers for Disease Control and Prevention, one in four Americans ages 65 and older falls each year. Falls are the leading cause of injury (e.g., fractured hips, wrists, spine, head injuries and severe bruises) and a major cause of fatalities in older adults.

A Muscular Collaboration

Core muscles are essential for almost every movement your body makes and they play a critical role in balance and stability. Core muscles help to transfer forces between the upper body and lower body and are involved in tasks such as lifting, twisting, reaching, and bending. Strong core muscles are also fundamental in preventing falls and injuries, particularly in the lower back.

Core muscles include the abdominals, which are often the focus of core training, but also involve several other muscles.

Rectus Abdominis. Sometimes referred to as the “six-pack” among body builders, rectus abdominis muscles are located on the front of the abdomen between the ribs and the pelvis. They run vertically along the front of the abdomen, and are primarily responsible for flexing the lumbar spine (the motion of bending forward).

Obliques (Internal and External). These muscles are located on the sides of the abdomen, running diagonally. The external obliques are visible and lie on the surface, while the internal obliques are underneath. These muscles help rotate the torso (twist left and right) and assist with lateral flexion (bending to the side).

Transverse Abdominis. This deep layer of abdominal muscle acts like a corset, wrapping around your torso to help protect and stabilize the spine and pelvis.

Erector Spinae. This set of muscles runs along your back from your hips to the base of your skull. These muscles are crucial for maintaining good posture and supporting the spine during lifting tasks.

Multifidus. Located under the erector spinae and along the vertebral column, these muscles extend and rotate the spine (e.g., reaching up and turning to get something from a shelf).

Pelvic Floor Muscles: These muscles support the organs within the pelvis and play a key role in pelvic stability. Kegel exercises develop these muscles and help treat and prevent some types of incontinence.

Diaphragm. This is the primary muscle used in breathing. It sits at the base of the chest and also works as a stabilizing force for the upper body.

Training Core Muscles

To effectively strengthen your core, it is important to perform a variety of exercises that target all these muscle groups. An easy way to feel your core muscles is to intentionally cough (your core muscles will automatically pull inward). You want this pulling inward feeling when you perform core exercises. The idea is to keep breathing, of course, but at the same time gently but firmly hold the muscles in.

Exercises like planks, bridges, abdominal crunches, and leg lifts help in strengthening the core. Activities such as yoga and Pilates are also excellent for engaging and strengthening the core muscles through controlled breathing, movements, and balance challenges.

Special Considerations

Functional training/core exercises can of course be done on your own. But if you’re not familiar with how to do these exercises correctly, you might not get all the benefits. Consider taking group classes and/or some one-on-one training (e.g., Pilates or functional fitness personal trainers). Some people may especially benefit from the physical therapists who design custom programs that consider a person’s health and physical status. Tan shares this example:

“My 70-year-old patient, Susie, has neuropathy due to chemotherapy side effects. She has been proactive in maintaining her exercise regimen, including daily 30-minute walks and thrice-weekly chair yoga at home. Despite her efforts, she experienced instability while walking. I identified which specific areas to work on, guided her with specific exercises (including flexibility, strengthening, balance, and stability training, using different body movements such as head turning for balance while standing on a foam surface). I provided tips to help her avoid falls, for example, how to have better gait quality, utilizing proper movement of hips, knees, ankle, foot during walking.

“As a result, Susie no longer feels fearful of walking outdoors or in crowded places like malls. She reports improved muscle coordination, a lighter and more graceful movement, enhanced balance, and no longer needs to lock her knees for stability. Her overall sense of balance and awareness have significantly improved.”

Smart Starts to Exercise

When starting standing balance exercises, it’s always a good idea to be near a wall or stand in front of table or countertop, in case you need support. People with injuries and chronic conditions should consider working with a physical therapist, especially if they haven’t worked out in a while. Modifications can work wonders in helping you to be successful with exercise. “For people with osteoarthritis, if there is more pain during exercising, modify the positioning, such as sitting down or not bringing the arm or leg too high up, to avoid further irritation of joints and muscles,” recommends Tan. “People who have cardiac and lung conditions should avoid exercising in warm environments, as it can lead to dizziness, fainting, dehydration, or disruption of blood pressure.”

The benefits of balance exercises include good posture and coordinated movement. Practice these types of exercises at least three times per week and you’ll find that your balance will improve in just a few weeks. You may find that your mind is calmer and more focused, too.

The post How to Gain Better Balance appeared first on University Health News.

Your personal limits may be influenced by previous injuries or chronic health conditions like arthritis, heart failure, and lung disease. If this is the case, check with your doctor about how much you should be pushing yourself. Also try minor adjustments—for example, golf will be less of an effort if you play nine holes instead of 18. Use clubs with lightweight shafts and perimeter-weighted heads for better shock absorption, and low-compression golf balls (these have a softer core, so you don’t have to swing with as much force to achieve maximum distance from your shot). If tennis is your sport, play doubles, since this means you’ll hit roughly half the shots you would in a singles game, as well as covering only half the court. Play on soft surfaces and avoid overhead shots. If you jog, you’ll benefit just as much from a lower-impact brisk walk.

Warming up properly before engaging in sports can help prevent injuries, so spend at least five minutes doing gentle stretching exercises to loosen your muscles and marching on the spot to increase your circulation. Once you finish your activity session, the same exercises can help you cool down again into a normal resting state. If you experience any worrisome symptoms during sports—including chest pain or pressure, unusual shortness of breath, pain, and/or dizziness—stop what you are doing and contact your doctor.

Studies have shown that sports positively affect a range of conditions, including cardiovascular disease, cancer, arthritis, osteoporosis, lung diseases, and depression. Whatever your age and health status, you still can enjoy the sports you love or find new options that suit you better. Just set realistic limits, pace yourself, follow any precautions recommended by your doctor, and stay hydrated while you are physically active.

The post Enjoy Sports Safely appeared first on University Health News.

Vitamins are a very popular form of dietary supplement. In general, we only benefit from vitamin supplements if we have an inadequate intake (usually over a long period of time) or have problems absorbing the nutrient (see Risk for Vitamin Inadequacy box). With the possible exception of vitamin D, inadequate vitamin intake is rare in the United States. Healthy people get all they need from their usual dietary intake.

Let’s take a look at what the latest research says about the risks and potential benefits of vitamin supplements.

Vitamin A.

Diets high in vitamin A and beta-carotene (a pre-form of vitamin A) are associated with lower risk for certain kinds of cancer, but the use of supplements does not appear to help prevent cancer. In fact, taking high doses of betacarotene supplements has been associated with higher risk of lung cancer in smokers, former smokers, and people exposed to asbestos.

High doses of vitamin A from supplements can cause severe headache, blurred vision, nausea, dizziness, muscle aches, bone fracture in older women, problems with coordination, and, in extreme cases, even coma and death. The recommended safe upper limit for vitamin A is 3,000 micrograms (mcg) a day total from foods, beverages, and supplements. (Note that upper limits are well above recommended intake levels. Adverse events may occur if intake is above this limit.)

Vitamin B6 (pyridoxine).

While low blood levels of B6 have been associated higher risk for colorectal cancer, taking supplements has not been shown to prevent cancer or improve outcomes. Taking B6 supplements has not been shown to improve cognitive health. It was once thought that B vitamin supplements could lower risk for heart attack and stroke, but research has shown they do not.

Taking 1,000 milligrams (mg) or more of B6 a day can lead to nerve damage over time. This usually resolves when supplements are stopped. Nausea, heartburn, extreme sensitivity to sunlight, and painful skin patches are also possible. The safe upper limit for vitamin B6 from all foods, beverages, and supplements is 100 mg a day.

Vitamin B12 (cobalamin).

Vitamin B12 supplements are marketed as a way to increase energy and endurance, but this is only true for people who have a B12 deficiency. Research does not support the use of B12 supplements to reduce risk of developing cardiovascular disease or cognitive decline.

Biotin (vitamin B7).

There is little scientific evidence to support marketers claims that biotin supplements can improve the health of hair, skin, and nails. Aside from possibly causing false results on thyroid tests, there are no known harms from biotin supplementation.

Vitamin C.

Contrary to popular belief, research shows that vitamin C supplements do not reduce the risk of getting colds—although routine use might shorten the duration of colds or make symptoms somewhat milder. Dietary patterns high in fruits and vegetables rich in this vitamin are associated with lower risk of lung, breast, and colon cancer. This association may be due to other dietary factors associated with high fruit and vegetable intake, as vitamin C supplements have not been shown to be protective.

Regular use of vitamin C supplements may cause false‐negative results in urine tests used to detect urinary tract infections, and blood or glucose in the urine. The upper limit for intake of vitamin C is 2,000 mg a day. More than this can cause diarrhea, nausea, and stomach cramps.

Vitamin D.

We get vitamin D from sun exposure and some foods, but may not get adequate amounts from dietary intake. Since this vitamin is essential for calcium absorption, low D can impact bone health (although supplementation has not consistently been shown to help with osteoporosis). No benefits of vitamin D supplementation have been identified with regard to cancer, heart disease, depression, and type 2 diabetes prevention. In the body, vitamin D is involved in immune function, but findings on whether supplements help boost immunity have been inconsistent.

Consuming excessive amounts of vitamin D from dietary supplements can cause serious problems, including nausea, muscle weakness, confusion, kidney failure, and irregular heartbeat. The safe upper limit from all foods, beverages, and supplements is 4,000 International Units (IU) a day (100 mcg). It is important not to exceed that level (or get near it unless instructed by a healthcare provider).

Vitamin E.

Deficiency of vitamin E is rare. The best available research finds no benefit from vitamin E supplementation, particularly for preventing coronary heart disease, cancer, or cognitive decline.

High doses of supplements can increase risk of bleeding, hemorrhagic stroke, and prostate cancer. If you consume a supplement, do not take more than 1,000 mg (1,500 IU) a day for natural vitamin E supplements and 1,600 mg (1,100 IU) a day for synthetic vitamin E supplements. A large study found that even 180 mg (400 IU) a day for several years was associated with higher prostate cancer risk.

Folate (vitamin B9).

Low folate status at conception and in the early part of pregnancy can cause neural tube defects like spina bifida in the fetus. Enrichment of wheat flour, cornmeal, and rice in the U.S. with folic acid (a well absorbed synthetic form of folate) has led to a marked decline in cases of this birth defect. No other benefits to folic acid supplementation have been identified.

The recommendation is to limit folic acid/folate from all foods, beverages, and supplements to a maximum of 1,000 mcg (1 gram) a day. Higher doses can mask a vitamin B12 deficiency. High intakes have also been associated with higher risk of colorectal cancer.

Vitamin K.

Eating more vitamin K-rich foods like leafy green vegetables and vegetable oils is associated with strong bones, but studies to date disagree as to whether supplements improve bone strength.

No upper intake limit for vitamin K has been established due to lack of data. People taking warfarin (Coumadin) should follow the advice of their healthcare provider regarding dietary intake of vitamin K-rich foods.

Niacin (vitamin B3).

Very high doses of niacin (in the form of nicotinic acid) lower blood levels of LDL (bad) cholesterol and triglyceride levels and raise levels of HDL (good) cholesterol in people with atherosclerosis—but this has not been consistently found to translate into lower risk for heart attack or stroke. In fact, a new study raises the possibility that excess niacin from supplements may actually increase risk for cardiovascular disease.

High doses can lead to flushing (a temporary reddening of the skin). Thirty milligrams or more of nicotinic acid a day can lead to red, burning, tingling, itchy skin on your face, arms, and chest and cause headaches, rashes, and dizziness.

Pantothenic acid (vitamin B5).

There is little evidence to support the claims made for pantothenic acid supplements. Little is known about the long term effects of high dose pantothenic acid supplementation.

Riboflavin (vitamin B2).

Some healthcare providers recommend riboflavin supplements (at around 400 mg a day) for preventing migraines, although not all studies agree this is helpful. Keep in mind that your body can’t absorb more than about 27 mg of riboflavin at a time, so higher doses of supplements will just be excreted. Adverse effects from riboflavin supplementation are rare.

Thiamin (vitamin B1).

Thiamin supplementation is being studied for Alzheimer’s diseases, heart failure, type 1 and 2 diabetes, and thiamin deficiency in people with alcohol use disorder, but no benefits have been proven. Flushing, hives, itching, weakness, sweating, nausea, and restlessness have been reported with high dose thiamin supplementation.

While most people in the U.S. already get all the vitamins they need from dietary intake, making healthy choices (a variety of plants along with seafood, fat free and low-fat dairy, plant oils, and some eggs, lean meats, and poultry) is the best way to meet all your vitamin needs. It’s practically impossible to get harmful levels of any one nutrient from dietary intake alone!

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Medicare’s coverage for colonoscopies is a little complicated. One thing that has recently changed is coverage for the type of colonoscopy you reference. Up until the end of 2022, follow-up colonoscopy procedures after a positive result from a stool-based screening test were deemed diagnostic as opposed to screening, and there was a copay. However, since January 2023, Medicare has categorized these followup colonoscopies as a continuation of the screening protocol. This means there is no copay—but there is an important caveat. If polyps (the abnormal growths that can develop into colorectal cancer) are detected and removed during the follow-up colonoscopy, then it reverts to being a diagnostic test for billing purposes, and there is a 15 percent copay. From 2027 to 2029 this cost-share will reduce to 10 percent, and by 2030 it will be covered 100 percent by Medicare.

Studies have suggested that only about half of people who have a positive result from a stool-based test go on to get a follow-up colonoscopy, and it’s possible that the copay may have contributed to this low uptake. Hopefully the incremental reduction in the copay will encourage people to get this important procedure if a stool-based test finds cause for concern.

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

I recently had a computed tomography scan due to stomach symptoms. Ahead of seeing my doctor, I looked at the results summary on my patient portal. They note something called “pericardial effusion.” What is this?

Pericardial effusion is a buildup of fluid in the pericardium (the sac that surrounds the heart). The fluid provides a protective cushion for the heart muscle, but in some circumstances it may increase. Often the buildup is minor and asymptomatic, and treatment may not be needed. But if the fluid increases too much, it can prevent the heart from expanding properly as its chambers fill with blood. This type of buildup is very unusual, so try not to worry while you wait to see your doctor. He or she will be able to shed light on how serious the effusion is, whether any further testing is needed, and what can be done to monitor or address the condition. In the meantime, certain symptoms—including chest pain and/or pressure, shortness of breath, a rapid heart rate, dizziness, and fainting—warrant calling 911.

Bruce J. Darrow, MD, PhD

Cardiology

While undergoing treatment for an enlarged prostate, I was diagnosed with bladder cancer. Can you tell me more about this cancer?

Some of the symptoms that can accompany an enlarged prostate—for example, frequent urination, weak urine flow, and blood in the urine—also can signal bladder cancer. This cancer may be detected during a prostate procedure. It isn’t clear why the cancer develops, but it is more likely to occur in older men, smokers, people who have had radiation treatment or used certain chemotherapy drugs, and those who have worked in careers that exposed them to chemicals.

Initial treatment for bladder cancer typically involves removing the tumor via a surgical procedure or by using an electrical current to burn away the tumor. Further treatment decisions are defined by the grade of the cancer (how aggressive the cells look under the microscope) and the stage of the cancer (how deeply it invades into the bladder wall). Before you make any decisions about further treatment, have a discussion with your doctor about how well you are likely to tolerate it. Options that may be recommended include having additional medication instilled directly into the bladder, and bladder removal surgery or radiation therapy (often along with chemotherapy) if the cancer has penetrated deeper into layers of the muscle wall. Your doctor also may recommend immunotherapy (drugs that help the immune system recognize and destroy cancer cells) or targeted therapy (drugs that target the genetic changes that cause cells to become cancerous).

Matthew Galsky, MD

Oncology

The post Ask the Experts: Medicare and Follow-Up Colonoscopy; Pericardial Effusion; Bladder Cancer appeared first on University Health News.

Start with Self-Help

If your heartburn isn’t too frequent or severe, you may find that self-help measures (see What You Can Do), relieve the symptoms. However, if you’re still experiencing mild intermittent heartburn, OTC antacids could make a difference. Examples include Tums®, Rolaids®, Maalox®, and Gaviscon®. All of them start working rapidly, but the effects typically wear off after a couple of hours. “Keep in mind that overusing OTC antacids can result in side effects, such as diarrhea and constipation,” Dr. Shah cautions.

Next Steps

Severe, frequent heartburn can result in potentially serious

complications because stomach acid is highly corrosive. “In fact, it’s only slightly less powerful than battery acid,” Dr. Shah notes. “Your stomach can handle this because it is lined by cells that produce a protective mucus barrier. Your esophagus does not have these cells, and constant exposure to stomach acid can lead to inflammation and the development of abnormal esophageal cells that may become cancerous.” If you are at risk for these complications, your doctor may recommend you take an H2 blocker or a PPI, both of which inhibit the production of stomach acid.

• H2 Blockers These include famotidine (Pepcid® AC), cimetidine (Tagamet® HB), and nizatidine (Axid® AR). They inhibit the action of histamine 2, a chemical that signals cells in the lining of the stomach to produce acid. H2 blockers work faster than PPIs (usually within an hour), but the effects don’t last as long. Side effects are rare, but may include headaches, dizziness, confusion, a rash, and/or diarrhea. Tell your doctor if you need to take an OTC H2 blocker more than three times a week to control your symptoms, since it’s possible you may need a prescription-strength H2 blocker or a PPI.

• PPIs include Omeprazole (Prilosec®) Esomeprazole (Nexium®), and lansoprazole (Prevacid®). PPIs work by blocking an enzyme needed for producing acid in the stomach. They can cause minor side effects, such as nausea, headaches, constipation, and diarrhea. More serious side effects are rare, but tell your doctor if you develop a rash, have difficulty breathing or swallowing, become dizzy, or experience a rapid heart rate or uncontrollable shaking.

OTC PPIs are designed to treat occasional heartburn and shouldn’t be used for longer than 14 days. “Overall, PPIs have a good safety profile,” Dr. Shah says. “However, some studies have suggested that people who take PPIs every day on a long-term basis have a greater risk of fractures, kidney failure, stroke, and infection with Clostridium difficile, a bacterium that can cause nausea, vomiting, diarrhea, and other potentially serious symptoms.” He adds that the studies in question were observational studies, meaning that it’s possible other factors may have influenced the risk, but recommends you alert your doctor if you find that you need to take these drugs for longer than a two-week period.

Dementia Link

As to the recent data pointing to a greater risk of dementia in people taking PPIs (Neurology, Oct. 31, 2023), this also was an association and not cause-and-effect. The increase in dementia risk was seen in a small number of the study participants (58 of the 497 who took PPIs for more than 4.4 years developed dementia). A study published in the September 2023 issue of Gastroenterology found no link between dementia and use of either PPIs or H2 blockers.

Some experts speculate that if there is a link between PPIs and dementia, it may be connected to the fact the drugs interfere with brain enzymes that regulate the buildup of a protein called amyloid in the brain. An abnormal form of amyloid is thought to contribute to dementia in older age. “But it also is possible that factors common to both GERD and dementia— including eating an unhealthy diet, lack of exercise, poor sleep, comorbidities, and the use of multiple medications—influenced the data,” Dr. Shah concludes.

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While the risk of falls may increase with age due to factors such as changes in balance, vision, and muscle strength, frequent falls are not considered a normal or inevitable part of the aging process.

Here are some common factors that could contribute to frequent falls in older adults:

Balance and Gait Issues: Changes in balance and walking patterns can occur with age. Conditions such as muscle weakness, joint problems, or neurological issues may affect your ability to maintain balance.

Vision Problems: Poor vision or eye conditions, such as cataracts or glaucoma, can increase the risk of falls. Regular eye checkups are important for identifying and addressing vision issues.

Medications: Some medications cause dizziness, lightheadedness, or other side effects that can contribute to falls.

Foot Problems: Issues with your feet, such as pain, numbness, or poor footwear, can affect balance and increase the risk of falling.

Neurological Issues: Conditions such as peripheral neuropathy or Parkinson’s disease may affect coordination and balance.

Environmental Factors: Clutter, uneven flooring, and poor lighting in your home can contribute to falls. Making your living environment safer can help prevent accidents.

Dehydration: Not getting enough fluids can lead to dizziness and weakness, increasing the risk of falls.

Lack of Physical Activity: Insufficient physical activity can lead to muscle weakness and reduced flexibility, making it more challenging to maintain balance.

Schedule an appointment with a physician for a thorough physical assessment. Taking proactive steps to address the underlying causes of your symptoms can help improve your safety and quality of life.

I’ve heard about blood tests that can detect cancer before symptoms appear. Should I get tested?

There are around 20 multi-cancer early detection (MCED) tests in development, and at least two that are available—though not yet approved by the FDA—including the Galleri test (GRAIL) and the OneTest (2020 Gene Systems). There are pros and cons associated with these tests. One of the biggest advantages is that it is possible for cancer to be detected early, and when cancer is found early, it’s often easier to treat and has a higher chance of being cured. If you have a family history of a specific type of cancer, the option to be tested can offer peace of mind, by either determining that no cancer is detected or by catching a potential problem early. Another benefit associated with these early detection tests is that if the test shows that you have cancer, it can help your doctors plan the best treatment for you because knowing the type and stage of cancer is crucial for creating an effective plan.

Some of the cons associated with these tests include false positive and false negative results. Sometimes, the test might show that you have cancer when you actually don’t. This can be stressful and lead to unnecessary treatments and diagnostic tests. On the other hand, the test may not detect cancer even if it’s there. This can give a false sense of security, delaying the start of necessary treatment. MCED tests do not detect all cancers or measure your genetic risk of developing cancer in the future. Specialists say these new blood tests should be used in addition to, not in place of, other cancer-screening tests recommended by your physicians. Ultimately, the decision of whether to have your blood tested for the presence of cancer is one that should be made in conjunction with your doctors based on your medical history and individual circumstances.

The post Ask Dr. Etingin: Falling; Blood Tests appeared first on University Health News.

A person whose blood pressure is usually normal has an appointment at a clinic or medical center. There is a bit of anxiety about the visit. Anxiety elevates blood pressure, and having it checked is a routine procedure.

Blood pressure is taken by a physician or other provider who often wears a white coat that symbolizes medical professionalism. The reading is higher than it normally would be when not in a clinical setting. The presumed result: white coat syndrome.

Until recently, white coat syndrome had been considered a temporary spike—no harm, no foul. But not anymore.

Real—Dangerous for Some

White coat syndrome/hypertension was first described more than 40 years ago. Since then, multiple studies have confirmed that it’s a real thing. The original scenario is the same—anxiety can elevate blood pressure in a clinical setting. But current research suggests that white coat syndrome may also be a symptom of something more concerning.

In February 2022, a review of studies in the journal Hypertension became the first to provide evidence that white coat syndrome in patients (with no previous organ damage) had an increased risk of mortality, new hypertension, and new organ damage. This study and others have resulted in a decidedly different approach to white coat syndrome diagnosis and treatment. (https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.121.18792)

Blood Pressure—How High is Too High?

To be clear, white coat hypertension for most people is still a one-time event that needs attention only in combination with other cardiovascular conditions. According to Cleveland Clinic and other medical centers, the syndrome affects 15-30 percent of people who already have high blood pressure. Patients who don’t normally have high blood pressure can also have the syndrome. (https://my.clevelandclinic.org/health/diseases/23989-white-coat-syndrome)

The definition of high blood pressure has been a moving target and remains a number that your physician determines is right for you. The American Heart Association defines “normal” as less than 120 for the upper (systolic) number; less than 80 for the bottom (diastolic) number. “Elevated” is 120-129 over 79 or less. For numbers defining three advanced stages of hypertension, go to https://www.heart.org/en/health-topics/high-blood-pressure.

The definition of normal can change, depending on a person’s age and health conditions. The AHA’s guideline for those 65 and older is lower than 130/80.  Normal for patients over the age of 80 may be higher.

Diagnosis— Multiple Readings

Diagnosis of white coat syndrome requires at least three separate blood pressure readings at a clinic, as well as elevated numbers when checked at home. Home blood pressure kits and regular checks are a good idea, regardless of the white coat issue.

When you take your blood pressure (BP) at home, follow these CDC guidelines: 1) nothing to eat or drink 30 minutes before taking BP; 2) empty bladder; 3) feet flat on the floor, legs uncrossed; 4) arm resting on a surface, chest high; 5) cuff snugly against bare skin, not over clothing; 6) no talking; 7) same time every day; 8) at least two readings, 1-2 minutes apart. (https://universityhealthnews.com/daily/heart-health/how-to-get-an-accurate-blood-pressure-reading/)

Treatment—Lifestyle Changes, Medications

If blood pressure is found to be slightly elevated—your doctor makes that call—you may be asked to consider lifestyle changes. You’ve heard them; all easier said than done. Here’s a review:

• Lose weight.
• Sit less, exercise more.
• Eat more fruits and vegetables, less red meat and processed foods.
• Limit daily salt intake to 2300 mg.
• Don’t smoke.
• Work on managing stress. (https://universityhealthnews.com/daily/stress-anxiety/how-to-deal-with-stress/)

If your blood pressure is more than slightly elevated, your doctor may prescribe medications to lower it. Examples are diuretics, alpha- and beta-blockers, ACE inhibitors, and calcium blockers. The Hypertension study mentioned earlier also found that patients with white coat syndrome who take medications to control blood pressure don’t have elevated risks of cardiovascular disease.

Antihypertensive drugs carry risks, mostly mild, for some patients. Ask your doctor about medications that might lower your blood pressure too much. Hypotension, as it’s called, could cause dizziness, lightheadedness, passing out, weakness, nausea, and other symptoms.

How low is too low? The National Library of Medicine says that while there is no universally-accepted standard, blood pressure readings under 90/60 indicate hypotension.

White Coat Syndrome—Answers and Actions

It’s real—well documented. It can be dangerous for some, leading to a variety of conditions that require medical intervention. High blood pressure, whether conventional or white coat, is treatable. It starts with lifestyle changes, and for more serious cases, advances to effective and safe antihypertensive medications.

Don’t dismiss white coat hypertension if it shows up at your next doctor’s appointment. Have it checked or regularly check it yourself.

Other Helpful Links from University Health News

https://universityhealthnews.com/daily/heart-health/uhn-blog-whats-the-right-blood-pressure-for-you-it-depends/

https://universityhealthnews.com/daily/heart-health/is-the-blood-pressure-reading-from-your-doctors-visit-accurate/

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When these sensations come on suddenly, you might first think you’re having a heart attack. But for millions of people, those are symp­toms of a panic attack, an event experienced by about one in 10 adults at some point in their lives.

If you’ve never had a panic attack, the first time you do can be alarming and may fill you with questions. How long will it last? Will I have more of these? Does this indicate a mental health problem?

Nicole LeBlanc, PhD, a clinical psychologist with Massachusetts General Hospital’s Center for Anxi­ety and Traumatic Stress Disorders, says that one way to think about a panic attack is that it’s “a sudden onset of the body’s fight or flight response.”

It’s not always clear what causes a panic attack, though genetics and changes in certain brain functions may play a role. Likewise, a buildup of stress or having a temperament that tends to become overwhelmed by stress or negative feelings may also raise your risk of having a panic attack.

“A panic attack is a sudden, intense surge of fear that comes on quickly and peaks within a few minutes,” Dr. LeBlanc explains, adding that a panic attack is usually accompanied by physical symptoms of fear such as heart pounding, sweating, shortness of breath, feel­ing of choking, nausea, dizziness, chills or hot flashes, and numbness or tingling. Things around you also may seem strange or unreal.

Panic Attack or Heart Attack?

Given the nature of a panic attack’s symptoms, their onset may have you thinking you’re having a heart attack or that some other medical condition has developed unrelated to anxiety or fear. Dr. LeBlanc notes that there are indeed many medical conditions with symp­toms similar to those associated with panic attacks.

“For example, hyperthyroidism, seizure disorders, and cardiac condi­tions can all cause symptoms that look like a panic attack,” she says. “If a person has had a panic attack, they should see their doctor, who will order tests to assess for a medical cause for the symptoms. Once a medical cause has been ruled out, a person can be diagnosed with a panic attack.”

Unlike a panic attack, heart attack symptoms tend to last and even worsen until you are treated. They also may come and go, while panic attack symp­toms usually last for a short, finite amount of time (often about 20 minutes or less) without lingering or returning within minutes after they fade.

And while a heart attack frequently brings on severe chest pain, a panic attack may or may not cause chest pain. When chest pain is present during a panic attack, it’s often described as a sharp or shooting pain. Chest pain associ­ated with a heart attack, however, often feels like intense pressure or squeezing of the heart. Heart attack symptoms also may, but not always, include pain in the arms, neck, back, or jaw. Pain in these areas is less common during a panic attack.

It’s also worth noting that a panic attack shares some of the same characteristics as an anxiety attack, but they are two different events. Common features include worry and fear, as well as physical symptoms such as a racing heart, shortness of breath, and, in many cases, dizziness or lightheadedness.

But anxiety and panic attacks differ in some important ways. While a panic attack can erupt suddenly and without any warn­ing, an anxiety attack tends to build gradually, allowing you to become aware that your stress or fear is bringing on physical symp­toms. Panic attacks may or may not have an obvious or definable trigger, but anxiety attacks can usually be traced to a particular stressor. Finally, panic attacks typ­ically resolve in a matter of min­utes. An anxiety attack may last for hours, days, or weeks.

Do You Have Panic Disorder?

If you have occasional panic attacks, you may learn to recog­nize their symptoms early on, so you’ll have a good idea of what’s happening. But having more than one panic attack may stir up other health concerns. Namely, you may wonder if you have panic disorder.

“Many people will experience one or more panic attacks in their lives,” Dr. LeBlanc says. “Having a panic attack does not mean that a person has panic disorder. A person has panic disorder if they have panic attacks and start to worry so much about the panic attacks that it interferes with their life. For example, a person with panic disorder might worry that having a panic attack means they racing heart, sometimes accompanied by chest pain, is a common symptom of a panic attack.

are going crazy, so they start to avoid situations that they think could trigger panic attacks, like going into crowded places.”

When a Panic Attack Occurs

If you sense that you’re having a panic attack, or if you know one is coming on because you’ve experi­enced one or more attacks previ­ously, the best advice is to let it run its course. “Trying to stop or fight off a panic attack usually makes it worse,” Dr. LeBlanc says. “Instead, a person can think about ‘riding the wave’ of their panic attack until it passes on its own.”

She adds that if a person knows they have panic attacks (and not a medical condition), they can cope with the discomfort of an attack by reminding themselves that the attacks aren’t dangerous and are usually short-lived.

Treatment is available for panic attacks, but it’s not always necessary, r. LeBlanc says. “If a person expe­riences occasional panic attacks that do not bother them too much, they likely don’t need treatment,” she says. “However, if a person is both­ered by their panic attacks, there are very effective treatments that can help. One of the most effective treatments for panic disorder is called cognitive behavioral therapy. In cognitive behavioral therapy, patients learn skills to cope with panic attacks in the moment when they occur. A medical doctor can also prescribe medications that can help with panic attacks.”

If you have had one or more panic attacks, or you’re not sure if a recent event was a panic attack, talk with your doctor. If you find your­self occasionally or frequently feel­ing overwhelmed by stress or fear, talk with a mental health profes­sional soon.

The post How to Recognize and Respond to a Panic Attack appeared first on University Health News.

Regardless of the scenario, it’s essential to understand that age-related changes can significantly impact how your body reacts to medications. For example, people with longstanding chronic conditions might not need the same dosage. There may also be newer and better options to try.

Physiological Changes

In our later decades, our bodies undergo various physiological changes that can affect how medications are processed. For example, liver and kidney function gradually become less efficient. These organs play a crucial role in metabolizing and eliminating medications, vitamins, and other supplements. Our fat-to-muscle ratio also changes with age, which can increase blood concentration levels of drugs and supplements.

As a result, these substances may be processed more slowly in older adults, leading to excess accumulation over time. Here’s a common example. “Medications for blood pressure, such as hydrochlorothiazide and atenolol, may need dose adjustments based on a person’s kidney function,” explains, Grace Cheng, PharmD, UCLA Clinical Pharmacist. “People taking these medications also may be at higher risk of side effects such as dizziness, drowsiness, and falls.” In some cases, changing the medication and/or when it is taken can be of benefit.”

Polypharmacy, a Common Challenge

One of the most common medication challenges is managing the sheer number of daily medications a person takes. A key cause of this is when a person receives prescriptions from multiple specialists. The term polypharmacy describes the practice of taking multiple medications simultaneously, typically when an individual is prescribed or uses more medications than is clinically necessary or appropriate. The concept includes the use of numerous prescription drugs as well as over-the-counter (OTC) medications, vitamins, and supplements. All these substances combine and may interact with each other and not always in your favor.

While some level of polypharmacy may be necessary for some people, it can increase the risk of adverse drug interactions, side effects, medication errors, and other complications. Dr. Cheng describes this typical scenario that can lead to polypharmacy. “Medications may be added to treat the side effects of another medication, leading to more and more medications,” she explains. “My recommendation is to keep an open communication with your providers regarding your concerns about the medications and supplements that you may take.”

Tips for Better Med Management

One useful strategy in managing multiple medications is having all your prescriptions filled at the same pharmacy. That makes it easy to get a complete list of all medications. Some pharmacists may be willing to review your medications and alert you to any potential concerns. Ask what’s possible.

Keeping your primary care physician aware of all your prescriptions is also important. Given the limited time most physicians have allotted for each patient, consider making an appointment with your primary care physician specifically to discuss your medications. Take your supplement and prescription bottles with you so your provider can easily see the details of each. Express your concerns about any medications you believe may not be suitable for you, and ask about potential alternatives or adjustments. Discuss any side effects, especially when starting new medications. Perhaps there might be an alternative medication or even a nondrug treatment you can try. Be honest about not taking medications as prescribed, and let your provider know why.

The Role of the BEERS List

The BEERS criteria, developed by the American Geriatrics Society, is a list of medications that are considered potentially inappropriate for older patients. The list was updated in 2023 (https://tinyurl.com/BeersList2023). The medications on the list may pose a higher risk of adverse events and may outweigh the potential benefits in older adults. However, note that these medications are labeled as “potentially” inappropriate. “Please do not discontinue the medications abruptly until you can speak with your providers,” advises Dr. Cheng. “There are instances when these medications can be used cautiously even in older patients, but a care plan should be discussed with the patient, caregivers, and providers, with close monitoring parameters.”

Understanding metabolic changes and nuances of medication management as you age are essential. Staying aware and engaged in your medical care can enhance your overall well-being for years to come.

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A: Iron deficiency anemia is a fairly common type of anemia in which the blood contains insufficient amounts of healthy red blood cells, which are responsible for carrying oxygen to tissues throughout the body. This condition results from an inadequate or insufficient amount of iron. When iron is lacking, the body cannot produce enough of a compound in red blood cells that would allow them to adequately carry oxygen (hemoglobin). Iron deficiency anemia may start on the mild side and may even go unnoticed for a while. However, as this condition continues and iron levels drop further and anemia worsens, symptoms and signs may become more notable. These symptoms may include: weakness, cold hands and feet, brittle nails, pale skin, intense fatigue, poor appetite, chest pain, rapid heartbeat, or shortness or breath, headache, dizziness, lightheadedness, and more. If you suspect iron deficiency anemia, be sure to discuss your concerns with your physician or health care provider to receive guidance on steps to take to counter this insufficiency-related anemia in a safe and controlled manner.

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