Four kinds of athletic pains, not to ignore.....adults or kids!

Schools and colleges have just opened again and the kids have started to practice and play various sports. As they will play, they will fall often, get up and continue but some injuries will be not as trivial. Contrary to popular belief most of us parents actually tend to 'under-react' as long the child says he or she is 'ok"? Most of the times thats usually the case and with ice, a couple of days of rest and some OTC painkillers kids jump back to normal and we all happily forget about the injures.

I thought this will be a good time to write a short blog about the sign and symptoms of sports injuries which we just should not ignore. A quick visit to the local urgent care if not the ER is indeed needed to make sure that the  injury is minor and not something serious. Urgent care visit will make sure that all is really 'ok" and you can still be sure of the homework been done that night.

Athletes really can tolerate more pain than the average person, so we have to take into the account the signs that come with the normal complaints of pain. The tricky part here is to decode the symptoms. Here are four signs you shouldn’t ignore while dealing with an injured athlete at home or even after a minor play ground incident in younger children.

1: Sharp, stabbing, shooting pain.

The mundane muscle and ligament injuries generally will not last more than a few days and will more be of a nagging soreness in nature than sharp localized pain. Soreness is not be be worried about but the localized pain, the kind that can be 'pin-pointed' to a specific part of the body and is persistent for more than 24 hours is to be worried about! Joint injuries as in the ankle where the range of motion is restricted and/or painful may be an issue. If the shoulder cannot be raised beyond a certain point will generally mean bigger issue than the simple muscle soreness. Sharp pains can be signs of everything from muscle spasms to strains or tears. It may even be a fracture and will not even show up on an X-ray done right away due to swelling and a repeat x-ray may be needed to confirm the doubt. So do not ignore any sharp pain in a joint at all. Most of the times you cannot weight-bear if there is a fracture but then some muscle injures can cause non weight bearing too and its best for a doctor to check it out.

2: Swelling

If a joint in question is visibly bigger than the other and even if its not an excruciating pain, swelling is a sign that something’s wrong. Pain depends on whether or not the muscle tear is complete—when it is, you can sometimes feel less pain, A ligament tear like an ACL usually causes swelling within hours of an injury. The area will be discolored and swelling will look like a tennis ball. A joint fracture like I mentioned is easy to notice as the pain will be immense and the joint will 'limp over' and will NOT weight bear or be able to lift up at all. Go to the ER or urgent care quickly.

3: Lightheadedness
“Hypoglycemia or low blood sugar" in college athletes sometimes very common when they try to do a heavy workout early in the morning without enough carbohydrates in their system. Low blood sugar can leave them feeling dizzy and lightheaded. It can lead to fainting and might end up in falling over. Taking rest and ingesting some sugar should help right away but more than fainting I will get worried about the resultant injury from the actual fall. Athletes need to have healthy carbs in the system especially before a long training session. Lots of clear fluids in the system will help keep the heat stroke away too.

4: Head injury, which gives a feeling of "not being well"

“Don’t put yourself at risk to take another blow to your head until you’ve recovered from the previous one,” says Allen Sills, M.D., professor of Neurological Surgery, Vanderbilt University. “Minor injuries add up to catastrophic ones.” I think these are some very wise statements and older kids generally boys don't tend to adhere to these advices. With a recent head injury of any kind, even a minor head bump which is not a full blown 'blow to the head' causing dizziness, sensitivity to light or noise, or fogginess, and/or throwing up should never be ignored and a visit to ER or even a 911 call would not be an over-reaction. It can be a precursor to a major head injury and can even be fatal. There are many studies that have proved that repeated head injuries can cause decreased mental function over time.

In conclusion if there is even a one percent chance that the injury is more than minor, it needs to be checked out by a Doctor and a few hours in the waiting rooms are well worth it. As usual email me for any further clarifications or questions.

~Dr V.

References:
images: www.healthofchildren.com

Raw meat eating, proper cooking, storing of food and the related food borne diseases.

I know a lot of people who like to eat their steaks raw and bloody and some also like to eat other meat dishes like Crudos. Many like fish (sushi) and oysters raw! In my opinion human race evolved eating meat as the primary source of nutrition and our system is apt to eating meat raw as in the prehistoric times food handling and cooking practices may have been questionable? Regardless to the debate about evolution and meat eating habits of humans or if some even count fish as "meat" I will elaborate on the diseases we can get by eating any meat raw. As in any other instance the human body can resist a lot of infections and not everyone eating raw meat will get sick or even have the symptoms but the perils are perpetual and imminent. I will also touch upon the food handling and food storing habits which can reduce many infections. 

Food when cooked and left out for just even more than 2 hours at room temperature, bacteria can multiply quickly. Most colonies of bacteria grow undetected because they don't produce a bad odor or change the color or texture of the food. While freezing the food can slow or stop bacteria's growth but it does not completely destroy the bacteria. The microbes can become reactivated when the food is thawed and reheated.

The risk of disease from ingesting infectious pathogens found in raw meat is significantly higher than cooked meat, although they both can be contaminated. Meat can be incorrectly or insufficiently cooked, allowing disease-carrying pathogens to be ingested. Also, meat can be contaminated during the production process at any time, from the slicing of prepared meats to cross-contamination of food in a refrigerator. Most food borne infections are undiagnosed and unreported, though CDC estimates that every year about 80 million people in the US become sick and about nine thousand die due to food borne illness.

The following are some of the sources, symptoms and pathogens of common food borne illnesses. 

Sources of illness: Raw and undercooked meat and poultry
Symptoms: Abdominal pain, diarrhea, nausea, and vomiting
Bacteria: Campylobacter jejuni, E. coli O157:H7, L. monocytogenes, Salmonella

Sources of illness: Raw foods; unpasteurized milk and dairy products, such as soft cheeses
Symptoms: Nausea, vomiting, fever, abdominal cramps, and diarrhea
Bacteria: L. monocytogenes, Salmonella, Shigella, Staphylococcus aureus, C. jejuni

Sources of illness: Raw and undercooked eggs. Raw eggs are often used in foods such as homemade hollandaise sauce, caesar and other salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings.
Symptoms: Nausea, vomiting, fever, abdominal cramps, and diarrhea
Bacterium: Salmonella enteriditis

Sources of illness: Raw and undercooked shellfish
Symptoms: Chills, fever, and collapse
Bacteria: Vibrio vulnificus, Vibrio parahaemolyticus

Sources of illness: Improperly canned goods; smoked or salted fish
Symptoms: Double vision, inability to swallow, difficulty speaking, and inability to breathe. These things are serious and I would go to ER right away!
Bacterium: C. botulinum

Sources of illness: Fresh or minimally processed produce; contaminated water
Symptoms: Bloody diarrhea, nausea, and vomiting
Bacteria: E. coli O157:H7, L. monocytogenes, Salmonella, Shigella, Yersinia enterocolitica, viruses, and parasites

You may have to be worried and go see a doctor right away if any of the following symptoms occur with diarrhea:

• High fever—temperature over 102.
• Blood in the stools.
• Diarrhea that lasts more than 3-4 days.
• Prolonged vomiting that prevents keeping liquid down.
• Signs of severe dehydration, such as dry mouth, sticky saliva, decreased urination, dizziness, fatigue, sunken eyes, low blood pressure, or increased heart rate and breathing rate.
• Signs of shock, such as weak or rapid pulse or shallow breathing.
• Confusion or difficulty reasoning.

Most cases of foodborne illnesses can be prevented through proper cooking or processing of food, which kills most of the bacteria. In addition, because bacteria multiply rapidly between 40°F and 140°F, food must be kept out of this temperature range.

I will point out some tips to keep the food from going bad and become a risk to health...

• Refrigerate foods promptly. If prepared food stands at room temperature for more than 2 hours, it may not be safe to eat. It does apply to the left over pizza on the bedside table and eating it for breakfast as done regularly in dorm rooms! Set your refrigerator at 40°F or lower and your freezer at 0°F.
• Cook food to the appropriate internal temperature—145°F for roasts, steaks, and chops of beef, veal, and lamb; 160°F for pork, ground veal, and ground beef; 165°F for ground poultry; and 180°F for whole poultry. Use a meat thermometer to be sure. Foods are properly cooked only when they are heated long enough and at a high enough temperature to kill the harmful bacteria that cause illnesses.
• Prevent cross-contamination. Bacteria can spread from one food product to another throughout the kitchen and can get onto cutting boards, knives, sponges, and countertops. Keep raw meat, poultry, seafood, and their juices away from all ready-to-eat foods.
  
  
  
• Make sure to wash your hands for at least 20 seconds with warm, soapy water before and after handling raw meat, poultry, fish, shellfish, produce, or eggs. 
• Wash utensils and surfaces before and after use with hot, soapy water and sanitize them with diluted bleach. 
• Keep cold food cold and hot food hot. (This is actually a really good tip, I have found in my research). 
• Maintain hot cooked food at 140°F or higher.
• Reheat cooked food to at least 165°F.
• Refrigerate or freeze perishables, produce, prepared food, and leftovers within 2 hours.
• Never defrost food on the kitchen counter. Use the refrigerator, cold running water, or the microwave oven.
• Never let food marinate at room temperature—refrigerate it.
• Divide large amounts of leftovers into small, shallow containers for quick cooling in the refrigerator.
• Remove the stuffing from poultry and other meats immediately and refrigerate it in a separate container.
• Wash all unpackaged fruits and vegetables under running water just before eating, cutting, or cooking. Scrub firm produce such as melons and cucumbers with a clean produce brush. Dry all produce with a paper towel to further reduce any possible bacteria.
• Do not pack the refrigerator. Cool air must circulate to keep food safe. 

  
  

  So what does all this really mean as far as "eating meat raw or bloody"? I personally like my steak medium-well done and even butter flied (it makes it easier to get it thoroughly cooked) and I am not a big sushi fan but that's just me. I will leave it to the readers and their own personal taste preferences but as I mentioned the risks are real and its better to take precautions proactively. Once ingested there is nothing much which can be done to prevent an infection till you have the symptoms and some times we can be late to react and seek treatment. So its best to keep the above mentioned symptoms in mind and act quickly if they get you worried.
  
  ~ Dr V.
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    References

    Ahn, D. U., Jo, C., Olson, D.G. “Analysis of volatile components and the sensory characteristics of irradiated raw pork.” Meat Science 54.3 (2000): 209-215. Print.

    Altekruse, Sean F. DVM. “A multi-state survey of consumer food-handling and food-consumption practices.” American Journal of Preventive Medicine 16.3 (1999): 216-221. Print.

    Altekruse, S. F. et al. “Vibrio Gastroenteritis in the US Gulf of Mexico Region: The Role of Raw Oysters.” Epidemiology and Infection 124.3 (2000): 489-495. Cambridge University Press. Print.

    Bestor, Theodore C. “Supply-Side Sushi: Commodity, Market, and the Global City.” American Anthropologist 103.1 (2001): 76-95. Blackwell Publishing on behalf of the American Anthroplogical Association. Print. Stable URL: http://www.jstor.org/stable/683923

    Duffy, Geraldine et al. “A review of quantitative microbial risk assessment in the management of Escherichia coli O157:H7 on beef.” Meat Science 74.1 (2006): 76-88. Print.

    Hulebak, K.L.; Schlosser,W. “HACCP History and Conceptual Overview.” Risk Analysis. 2002. Vol 22. Pgs 547-552. Print.

    Ingham, Steven C., Losinski, Jill A., Becker, Katie L. “Growth of Escherichia coli O157:H7 and Salmonella Serovars on Raw Beef, Pork, Chicken, Bratwurst and Cured Corned Beef: Implications for HACCP Plan Critical Limits.” Journal of Food Safety 24.4 (2004): 246-256. Print.

    Jalali, Mohammad et al. “Prevalence of Salmonella Spp. in Raw and Cooked Foods in Isfahan-Iran.” Journal of Food Safety 28.3 (2008): 442-452. Print.

    Kegode, Redempta B. et al. “Occurrence Of Campylobacter species, Salmonella species and Generic Escherichia coli in Meat Products from Retail Outlets in the Fargo Metropolitan Area.” Journal of Food Safety 28.1 (2008): 111-125. Print.

    Li Y., Zhuang S., Mustapha A. “Application of a multiplex PCR for the simultaneous detection of Escherichia coli O157:H7, Salmonella and Shigella in raw and ready-to-eat meat products.” Meat Science 71.2 (2005): 402-406. Print.

    Myint, M.S. et al. “The effect of pre-enrichment protocol on the sensitivity and specificity of PCR for detection of naturally contaminated Salmonella in raw poultry compared to conventional culture.” Food Microbiology 23.6 (2006): 599-604. Print. Sammarco, M.L., Ripabelli G., Grasso, G.M. “Consumer Attitude and Awareness towards Food-relate Hygienic Hazards.” Journal of Food Safety 17.4 (1997): 215-221. Print.

    Scanga, J.A et al. “Microbiological contamination of raw beef trimmings and ground beef.” Meat Science 56.2 (2000):145-152. Print.

    Smil, Vaclav. “Eating Meat: Evolution, Patterns, and Consequences. Population and Development Review 28.4 (2002): 599-639. Print.

    Tebbutt, G.M. “An Evaluation of Various Working Practices in Shops Selling Raw and Cooked Meats.” The Journal of Hygiene 97.1 (1986): 81-90. Cambridge University Press. Print. Stable URL:http://www.jstor.org/stable/3863214

    Wallace, Barbara J. MD et al. “Seafood-associated disease outbreaks in New York, 1980–1994.” American Journal of Preventive Medicine 17.1 (1999): 48-54. Print.

Our mouth..a portal to a healthy body!

Just as any other body part our mouth also has millions of bacteria, a wide majority harmless and much needed. Then some of the harmful bacteria which can grow out of control and cause oral infections, tooth decay and gum disease etc. Generally the body's natural defenses and good oral health care, such as daily brushing and flossing, can keep most of these bacteria under control. Many dental procedures, medications, reduced saliva flow can disrupt the normal balance of bacteria in the mouth or even breach the mouth's normal protective barriers and enter the bloodstream.

Once in the blood steam these bacteria can have profound effect on the general health such as........

• Endocarditis is a Gum disease and various dental procedures that can cut your gums may allow bacteria to enter  the bloodstream. Along with a weak immune system or a damaged heart valve, this can cause infection in the body such as an infection of the inner lining of the heart (endocarditis). That is some serious trouble and can casue fatality.

• Cardiovascular disease due to clogged arteries can lead to stroke possibly due to chronic inflammation from periodontitis which is a severe form of gum disease.

• Pregnancy and birth. Gum diseases has also been linked to premature birth and low birth weight.

• Diabetes generally reduces the body's resistance to infection and can put the gums at risk. People who have inadequate blood sugar control may develop more frequent and severe infections of the gums and result in increased teeth loss in many people.

• Osteoporosis is a condition which causes bones to become weak and brittle and it may be associated with periodontal bone loss and tooth loss.

• Erectile dysfunction in men is a very real problem with people who have poor oral health.

All these big issues but its so simple to keep it under control as long as we follow a few of these steps daily....


Brush your teeth at least twice a day and if night brushing is somehow not possible at least gargle before bed. It will clear some amount of leftover stale food from the mouth.

• Replace the toothbrush every three to four months this a very important step and most of us are just not aware of the consequences.

• Floss daily at least once. Always brush after flossing so the small particles are washed away and do not stay in the mouth, I have seen a lot of people just dry floss and that actually may result in bad breath due to plaque being relased while flossing.

• "Gargle with green tea, says Researchers at the University of British Columbia who tested different strategies for eliminating bad breath and found that green tea was most effective at wiping out the germs and the volatile sulfur compounds (VSC) that cause stench mouth."

• Maintain a healthy diet, limit between meal sugary snacks and workout regularly.

• Maintain regular dental checkups and cleanups. Keep an eye for signs and symptoms of oral disease and contact your dentist as soon as any problem arises. 

• Men in general should be very vigilant about dental health as I will now touch upon a very important and sensitive issue related to oral health and sexual health. 
Researchers at China’s Luzhou Medical College noticed that rats with periodontitis had less of the enzyme eNOS, which is involved in achieving an erection. The study supports past research that shows gum disease is more common in guys with ED than men without it. 

"Maybe, maybe not. “Since periodontal disease is considered an inflammatory disorder, it may play a role in the progression of ED,” says Leonard G. Gomella, M.D., professor and chairman of the Department of Urology at Thomas Jefferson University. More research of human inflammatory issues is needed to better understand any association between periodontal and penile health." Regardless it may be better to pick up the brush proactively then pop in a "blue pill" after the fact!

So in conclusion its better to take a precautionary approach and since the prevention of oral diseases is so simple and easy. Our mouth is indeed the gateway to our body and lets maintain a healthy mouth for a healthy body!


~Dr V

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"Men are from Mars and Women are from Venus"? Lets Analyze it medically and physiologically!

I thought that after all the diets and labels, workouts and headaches, this seems to be a refreshing topic and of course ever so controversial and very interesting! What I really want to do here is to compare male and female brain anatomy, the reasoning behind certain difference between men and women and look into the skill sets performed by both sexes that we all have learned to identify the sexes with? 

I will try to keep it less medical and more informative but there is a lot of scientific date to analyze. The debate seems to be endless and I will not get biased and keep it very concise and objective. It may still to be disagreeable to a few so feel free to initiate the discussion with me, as always!

I am not sure how many of you have read this book "Men are from Mars and Women are from Venus" by John Gray published in 1992. His main theories are "that men complain about problems because they are asking for solutions while women complain about problems because they want their problems to be acknowledged". 

Here’s what Aristotle said "The female is softer in disposition, is more mischievous, less simple, more impulsive and more attentive to the nurture of the young…The fact is, the nature of man is the most rounded off and complete."

Stanley Hall, the influential American psychologist, says..."She works by intuition and feeling; fear, anger, pity, love and most of the emotions have a wider range and greater intensity. If she abandons her natural naiveté and takes up the burden of guiding and accounting for her life by consciousness, she is likely to lost more than she gains and that she who deliberates is lost”. All I can say to this is……WOW!!

The "father" of sociobiology, Edward O. Wilson, of Harvard University, said “human females tend to be higher than males in empathy, verbal skills, social skills and security-seeking, among other things, while men tend to be higher in independence, dominance, spatial and mathematical skills, rank-related aggression, and other strong characteristics”

So at first glance it looks like the old timer socio-biologist were kind of gender biased?

Apart from the visible anatomical sexual differences, scientists always knew that there are many other differences in the way the brains from men and women process language, information, emotion, cognition, etc. One of the most interesting differences appear in the way men and women estimate time, judge speed of things, carry out mental mathematical calculations, orient in space and visualize objects in three dimensions, etc. In all these tasks, women and men are strikingly different; as they are too in the way their brains process language. This may account, scientists say, for the fact that there are many more male mathematicians, airplane pilots, bush guides, mechanical engineers, architects and racecar drivers than female ones.

On the other hand, women are better than men in human relations, recognizing emotional overtones in others and in language, emotional and artistic expressiveness, esthetic appreciation, verbal language and carrying out detailed and pre-planned tasks. For example, women generally can recall lists of words or paragraphs of text better than men.

Back in 2001, MIT’s Quarterly Journal of Economics published a paper called “Boys Will Be Boys: The authors, Brad Barber and Terrance Odean, gained access to the trading activity in over 35,000 households, and used it to compare the habits of men and women. What they found, is that men not only trade more often than women but do so from a false faith in their own financial judgment. Single men traded less sensibly than married men, and married men traded less sensibly than single women: the less the female presence, the less rational the approach to trading in the markets. Hmmm... I guess men do need that lady luck on their side after all or maybe its lady's whip? to keep them in line?

Here is some focus on the anatomical differences: The brain is made primarily of two different types of tissue, called gray matter and white matter. In human brains, gray matter represents information processing centers, whereas white matter works to network these processing centers.

This new research reveals that men think more with their gray matter, and women think more with white. Researchers stressed that just because the two sexes think differently, this does not affect intellectual performance. "These findings suggest that human evolution has created two different types of brains designed for equally intelligent behavior," said Haier.

The results from this study may help explain why men and women excel at different types of tasks, said co-author and neuropsychologist Rex Jung of the University of New Mexico. For example, men tend to do better with tasks requiring more localized processing, such as mathematics, while women are better at integrating and assimilating information from distributed gray-matter regions of the brain, which aids language skills.

Scientists working at Johns Hopkins University, recently reporting in the "Cerebral Cortex" scholarly journal have discovered that there is a brain region in the cortex, called inferior-parietal lobule (IPL) which is significantly larger in men than in women. This area is bilateral and is located just above the level of the ears (parietal cortex)

Furthermore, the left side IPL is larger in men than the right side. In women, this asymmetry is reversed, although the difference between left and right sides is not so large as in men, noted the JHU researchers. This is the same area which was shown to be larger in the brain of Albert Einstein, as well as in other physicists and mathematicians. So, it seems that IPL's size correlates highly with mental mathematical abilities

In general, the IPL allows the brain to process information from senses and help in selective attention and perception (for example, women are more able to focus on specific stimuli, such as a baby crying in the night). Studies have linked the right IPL with the memory involved in understanding and manipulating spatial relationships and the ability to sense relationships between body parts. It is also related to the perception of our own affects or feelings. The left IPL is involved with perception of time and speed, and the ability of mentally rotate 3-D figures as in video games.

Other researchers, led by Dr. Bennett A. Shaywitz, a professor of Pediatrics at the Yale University School of Medicine, discovered that the brain of women processes verbal language simultaneously in the two sides (hemispheres) of the frontal brain, while men tend to process it in the left side only and it proves why women have better language skills.

According to the Society for Neuroscience, the largest professional organization in this area, evolution is what gives sense to it. "In ancient times, each sex had a very defined role that helped ensure the survival of the species. Cave men hunted. Cave women gathered food near the home and cared for the children. Brain areas may have been sharpened to enable each sex to carry out their jobs".  The advantage of women regarding verbal skills also makes evolutionary sense. While men have the bodily strength to compete with other men, women use language to gain social advantage, such as by argumentation and persuasion, says Geary, which many men seem to link to "nagging"

Author Deborah Blum, who wrote "Sex on the Brain: The Biological Differences Between Men and Women" has reported the current trend towards assigning evolutionary reasons for many of our behaviors. She says: "Morning sickness, for example, which steers some women away from strong tastes and smells, may once have protected babes in-utero from toxic items. Infidelity is a way for men to ensure genetic immortality”. Interesting, so women should not blame men for being "players". It’s just how the nature made them!

Jameson et al. suggest that there may be two (or more) different modes of seeing color, each processed differently in the male and female brain. Which determines why men cannot perceive the wide spectrum of colors and that’s why a man's closet usually have the basic colors like black, blue grey etc and they have no clue when asked about colors like ....azure, coral, magenta rose, fuchsia and viridian etc, Are these even real colors? or just the usual trick questions for men? 

What I have concluded is that male and female brain just can't be generalized but they need to be considered as entirely different organs! They are practically just as different as reproductive organs in males and females! Men and women are made different, think different and can act entirely differently in the same situation. So if the men are not paying attention to garbage, cleanliness, organization and being a couch potato or are late to react to a baby's crying then I guess there is proof in the studies that they are wired differently than the women. Women sure are wired anatomically to be the person in the household to be empathetic, caring, loving, even more emotional and impulsive too! This still does not mean that we can't find women who are experts in math and also language skills or men who are multi lingual and also great "home makers" Its only when we do a research using a large group is when these facts are seen!

We can now understand why a lot of women often complaint that the "men just can't seem to grasp the perpetual and evidentiary simple facts at times" and we also understand why women draw an almost blank when it comes to video games and then they just shrug it off by saying "its just so boring"! 

That's just how nature has made us and we have evolved as species. As always feel free to send me emails and other meaningful research articles so I can improve these blogs in future.

~Dr V

Thanks to....

Sabbatini, R.M.E.: The PET Scan: A New Window Into the Brain
Gattass, R.: Thoughts: Image Mapping by Functional Nuclear Magnetic Resonance
Cardoso, S.H.: Why Einstein Was a Genius?
Sabbatini, R.M.E.: Paul Broca: Brief Biography
Sabbatini, R.M.E.: Mapping the Brain

References

1. Frederikse, M.E., Lu, A., Aylward, E., Barta, P., Pearlson, G. Sex differences in the inferior parietal lobule. Cerebral Cortex vol 9 (8) p896 - 901, 1999 [MEDLINE].
2. Geary, D.C. Chapter 8: Sex differences in brain and cognition. In "Male, Female: the Evolution of Human Sex Differences". American Psychological Association Books. ISBN: 1-55798-527-8 [AMAZON].
3. Harasty J., Double K.L., Halliday, G.M., Kril, J.J., and McRitchie, D.A. Language-associated cortical regions are proportionally larger in the female brain. Archives in Neurology vol 54 (2) 171-6, 1997 [MEDLINE].
4. Collaer, M.L. and Hines, M. Human behavioural sex differences: a role for gonadal hormones during early development? Psychological Bulletin vol 118 (1): 55-77, 1995 [MEDLINE].
5. Bishop K.M. and Wahlsten, D. Sex differences in the human corpus callosum: myth or reality? Neuroscience and Biobehavioural Reviews vol 21 (5) 581 - 601, 1997.
6. LeVay S. A difference in hypothalamic structure between heterosexual and homosexual men Science. 253(5023):1034-7, 1991 [MEDLINE].
See also: LeVay, S.: "The Sexual Brain". MIT Press, 1994 [AMAZON]
7. Shaywitz, B.A., et al. Sex differences in the functional organisation of the brain for language. Nature vol 373 (6515) 607 - 9, 1995 [MEDLINE].
8. Rabinowicz T., Dean D.E., Petetot J.M., de Courten-Myers G.M. Gender differences in the human cerebral cortex: more neurons in males; more processes in females. J Child Neurol. 1999 Feb;14(2):98-107. [MEDLINE]
9. Schlaepfer T.E., Harris G.J., Tien A.Y., Peng L., Lee S., Pearlson G.D. Structural differences in the cerebral cortex of healthy female and male subjects: a magnetic resonance imaging study.Psychiatry Res. 1995 Sep 29;61(3):129-35 [MEDLINE].
10. Wilson, E.O. - "Sociobiology". Harvard University Press, 1992 [AMAZON].
11. Moir A. and Jessel D. - "Brain Sex". 1993 [AMAZON] See also: Excerpts from the book
12. Blum, D. - "Sex on the Brain: The Biological Differences Between Men and Women". Penguin, 1998 [AMAZON]
13. Kimura, D. - "Sex and Cognition". MIT Press, 1999 [AMAZON]

The truth behind the FDA food labeling guidelines!

I understand that in today's world, we all are wellness savvy, health conscience and very well educated consumers who are not afraid to ask questions and make the right choices! We all want full disclosure and demand only the best from the products manufacturers especially when it comes to the food. We want our family to consume nothing but healthy, no trans. fat, cholesterol free and low sugared stuff. We read the food labels carefully and a few of us can even tell what some of these ambiguous labels really mean? But is that enough? Or these guidelines which these food manufacturers use to label are so loose that so much misinformation can just slide right under the radar? 
With millions of food products on the shelves all over the Country, all FDA really can do is trust these manufacturers to be truthful and consciences enough to put the right things on these labels. FDA can merely dictate what goes on the labels and how it has to be displayed for the consumers but real testing of all of the products out there is impractical and impossible! 

I would take an assumption that most of the manufacturers are truthful and have no intentions to fool us and even then they have so many loopholes that I am not even sure what to say here? Here are some of common 'misrepresentation' or 'misinformation' which is legally allowed under federal laws! 
Lets try to unravel some of these mysteries....Most are self explanatory but I have added some of my comments in red on the following food labels guidelines! Remember these terms are Gov. mandated and refer to each serving size.

• Free or without means an amount that is nutritionally "trivial".
  As of January 1, 2006, the U.S. Food and Drug Administration rules on labeling allow foods with less than 0.5 grams of trans fats per serving to claim "zero" grams of trans fats on their labels. That means that consumers who consume three or four servings of these foods in a day will have eaten an extra gram or two of trans fats without realizing it!
  
• Low or little means low enough to allow frequent consumption without exceeding the "Daily Value" for the nutrient. 
• Most contains at least 10% more of the "Daily Value" for the nutrient than the reference food it resembles. I believe this is true, so if you are calorie hawk....beware.
• High, rich in or excellent source means it contains at least 20% "Daily Value" for the nutrient. Only 20% more doesn't mean we got a lot of what we wanted.
• Good source is between 10 to 19% of the "Daily Value" for the nutrient. This is still not that ambiguous.
• Light or Lite is a nutritionally altered product that contains one-third fewer calories or half of the fat of the reference food. I am personally not a fan of light foods!
• Lite can also mean that 50% of the fat ( compared to regular food) when the food derives 50% or more of its calories from fat. 
• It also can mean that the sodium content of a low-calorie, low-fat food has been reduced by 50%.
• Calorie free is fewer than five calories. This won't impact too much but it all adds up quickly if we are not watching!
• Low calorie is 40 calories or less. So read and calculate your calorie intake again because in a high calorie food, lower/lite version would not be that low in calories.
• Reduced or fewer calories means the product has at least 25% less calories. 
• Sugar free means less than 0.5 grams. This can be an issue if you are diabetic. We may keep thinking "sugar free" in our minds but we can exceed our daily quota in no time.
• Reduced sugar is at only 25% less sugar. A real concern for diabetic people.
• High fiber is 5 or more grams of fiber. We need a lot of fiber in our daily diets and in my opinion lack of fiber is one big health concern!
• Good source of fiber is 2.5 to 4.9 grams of fiber.
• More or added fiber means at least 2.5 grams more fiber.
• Fat free is less than 0.5 grams of fat. Portion control!!
• Saturated fat free is less than 0.5 grams of saturated fat and the level of trans fatty acids does not exceed 1% of total fat.
• Low fat contains 3 grams or less.
• Reduced or less fat is at least 25% less. This is again important as we are talking about fat!
• Low saturated fat is 1 gram or less and not more than 15% of calories.
• Reduced or less saturated fat is at least 25% less.
• Cholesterol free means less than 2 mg of cholesterol and 2 grams or less of saturated fat. Naturally present cholesterol is something which just can't be avoided sometimes like in eggs and shrimp.
• Low in cholesterol is 20 mg or less of cholesterol and 2 grams or less saturated fat.
• Reduced or less cholesterol means it is 25% less cholesterol and 2 grams or less of saturated fat.
• Sodium free is less than 5 mg. This is important as extra Sodium is the single biggest reason of weight gain, in my opinion.
• Low sodium means less than 140 mg or less.
• Very low sodium is 35 mg or less. Very low sodium has still has so much sodium.
• Reduced sodium is at least 25% less.
• Light in sodium contains at least 50% less.
• Lean means the product has less than 10 grams of fat, less than 4 grams of saturated fat, and less than 95 mg of cholesterol per serving and per 100 grams.
• Extra lean is less than 5 grams of fat, less than 2 grams of saturated fat, and less than 95 mg of cholesterol per serving and per 100 grams. So even extra lean does not give us a green signal to keep munching our favorite fatty snack all day long!

So the bottom line is that we need to watch what are eating but don't dwell too much on the labels. Labels should be used to educate ourselves and know what's in the box but they can't be over read or under read and be allowed to mislead us in making wrong choices and create unhealthy eating habits. My point here is that we need to know the real info. on the labels  and just because the front of the box says "low, lite, lean, reduced, fewer" does not mean that we become carefree and are free to over indulge!

~Dr V

Reference: http://www.eat-well-to-be-well.com/food-labels.htm

Is every excruciating headache a migraine? And what if it is?

We often hear our friends and family members complain that they are having an episode of "migraine"! Do they really have migraine? or is it just a regular headache? I have seen that people who somehow believe that they have "migraine" without ever getting it officially diagnosed, often will get offended that some one has termed their "migraine" just a mere headache! They believe that the other person does not understand the seriousness of their pain and symptoms. And on the other hand migraine is one of the most common under diagnosed condition among people. So what is the real difference between a 'common headache' and a 'migraine'? This is not to just avoid offending people but to really understand the condition. I have myself suffered a lot with the headaches and I made some changes in life stye and my episodes have reduced and I did try migraines meds. a couple of times but honestly I am still unsure if I had migraines or just regular headaches? My symptoms were quite fudged...
So the the most common definition of a headache is a "pain in the head or upper neck area" which sounds really simple? well no.....

Here is some brief basic info on headaches and then I will go back to the real question, whether all headaches are migraines or something else? I have done so much research on this that I can almost write a book on this topic.

There are three major categories of headaches:

1. Primary: Tension headaches, migraines and cluster headaches come in this category.
2. Secondary headaches are caused by some underlying disease in the body.
3. Neuralgia Headaches are caused by a nerve issue probably in the upper neck and head area.

• Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men.
• Migraine headaches are the second most common type of primary headache. An estimated 35 million people in the United States (about 14% of the population) experience a migraine headache. Migraine headaches can affect children as well as adults. 
• Cluster headaches are a rare type of primary headache affecting 0.1% of the population.
• Lets talk about Tension headaches for a little bit, they are the most frequently occurring type of headaches and suprisingly their cause is still not known. They are generally caused by contraction of the muscles over skull area. We feel the muscle spasm and the related pain and the most common areas are the upper neck and area above our eyebrows. They can also cause the related muscles in the upper shoulders to go in spasm. Physical stress like manual labor, sitting at a desk concentrating etc can be factors and so can the be emotional reasons. The end result is the same, tension/spasm of the skull muscles 

Symptoms of tension headaches are........

"The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure.

Often is described as pressure encircling the head with the most intense pressure over the eyebrows.

The pain usually is mild (not disabling) and bilateral (affecting both sides of the head).

The pain is NOT associated with an aura, nausea, vomiting, or sensitivity to light and sound.

The pain occurs sporadically but can occur frequently and even daily in some people.

The pain allows most people to function normally, despite the headache"

The remedy can often be simple and mostly OTC (over the counter) meds like aspirin and other analgesics can help. Often ice or in some cases, even local heat also helps. If you believe that you are overdoing the OTC meds then please get some real medical advice. In my case, I created a monster out of my situation by taking too much Aspirin which caused me to be allergic to aspirin and all the aspirin related products. So almost every episode of my headaches caused me to have some major allergic reactions too. Finally I caught on to it and now I am only take non aspirin pills like Tylenol if needed.
Also chronic headache specially in the same spot in the head can actually be some thing very serious and should NOT be ignored and don't hesitate to seek medical advice. 


Now to understand Migraine in a language as simple as possible.

"The real migraine headache is a form of vascular (blood vessels) headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes the release of chemicals from nerve fibers that coil around the large arteries of the brain. These chemicals cause inflammation, pain, and further enlargement of the artery, causing a vicious circle of awful pain"

Migraine attacks commonly also activates the sympathetic nervous system in our body. The sympathetic nervous system is the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response, this activation itself can cause the increased sympathetic nervous activity in the intestine causing nausea, vomitting, and diarrhea. 


Now this will start making sense to many people! But here is the 'kicker' ..........sympathetic activity also delays emptying of the stomach into the small intestine and thus prevents oral medications from entering the intestine and being absorbed so the common pain meds do not work in this condition. Vasodilation of arteries can also decreases the circulation of blood, and this leads to cold hands and feet and cause light sensitivity and blurred vision.

• Migraine headaches usually are described as an intense, throbbing or pounding pain that involves one temple. (Sometimes the pain is located in the forehead, around the eye, or at the back of the head).
• The pain usually is unilateral (on one side of the head), although about a third of the time the pain is bilateral (on both sides of the head).
• The unilateral headaches typically change sides from one attack to the next. (In fact, unilateral headaches that always occur on the same side should alert the doctor to consider a secondary headache, for example, one caused by a brain tumor).
• A migraine headache usually is aggravated by daily activities such as walking upstairs.
• Nausea, vomiting, diarrhea, facial pallor, cold hands and feet, and sensitivity to light and sound commonly accompany migraine headaches. As a result of this sensitivity to light and sound, migraine sufferers usually prefer to lie in a quiet, dark room during an attack. A typical attack lasts between 4 and 72 hours.

An estimated 40%-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include:

• sleepiness,
• irritability,
• fatigue,
• depression or euphoria,
• yawning, and
• cravings for sweet or salty foods.

One of most common symptom described by almost 30 to 40 % of patients is the "Aura"

1. flashing, brightly colored lights in a zigzag pattern and usually starting in the middle of the visual field and progressing outward.
2. a hole in the visual field, also known as a blind spot.

A less common aura consists of pins-and-needles sensations in the hand and the arm on one side of the body or pins-and-needles sensations around the mouth and the nose on the same side. Other auras include auditory (hearing) hallucinations and abnormal tastes and smells. It may also cause to have dizziness fainting and in some extreme cases even have symptoms which can mimic one sided stroke.

For approximately 24 hours after a migraine attack, the migraine sufferer may feel drained of energy and may experience a low-grade headache along with sensitivity to light and sound. Unfortunately, some sufferers may have recurrences of the headache during this period.

So what do we do if our headache is really a big stinking migraine with all or most of the above mentioned bells and whistles and the not the common garden variety headache? Well see a well qualified medical practitioner right away. Till you can see a doctor, you can try to sleep if you can and use ice or other relaxation techniques like deep breathing as in yoga. You can also work to proactively work to reduce the so called 'trigger factors' to minimize the chances of migraine such as avoiding foods like strong cheese, nuts, pressed meats and chocolate. Avoid smoking, caffeine and alcohol too. Avoid episodes of long duration between the meals. Also try to stay away from bright flickering lights and try for sound sleep. So better avoid going to the '60's and 70's night' at the dance club.

As I mentioned you can try OTC analgesics but they might not be as effective due to the sympathetic nervous system response. For some women, the decline in the blood level of estrogen during the onset of menstruation is a trigger for migraine headaches too. Try to exercise regularly and avoid what ever might have known to 'trigger' these headaches spells. That may not completely avoid a major episode but surely can reduce the frequencies. In some cases that itself can be a big step in improving the quality of life.

For the most effective treatment see a doctor and the migraine can be effectively diagnosed by physical exam, MRI, CT scan and spinal tap. The doctors may prescribe you meds like the abortive medications for moderate or severe migraine headaches that are different than OTC analgesics. 
Instead of relieving pain, they abort headaches by counteracting the cause of the headache, dilation of the temporal arteries. In fact, they cause narrowing of the arteries. Examples of migraine-specific abortive medications are the triptans, ergot preparations and midrils. More commonly known as 

Beta blockers such as propranolol (Inderal), atenolol(Tenormin), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol(Corgard), and timolol (Blocadren). 

Tricyclic anti depressants (TCAs) such as amitriptyline(Elavil, Endep), nortriptyline (Pamelor, Aventyl), doxepin (Sinequan),imipramine (Tofranil), and protriptyline

Anti serotonin meds like Methysergide (Sansert) and calcium channel blockers such as diltiazem (Cardizem, Dilacor, Tiazac), verapamil (Calan, Verelan, Isoptin), and nimodipine.

Side Effects: While all of these meds might not work for all the patient strata but you can be assured of one common factor amongst them that almost all of these meds can have some serious side effects. Some of the common to really serious side effects are.....drowsiness, diarrhea, constipation, fatigue, decrease in endurance, insomnia, nausea, depression, memory loss, impotence, fast heart rate, blurred vision, difficulty urinating, dry mouth, constipation, weight gain or loss, low BP when standing, scarring around the lungs that can lead to chest pain, shortness of breath, as well as scarring of the heart valves, and serious toxicity. 

In the end all I can say is that use your common sense and try to prevent the migraine spells as much you can. The hardcore migraine suffers mostly know in advance that a spell is coming or at least know what causes it. Regular exercises, deep breathing, good healthy diet and de-stressers are the key elements of a proactive approach. I personally have done some key changes in lifestyle and don't take any more meds for it. If I have that feeling of a headache, I simply take some OTC anti allergic like Children's Benadryl, vapor steam and rest. I might have to take an occasional OTC tylenol but that's about it. The OTC anti allergy meds helps to prevent any allergic issues as I have come to a conclusion that at least my headaches were allergen related and once the sinuses are inflamed, it triggered my headaches. So write your issues down and try to narrow the possible causes to the simplest headaches and you may avoid a major spell?

~Dr. V  

REFERENCES:

Dowson AJ, Lipscombe S, Sender J, Rees T, Watson D. New Guidelines for the Management of Migraine in Primary Care. Curr Med Res Opin. 2002;18(7):414-439.

Goetz CG, Pappert EJ. Textbook of Clinical Neurology. 2nd ed. Philadelphia, PA: Saunders; 2003.

Holroyd KA, Drew JB. Behavioral approaches to the treatment of migraine. Semin Neurol. 2006 Apr;26(2):199-207.

Landy S, Smith T. Treatment of primary headache: acute migraine treatment. In: Standards of care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation; 2004. p. 27-39. [11 references].

National Guideline Clearinghouse. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. From: Snow V, Weiss K, Wall EM, Mottur-Pilson C. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med 2002 Nov 19;137(10):840-52. [121 references].

National Guideline Clearinghouse. Treatment of primary headache: acute migraine treatment. Standards of care for headache diagnosis and treatment.

Patwardhan MB, Samsa GP, Lipton RB, Matchar DB. Changing physician knowledge, attitudes, and beliefs about migraine: evaluation of a new educational intervention. Headache. 2006 May;46(5):732-41.

Ramadan NM. Migraine headache prophylaxis: current options and advances on the horizon. Curr Neurol Neurosci Rep. 2006 Mar;6(2):95-9.

Roger Cady, MD, David W. Dodick, MD. Diagnosis and Treatment of Migraine. Mayo Clin Proc. 2002;77:255-261.

Stephen D. Silberstein, MD, FACP. Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55:754-762.

Vincenza Snow, MD. Acute Migraine Treatment Guideline. Annals of Internal Medicine. 2003 Oct 1; 139(7):603-4.

Previous contributing author and editor: Dennis Lee, MD and Harley I. Kornblum, MD, PhD

image: www.popular-science.net