Pregnant Pause

Getting a good night’s sleep while you are pregnant can seem like an almost impossible task. Especially because finding a sleeping position that is comfortable for more than 5 minutes is difficult to say the least! Unfortunately, this is only likely to get worse as your pregnancy progresses and your tummy expands.

Sleeping on your left side with your knees slightly raised is often considered the best position for you and for your baby. It is said to help relieve nausea for those in the first trimester of pregnancy as well as to increase blood flow to the foetus, decrease swelling and reduce pressure on the liver and the blood vessels that carry blood to your heart from your legs.

Clock watching is just about the worst thing you can do if you are having trouble sleeping as it simply makes you more anxious about how long you have been awake, which in turn makes it even more difficult to get back to sleep. If you really cannot sleep you should try getting out of bed and reading a book or magazine until you begin to feel drowsy.Sleep problems tend to be worse in the first and third trimesters due to nausea, indigestion and a simple inability to get comfortable. The second trimester is sometimes called the ‘honeymoon’ period because many experience less disruptions to sleep during this time, however, you are unlikely to enjoy the same quality of sleep you did before you became pregnant.

If you are having trouble sleeping during the night and feel overly tired, an afternoon nap can do wanders for recharging your batteries and making you feel human again, even if it is just for half an hour. However, if you begin to feel overly anxious about sleeping you should talk about it with your health care professional.

Ask Dr Willis

Question: I am a 56-year-old man and for the last year I have had a problem with pain in my genital area and difficulty in urinating. My doctor says I have prostatitis and has referred me to a urologist. While I wait for the appointment on the Spanish NHS can you advise me on treatment etc?

Answer:  Prostatitis is a fairly common complaint. Estimates on the number of males in Europe who will experience prostatitis during their lifetimes range up to 50 percent. Many urologic disease experts feel that from 5 to 10 percent of males are experiencing prostatitis at a particular time, making it one of the most common urologic diseases in Europe.The prostate is a reproductive gland located just below the bladder and in front of the rectum. It wraps around the urethra, a tube that carries urine from the bladder. The prostate produces most of a male’s semen. Prostatitis is an infection or inflammation of the prostate gland that causes intense pain, urinary complications, sexual dysfunction, infertility and a significant reduction in the quality of life. Prior to the mid-1990s, very little research had been done that could lead to improved diagnostic techniques and a cure.

Prostatitis is difficult to diagnose and treat and has a wide range of debilitating and troublesome side affects. Unlike prostate cancer and benign prostatic hyperplasia (BPH), prostatitis often affects the lives of young and middle-aged men. According to The Prostatitis Foundation, prostatitis can result in four significant symptoms i.e. pain, urination problems, sexual dysfunction and general health problems, such as feeling tired and depressed. To diagnose prostatitis, a doctor will collect a patient’s urine and thoroughly examine his prostate gland. To check the prostate gland, a doctor will carry out a digital rectal examination, which involves inserting a well-lubricated gloved finger into the rectum to check for any abnormalities of the gland. The doctor also may collect a sample of prostate fluid so that it can be analysed. Some doctors also may want to carry out a prostate specific antigen test to measure the amount of this chemical in a person’s blood. Both prostatitis and prostate cancer can increase a patient’s PSA level.

Over the years, prostatitis has been subdivided into a number of categories but today commonly accepted variations of the disease include nonbacterial, acute and chronic. By far, the most common type of prostatitis is nonbacterial prostatitis. Symptoms may include frequent urination and pain in the lower abdomen or lower back area. Causes may be stress and irregular sexual activity.

Treatments for nonbacterial prostatitis may include anti-inflammatory medications or muscle relaxants, taking hot baths, drinking extra fluids, learning to relax when urinating and ejaculating frequently. I would also recommend some changes in a patient’s diet, with the exclusion of grains and sugar and inclusion of fruit, vegetables and oily fish.Acute bacterial prostatitis can be the result of bacteria, a virus, or a sexually transmitted disease. Symptoms may include fever and chills, low back pain, frequent and painful urination, weak stream urination, and infrequent urination. These infections often are treated with antibiotics, bed rest, stool softener and an increased fluid intake.Chronic prostatitis may be bacterial or the result of an inflammation of the prostate. Symptoms may include frequent bladder infections, frequent urination and persistent pain in the lower abdomen or back. This form of prostatitis often is treated with medications (often antibiotics), changes in the diet and appropriate non-prescription supplements.

Additional information about prostatitis can be found at www.prostatitis.org.

Ask Dr Willis Question: I have recently had my cholesterol tested and my doctor says that my total cholesterol is only slightly raised but tells me I have very low good cholesterol (23). What can I do to increase it up? I am 58 and am fit and well otherwise.Answer: Increasing your HDL (the “good”) cholesterol will provide huge gains for you. HDL protects us from heart disease and stroke. It scours our blood vessels for fragments of LDL and transports it back to the liver for reprocessing.A normal HDL is above 40 mg/dl for men and above 50 mg/dl for women. The higher this HDL reading is, the lower your risk for heart disease and stroke. There is a tenfold difference in heart degree risk between those with low HDL and those with higher HDL readings independent of their LDL (”bad”) levels. HDL is the particle that “mops up” the small damaging LDL cholesterol and transports it out of our circulation.Given this is a genetically inherited factor, large changes are difficult to obtain. Your lifestyle will have the largest positive impact.
Avoid:
- Smoking - Smoking will lower your HDL, which is not a good thing! Remember, you want a high HDL
- Inactivity - Regular aerobic exercise of 60 minutes daily will increase your HDL by 3-9%. Start slowly and gradually aim for this time over several weeks or months.
- Weight gain - Avoid saturated fats, especially the “trans” fats that have been shown to lower HDL and increase LDL. Omega-3 supplementation is useful. A six-pound weight loss is associated with a 1 mg/dl gain in HDL in most people, so aim to achieve your ideal body weight. This does not apply to those who are underweight.
- Excess alcohol - Moderate alcohol intake (especially of red wine) of no more than 2 drinks daily will often improve your HDL. Excess is harmful. The association with alcohol is not sufficient to recommend alcohol for treating low HDL but enjoy moderate intake if you wish, as it appears to be beneficial
- Low fibre junk diets - Increase the soluble fibre such as oatmeal, psyllium husks, in your diet. You will notice improved HDL and LDL readings by as much as 10%. Avoid processed and “junk” food if possible.For many years, doctors have had little to offer in the way of specific treatment but this is changing now. There is drug treatment available, but as you have noticed, the results are small. Niacin in prescription doses (such as Niaspan) is the most useful. Statins have little effect on your HDL and the trade off with side effects is not worth it. You will need to see your doctor for these medications, as they are not free of side effects and monitoring will be necessary. Also, some people do not respond as well as others, as you have experienced.No supplements have been shown to improve HDL with the exception of omega 3 supplementation. Do not waste your money on advertised products available without prescription. Specific medicine to increase HDL is not yet available.

Ask Dr Willis

Question: My mother is 86 years old and over the past few months, she has become more forgetful, is doing less and less, isn’t reading or sewing much at all any more, and most of the time she seems a little depressed. But when we talk to her about it, she says “I’m fine,” and when there’s a social occasion, she actually can muster up the energy to act like her old self for a few hours. She let me take her to a neurologist who told us she doesn’t think Mother has Alzheimer’s disease, just that she’s getting older. She takes a multiple vitamin-mineral tablet, as well as some memory supplements, but none of this seems to make any difference. Is there anything else I can do?

Answer: Your mother’s situation is not at all unusual but it does not necessarily need to stay that way. One of the simplest, safest, and least expensive things to try would be twice-weekly injections of vitamin B12, folic acid and B-complex. Often several weeks of these injections will make a noticeable difference in energy, low-grade depression and even memory in folks over 80.Particularly when people age, the foods they eat, as well as vitamin-mineral tablets (a minor point: switch to capsules), do not break down and absorb as well, often because of declining digestive capability. A shrinking stomach lining with age reduces the absorption of B vitamins. Giving some of these nutrients by injection can do the job when swallowing them does not.If the injections are effective or even partially effective, it is a good idea to have several tests done, starting with a “fasting plasma essential amino acid” determination. (Essential amino acids must be digested from our diets, as our bodies cannot make them.) In individuals over 80 who respond to B-vitamin injections, the essential amino acid test finds low levels of essential amino acids in an overwhelmingly large majority. Since these essential amino acids are transformed into both body proteins and neurotransmitters, supplementing them can improve strength, depression and memory. It is also important to check for minerals and vitamin B12, folate, C and D levels.

Supplementing with digestive enzymes can help a digestion that is struggling to cope with declining age-related digestive enzymes.

Five Worst Cancer-Causing Foods

There are some foods that people who are at high risk for developing cancer should definitely avoid. Generally, says natural health researcher Mike Adams, they should avoid foods that contain ingredients known to cause cancer, such as refined sugars and grains, hydrogenated oils, and nitrates. But which foods are the absolute worst?

According to Mike Adams, the top five cancer-causing foods are:1. Hot dogs — Because they are high in nitrates, the Cancer Prevention Coalition advises that children eat no more than 12 hot dogs a month. If you can’t live without hot dogs, buy those made without sodium nitrate.

2. Processed meats and bacon — Also high in the same sodium nitrates found in hot dogs, bacon, and other processed meats raise the risk of heart disease. The saturated fat in bacon also contributes to cancer. 3. Doughnuts — Doughnuts are cancer-causing double trouble. First, they are made with white flour, sugar, and hydrogenated oils, then fried at high temperatures. Doughnuts, says Adams, may be the worst food you can possibly eat to raise your risk of cancer.

4. French fries — Like doughnuts, French fries are made with hydrogenated oils and then fried at high temperatures. They also contain cancer-causing acrylamides which occur during the frying process. “They should be called ‘cancer fries,’ not French fries,” said Adams.5. Chips, crackers, and cookies — All are usually made with white flour and sugar. Even the ones whose labels claim to be free of trans-fats generally contain small amounts of trans-fats.

Hot Flushes in Women Linked to High Blood Pressure

Women who get hot flushes have higher blood pressure than those who do not, according to a new study led by Weill Cornell Medical College.
 
High blood pressure is a major risk factor for heart disease — the latter being responsible for half of all deaths among American women 50 and older.

“One-third of the women we studied reported having had hot flushes within the past two weeks. Among these women, systolic blood pressure was significantly higher — even after adjusting for whether they were pre-menopausal, menopausal or post-menopausal,” says Dr. Linda Gerber, the study’s senior author, professor of public health and medicine and director of the biostatistics and research methodology core at Weill Cornell Medical College. “Future research will help us better understand the mechanisms underlying this relationship and may help to identify potential interventions that would reduce the impact of hot flushes on blood pressure.”

While previous research has linked menopause to high blood pressure, the new Weill Cornell study, published in the March/April issue of Menopause: The Journal of the North American Menopause Society, may be the first to link hot flushes to high blood pressure.

Portable monitors recorded the blood pressure of 154 New York City women, ages 18 to 65 (mean age of 46), with no previous cardiovascular disease and either mild hypertension or normal blood pressure. Fifty-one women reported experiencing hot flushes. These women were found to have an age-adjusted mean systolic awake blood pressure of 141 and a mean systolic sleep blood pressure of 129 — compared to 132 and 119, respectively, for women not reporting hot flushes (P=0.004 and 0.007). The group differences for systolic blood pressure remained statistically significant after controlling for conventional hypertension risk factors, race/ethnicity, age and body mass index (BMI).

Hot flushes are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and usually last from two to 30 minutes on each occasion. The event may be repeated a few times each week or up to a dozen times a day. Hot flushes are thought to be caused by centrally increased activation of the sympathetic nervous system.

Pregnant Pause

Pregnancy is a time of great change and no matter whether it is your first or fifth baby it can be difficult to know which symptoms are ‘normal’ and which are worth checking up with your doctor. You should visit your doctor or midwife for a check-up as soon as possible if you experience any of the following:
- Severe stomach pain - whether you are experiencing sickness and diarrhoea or not.
- Vaginal bleeding
- Spotting in later pregnancy, heavy period like bleeding or leaking fluid. (Light spotting in early pregnancy is reasonably common but check anyway)
- Severe and prolonged headaches - lasting more than a couple of hours
- Fainting - see your doctor if you experience prolonged dizziness or are particularly light headed
- Prolonged visual disturbances - double vision, blurred vision, seeing spots etc - Sudden increase in thirst but unable to urinate or if urination becomes painful
- Severe vomiting - whether accompanied by stomach pain or not
- Sudden swelling of the hands, feet or face - or a significant increase in swelling
- Severe itching - especially if later on in pregnancy
- Fever - especially if over 100 deg F /37.5 deg C
- Sudden weight gain of more than a couple of lbs, noticeable and unrelated to eating
- Reduced foetal movements - no foetal movement for more than 24 hours after week 22
- Injury to the stomach - If you experience any fall or blow to the stomach. While it is important to look out for anything out of the ordinary whilst you are pregnant, you should try not to become to overly concerned about your developing baby’s health, instead focus on relaxing, eating well, taking care of yourself and looking forward to meet your baby when they are ready to make their way into the world.

MEDICAL NEWS FROM DR BERNARD WILLIS

While many health conditions affect both men and women, a number of health issues affect only women and some are more prevalent in women. In addition there are a number of conditions that may cause different symptoms in women, affect women differently and may require different treatment or prevention methods. In contrast both breast cancer and osteoporosis are thought of as women’s health concerns but they also occur in men.

If you are a woman you might worry excessively about developing breast or ovarian cancer but your anxiety could be misplaced. Although these cancers can shorten many women’s lives, a woman’s risk of having either one is far lower than their risk of having - and dying of - cardiovascular disease. This is not to say that women should forget about regular mammograms or ignore symptoms that may suggest ovarian cancer, particularly if they have a high-risk family history, but it does mean that women might benefit from a realistic appraisal of their true health risks. So, here is an up-to-date list of the leading causes of death for women in the UK:

No. 1 - Heart disease - This is responsible for more deaths in women than all forms of cancer combined. Women often think that heart disease affects mostly men but this is a dangerous myth. In reality, more women than men die of heart disease each year. The good news is that heart disease is one of the most preventable health conditions.

No. 2 - Stroke - This is not only is women’s No. 2 killer but also one of the leading causes of disability. Although stroke is highly preventable, certain risk factors - such as family history, age, sex and race - cannot be controlled. Even if you are at increased risk of stroke, you can still take steps to prevent it.

No. 3 - Cancer - It is easy to believe cancer is a major threat to women’s health but the kinds of cancer women are dying of might surprise you as:

* The most common cause of cancer death in women is lung cancer.
* Breast cancer is the second-leading cause of cancer death and
* Colorectal cancer is the third-leading cause of cancer.

Like heart disease, colorectal cancer is often mistakenly thought of as a man’s disease but equal numbers of men and women die of colorectal cancer each year. Many cancer deaths are related to nutrition and other controllable lifestyle factors.

No. 4 - Chronic obstructive pulmonary disease (COPD) - COPD is an overall term for a group of chronic lung conditions, including bronchitis and emphysema. The main cause of COPD is smoking and it is strongly associated with lung cancer, the No. 1 cause of cancer death in women. The quality of life for a person with COPD diminishes as the disease progresses. As shortness of breath and activity limitations increase, sufferers may eventually require oxygen use or even mechanical respiratory assistance to breathe.

Of course, every woman is unique but prevention is the best from of treatment. It might be a good idea for women to develop a personal risk profile in conjunction with her doctor and see what steps can be taken to develop an effective health strategy.

Mother & Baby Corner

Maggie, who is Clinica Tarraula’s Health Visitor and Midwife, will be pleased to answer all your questions. Please write to her at: Clinica Tarraula, Edificio La Plaza, No 8, Ctra Cabo La Nao s/n, 03730 Javea, Alicante or e-mail her on healthvisitor@ctonlineclinic.com.

Question: My son is 4 weeks old and I am concerned that he is constipated. I have just stopped breast feeding and started him on formula. He can go 3-4 days without a bowel movement, is this normal?

Answer: Constipation can be a problem in some babies although it is important to bear in mind that the frequency in which healthy babies open their bowels can vary greatly. The frequency of bowel movements can vary a great deal depending on whether they are breast or bottle-fed. Some babies grunt and go red in the face as if they struggle to move their bowels, however this does not mean they are constipated unless the stool is hard. The fact that this problem has started since you have stopped breastfeeding is not surprising as breastfed babies tend to have stools with a soft, often watery consistency whereas bottle-fed babies generally pass a more formed stool similar to the consistency of “toothpaste”.

The major dietary factor to be aware of is to ensure that your son has adequate fluids. At 4 weeks you should be aiming to give approximately 150 mls milk/kg body weight per day e.g. if your son is 4 kg in weight then you should be aiming for approximately 600 mls milk/day.  Breastfeeding on demand ensures that the baby gets the right amount of milk but when bottle-feeding you need to be more meticulous regarding the volume you give. Providing your baby’s stool is soft, regardless of frequency, he is not constipated.Ways to help:
* If bottle-feeding ensure the formula is made up properly with the correct ratio of powder to water.
* Offer extra cooled boiled water in between feeds.
* A warm bath
* Baby massage -  massage the tummy in a clockwise direction.Laxatives should not be given unless prescribed by a doctor.

If your son is having enough fluids and the problem does not resolve then I recommend that you take him to see a doctor. If you require any further support call in to my free Children’s clinic on a Wednesday from 2 - 7 pm.

Ask Dr Willis

Question: I have recently been diagnosed as diabetic and have been given a tablet called Dianben and told to check my sugar level every day. I have bought a glucose machine but I am not sure how it works and what I should be looking for. Can you help me?

Answer: When you have diabetes, managing your blood sugar level is the most important thing you can do to feel your best and prevent long-term complications. Consider it an opportunity to take charge of your health. For many people who have diabetes, target levels are:
- Before meals — between 90 and 130 milligrams per decilitre (mg/dL), or 5 and 7 millimoles per litre (mmol/L), also known as your fasting blood sugar level.
- One to two hours after meals — lower than 180 mg/dL (10 mmol/L).
- Before bedtime — between 110 and 150 mg/dL (6 and 8 mmol/L).

Remember that your target blood sugar range may differ, especially if you are pregnant or you develop diabetic complications. Also, your target blood sugar range may change as you get older. Sometimes reaching your target blood sugar range is a challenge but the closer you get, the better you will feel.

How often you need to test your blood sugar level depends on the type of diabetes you have and your individual diabetes treatment plan. If you have type 1 diabetes, your doctor may recommend testing your blood sugar level at least three times a day — perhaps before and after certain meals, before and after exercise and before bed. You may need to check your blood sugar level more often if you are ill or you change your daily routine. If you take medication — with or without insulin — to manage type 2 diabetes, your doctor may recommend testing your blood sugar level once a day. If you manage type 2 diabetes with diet and exercise alone, you may need to test your blood sugar level even less often.

To test your blood sugar level, you will need a blood sugar monitor. Some monitors are large with easy-to-handle test strips, while others are compact and easier to carry. Some monitors track the time and date of each test, the result and trends over time. You may even be able to download this information to your computer. Most blood sugar monitors require you to prick your fingertip with a special needle (lancet). Some lancets allow you to adjust the prick depth to accommodate differences in skin thickness. If you wonder which type of blood sugar monitor would be best for you, ask your doctor for a recommendation. When used correctly, you can count on your blood sugar monitor to provide accurate readings. If you think something is not right, start with the basics:
- Check the test strips. Throw out damaged or outdated strips.
- Check the monitor. Make sure the monitor is at room temperature, and the strip guide and the test window are clean. Replace the batteries in the monitor, if needed.
- Check the measurement scale (calibration). Some monitors must be calibrated to each container of test strips. Be sure the code number in the monitor matches the code number on the container of test strips.
- Check your technique. Wash your hands with soap and water before pricking your finger. Apply a generous drop of blood to the test strip. Do not add more blood to the test strip after the first drop was applied.

If you are still not sure what is wrong, do a quality control test according to the manufacturer’s instructions and check the owner’s manual for other troubleshooting issues. You can also take the monitor to your next doctor appointment.

Although finger pricks remain the gold standard for blood sugar monitoring, researchers are developing products designed to take the “ouch” out of the process. Look out for these future advances in the Diabetic press and websites.

No matter how your blood sugar is monitored, it is important for you to record the results of each blood sugar reading, whether you jot the results in a log or your monitor keeps track for you. If your blood sugar readings are consistently higher or lower than your target range — or blood sugar extremes do not respond to adjustments in diet or medication — you may need to revise your treatment plan. In some cases, your doctor may suggest changing your diet or including more physical activity in your daily routine. If that is not effective, you may need to take medication or adjust your medication dosage.