Archive for July, 2009

WEIGHT LOSS
•    Find a diet plan that fits your style
•    Keep a dietary diary
•    Eat a high-protein breakfast
•    Use a pedometer to reach 10,000 steps
•    Try Alli (orlistat) for an OTC weight loss crutch
By now you are probably sick and tired of hearing about the obesity epidemic in America. You already know that bigger is not better and that a large waist size increases the risk of diabetes, high blood pressure, and heart disease. But shedding pounds—and keeping them off—is one of the great challenges of modern life.
It’s not that there is any shortage of advice. There are dozens of diet programs and probably hundreds of diet books available to help you shed pounds, preferably painlessly. Effortless weight loss seems to be the perennial American dream. Some of the diets keep popping up like perennials, as well.
One of them, misleadingly titled “the new mayo clinic diet,” has been circulating on the Internet for a decade. Even then, it was a resuscitation of the “old” mayo clinic diet that had been passed from person to person since the 1960s. The actual Mayo Clinic has disavowed this diet in any of its incarnations, but that doesn’t stop enthusiasts from claiming that you can achieve weight loss of 50 pounds in 2 months by following the plan. People are instructed to breakfast upon eggs, bacon, and grapefruit. Lunch consists of salad, meat, and the ubiquitous grapefruit. For dinner, the dieter has (you guessed it) half a grapefruit plus as much meat as he or she wants and a green or red vegetable cooked in butter. People are encouraged to eat until they are
full.
The sad and simple truth is that there are no shortcuts to the shape you want. Taking off pounds requires taking in less energy than you are using up.This equation has two parts: how much you eat and how much you exercise. Changing either part calls for more effort than many of us can muster in an environment that encourages us to eat more and exercise less. No doubt that’s why new diets have such appeal, even though they are often a familiar approach recycled with a new twist.
There are so many diet plans out there that we can’t possibly tell you about each one. Instead, we will stick to some general guidelines that may help you figure out the best approach for you. This is an arena in which one size does not fit all and, sadly enough, there is no magic bullet. Getting weight under control can be quite a challenge, but it is also a great Opportunity to improve your health.
Dietary Approaches
There is no question that diet is crucial to weight loss. You may not want, or even need, to count calories. But even if you take a diet pill, you can’t lose weight without paying attention to what you eat. Dietitians are fond of pointing out that losing weight is a simple matter of using up fewer calories than you take in. “Simple” it may be, but it isn’t easy, as too many of us know! For best results, of course, you need to work on both sides of the equation.
Pick a Plan
Which diet is best for weight loss? That is a difficult question to answer. Most of the popular diets have not been subjected to rigorous study. Even when they have been studied, few of them have gone head-to-head with others to determine the better or best one.
Scientists at Tufts University did undertake a comparison of four popular diets under “real world” conditions. They enrolled people in the trial and then assigned them randomly to the low-carbohydrate Atkins diet, the low-fat Ornish diet, the Weight Watchers diet plan, or the Zone diet. Although there were some interesting differences in the blood fats at the end of the stud
in terms of weight loss, the programs were about the same.People on the more extreme diets—the low-carb Atkins and the low-fat Ornish—lost a bit more weight than those on the more moderate diets. But more people dropped out of those diet groups as well, perhaps because the more extreme diets are harder to follow.
The main trick is to figure out what diet plan you prefer. We don’t mean “what you like to eat”; if you use a diet that focuses heavily on what you like to eat, it will be far too easy to eat too much. No, you need to ask yourself what you are willing to eat. If going without a single piece of cheese for a year will be a major deprivation, you might not want to adopt a super-low-fat approach. If your Italian soul can’t survive without pasta, an ultra-low-carb approach is probably out. But don’t fret too much. Either diet will work, if you stick with it. And so will a lot of the more moderate diet approaches. The social reinforcement built into the Weight Watchers plan can be very helpful for some people; it drives others nuts.
A meta-analysis of diet studies shows that both low-carbohydrate and low-fat diets are about equally effective for weight loss.831 The question is, Do you need to raise good HDL cholesterol and lower triglycerides as well? If so, choose a low-carb diet. But if you really need to get your total cholesterol and your bad LDL cholesterol under control, the low-fat diet is a better way to go.
We have a friend who has managed to lose and keep off about 30 pounds over the years. This weight loss has brought his total cholesterol down so well that he does not need a cholesterol-lowering drug. Mis surprised his doctor, who assumed that he would require a prescription for Lipitor (atorvastatin) or Zocor (simvastatin) sooner or later.
What impresses us is his persistence. He is always very careful about what he eats. We asked him how he manages to keep it up day after day, and he said he makes it like a game with himself. He actually shifts back and forth between a lowcmb pattern and a low-fat pattern, which helps him prevent boredom. But on any given day, he decides which diet he is following and challenges himself to see how closely he can adhere to it. We don’t know if he gives himself points or has a reward system set up. But playing the game of eating right has a lot of rewards built into it, not the least of which is weight control.
If you like the idea of a game, then we have a wonderful “diet” book to recommend: Eat, Drink, and Weigh Less, by the fabulous vegetarian cookbook author Mollie Katzen and the respected nutrition researcher Walter C. Willett, MD, DrPH, MPH. They devised a numeric concept, the body score, that makes it easy to measure how well you are eating and challenge yourself to do even better. 832
Write It Down
Aside from getting you to focus more on low-calorie, high-nutrient vegetables and fruits, calculating your bodV score brings another tool into play: the dietary diary. Even if you do nothing else in your weight loss efforts, do this. Get yourself a portable notebook. It can be as nice as you like, or as inexpensive as a little flip pad. But it does need to -be small, because you should take it with you everywhere you go and write down everything you eat. Not just the menus of your meals, though that is necessary and can be fun. You must also note every tidbit, every nut, every chocolate chip that you eat between meals.
***** Dietary Diary
No matter which diet you plan to follow, this allows you to track your progress. The simple act of writing it down can help you become more aware of what you are eating. You learn to ask yourself, Do I really want this?
In addition, you can analyze the information in your dietary diary to see what circumstances conspire against your sticking to your plan. Try to figure out other ways to deal with problems like having to rush from appointment to appointment and therefore missing lunch, then discovering that you are starving before dinner and gobbling down a bag of tortilla chips with nacho cheese, sauce.
Downside: Inconvenience. But if you stick with it, writing down what you eat and what else is happening can be a great way to reinforce your diet.
Cost: It’s up to you. You could spend as little as 69 cents on a small notebook or as much as $30 on an elegant bound diary.
And don’t forget to write down what you drink as well. Some of us get a lot of calories from sweetened beverages like soft drinks, fruit drinks, or sweet teas. In fact, this makes up 21 percent of our national calorie consumption. 833 Switching to water most of the time could make a substantial difference in energy intake for some people.
Eat Breakfast
It might seem like a good idea to save on calories—and time—by skipping breakfast. You’ve got enough trouble just trying to pull
get dressed, putogether everything you’ll need for the day, and get out the door. If you’re a parent, you may need to do all of that for your children, as well! It’s not easy. But going without breakfast, or grabbing just a cup of coffee and a piece of toast, is a bad idea. A study that has looked at people who have successfully lost weight and kept it off found that most of them make breakfast an important meal, or at least a reliable one.”"
There are probably some breakfast choices that might be worse for dieters than no breakfast at all. Coffee and a Danish pastry come to mind, so do orange juice and a big stack of pancakes dripping with butter and maple syrup. Foods like this are high in sugar and refined flour that are quickly absorbed and push blood sugar and insulin up rapidly. (This can be quantified in scientific terms as the glycemic index of a food, which compares the food’s effect on blood glucose to that of table sugar.) The result, though, may be that your blood sugar level will crash in 2 or 3 hours, resulting in fatigue and maybe even hunger. Instead of these high-glycemic-index treats that will send blood sugar and insulin on a roller-coaster ride—first way up, then down, way down—you want a meal that will carry you through until lunchtime. That way you have a better chance of resisting the midmorning siren call of cookies or pastry. Breakfast is especially important for children, who pay better attention in school with a little nutrition under their belts.
We like a light scramble made of mostly egg whites plus a whole egg. If that’s too much trouble, how about low-fat cottage cheese with some vegetables? Our quickest breakfast, a smoothie, still has a fair bit of protein in it: a frozen banana (peel it before you put it in the freezer!), a couple of scoops of powdered whey protein, a few teaspoons of powdered egg white, a cup or so of frozen fruit or berries, and about 3/4 cup of yogurt and just enough fruit juice to get the blender to work.
With the juice, you don’t need any sweetener; the whey and egg white are good protein, much better than yogurt alone’, and the berries offer all kinds of nutrients as well as fiber. Anyway, the point here is that you should find a breakfast that fits your tastes and lifestyle and satisfies you so you won’t need a snack before lunch.
Keep Moving
As we pointed out earlier, even the most rigorous diet is only half of the story. The other half is increasing your energy expenditure through physical activity. It needs to be tailored to your lifestyle just as carefully as your meal plan.
The majority of Americans just don’t use their muscles very much. If there were games or sports you enjoyed when you were younger, think about whether you might find the time to dust off the rust and go back to playing tennis, say, or dancing. Choosing something you love means you’ll want to do it frequently, and that is more important than the type of exercise. Gardening, swimming, martial arts, yoga, bicycling, or anything else that gets you moving is fair game. There is definitely some activity that will help you use your muscles; it is up to you to figure out what it is and go for it.
If you can’t think of anything else, consider walking. It’s
Pedometer
This gadget is a favorite at our house. It’s small and lightweight, so you can set it to 0, clip it on your belt, and wear it all day long just to see how many steps you take. Of course, if you have a favorite walking or running course, you can measure the distance in miles or kilometers by wearing the pedometer while you traverse it. The goal of taking 10,000 steps a day is definitely doable, but it provides a good challenge. Public health folks offer it as a starting point.
Downside: it can be tricky to figure out the best place to wear this gadget to get an accurate count. Setting the pedometer so it measures your stride is not as hard as programming a VCR, but it can be a challenge.
Cost: Approximately $25 to $30. You can spend more, but you don’t need to.
cheap and readily available, and it’s good exercise. All you need is a pair of decent shoes and about 20 minutes to spare. If you have been very sedentary, you don’t even want to start with 20 minutes. Begin with 5 minutes and gradually work your way up to longer walks. To give yourself something of an extra challenge, get a step-counting pedometer. Then strive for 10,000 steps a day. Write down your step count every night in your dietary diary. When you can get to 10,000 steps reliably, day after day, set yourself a new challenge.
Herbal Disappointment
Dozens of dietary supplements are promoted as weight loss aids, but the science supporting most of them is lacking. Even when a study is done, the difference between those who took the product and those who took placebo is generally quite modest, possibly just a few pounds over several months. So if someone tries to sell you an all-natural supplement from somewhere exotic—whether it’s the Amazon, Outer Mongolia, or the North Pole—be suspicious. If you are told that the agent will turn on your fat burners or turbocharge your metabolism, double your skepticism. People have been selling herbal diet pills for more than 30 years. If they really worked, we’d all be as thin as we’d like to be. In most cases, the only thing that will lose weight is your wallet.
The track record for herbal diet pills is frankly rather discouraging. For quite a while, ephedra (Ephedra sinica) was promoted as a natural weight loss aid. Companies producing ephedra products made a lot of money until, eventually, the FDA reviewed all the reports of problems with this herb. The agency determined that ephedra was associated with a number of strokes, heart attacks, and other serious complications and called for its removal from the market. Aside from being overweight, some of the people who suffered life-threatening or even fatal side effects were otherwise in good health. This Stimulant might have helped people shed pounds in the short term, but it was not safe enough to be used for the long haul.
Ephedra has stimulant properties, which probably account both for its ability to promote some weight loss and for its potential to trigger a dangerous reaction. A couple of other natural products with stimulant activity have beensu ested for use in weight loss. Green tea835 and yerba matAl
have been considered for this purpose, though the research so far is not impressive. Both contain caffeine, along with other compounds that might be relevant.
Another purported stimulant, Garcinia cambogia (hydroxycitric acid), has also been included in a number of herbal weight loss preparations. A 3-month randomized controlled diet did not demonstrate any weight loss benefit beyond that of placebo.837
Q. What is hoodia? I keep getting e-mail messages that this is a wonderful way to lose weight. Does it work? Is it safe?
A. Hoodia is a cactus that grows in the Kalahari Desert in southern Africa. It is being promoted as a marvelous weight loss agent, but there is very little clinical research to support the claims.
One small, unpublished study (18 obese patients) demonstrated some benefit, but we would need to see far more evidence before recommending this plant product. Questions have been raised about the quality control used in manufacturing hoodia products, and long-term safety has not been established.
Nonprescription Help
One of the reasons that ephedra became so popular was that there were only a few other choices available without a prescription. The most popular over-the-counter (OTC) weight loss ingredient was a decongestant called phenylpropanolamine, or PPA for short. In its heyday during the 1970s and 19805, Dexatrim was one of the most popular brands.
PPA was not as safe as most dieters assumed, however. As early as 1980, British researchers had raised a red flag. When they gave PPA to healthy young medical students, they noted side effects such as an alarming elevation in blood pressure along with dizziness, heart palpitations, headache, insomnia, anxiety, and restlessness. By 1990, doctors in the United States had reported 142 bad reactions to PPA, including bleeding stroke, seizure, and even death. But it took the FDA 10 years to make a move. It requested a study of PPNs safety, particularly with respect to bleeding stroke. Yale investigators found that women who took PPA for the first time in a cough or cold remedy tripled their risk of a stroke. Those using the drug as an appetite suppressant appeared to be at 16 times the stroke risk of a woman not taking
the drug. 8-38
Given these data, FDA staffers estimated that PPA might be responsible for 200 to 500 strokes in people under the age of 50 each year. Extrapolating over all the years it was on the market, PPA could have accounted for as many as 10.000 strokes in people who otherwise would not have been vulnerable to that problem. The agency announced in 2000 that OTC weight loss products would need to be reformulated without PPA.This meant that most dieters could no longer rely on a pill to help them. Ephedra had been taken off the market because it was too dangerous. And PPA was removed as well, also because it was not safe enough.
With the approval of orlistat (available by prescription as
Orlistat (Alli)
This weight loss medication is also available by prescription under the name Xenical. It appears to be one of the few weight loss drugs considered safe for long-term use. Orlistat is intended to be used in conjunction with a reduced-calorie, reduced-fat diet. The drug prevents the absorption of fat from the gastrointestinal tract. Nearly twice as many people on orlistat manage to lose 15 percent of their body weight in a year as people on diet restrictions alone.
Side effects: Most of the side effects are gastrointestinal. Because orlistat prevents the absorption of fat, fat is retained in the imeslines. This may result in stomachache, diarrhea, nausea, flatulence, rectal discharge, and fecal incontinence. Headache is also a possible side effect.
Downside: The drug may interfere with the absorption of fat-soluble vitamins. Take a multivitamin either 2 hours prior to or 2 hours after taking Alli.
Cost: Approximately $50 to $60 per month Xenical) to go over the counter under the name Alli, people finally have a tested do-it-yourself option. The company has chosen the name Alli to imply that it will work best if allied with a full program of dietary and behavior modification approaches. The FDA appears confident that this drug does not pose significant safety issues.
Orlistat is a compound that prevents the absorption of fat. It can help people lose weight, but there are some drawbacks. For one thing, there’s the underwear risk: spotting with oily stool. There also may be increased flatulence, sometimes with discharge. Orlistat doesn’t take you off the hook for eating carefully: The 5- to 6-pound weight loss advantage over placebo occurs only when people eat a reduced-calorie, low-fat diet. Unfortunately, once people stop the medication, they often gain back the weight they lost.
Perhaps Alli would be best used as a “jump start” by someone who’s having a hard time pulling together the pieces of a diet plan. Few people will want to take it year after year, although it does appear to be cost-effective.839
Prescription Weight-Loss Drugs
The history of prescription diet pills in the United States is full of woe and intrigue. Starting in the 1950s, millions of overweight Americans were prescribed amphetamines to help them shed a few extra pounds. Such stimulants were supposed to be taken for only a few months at a time, but they were extremely seductive. Many respectable housewives became dependent on “speed.” This made physicians a bit more cautious about prescribing such medications to help people lose weight.
During the 1990s doctors began to combine two diet pills that had been around for decades. The combination of fenfluramine and phentermine (”fen-phen”) seemed to work better than either drug trouble was, the combination led to heart valve complications. At about the same time, a new appetite suppressant, dexfenfluramine (Redux), was approved. It, too, was associated with heart problems and a potentially life-threatening condition called pulmonary hypertension.
In 1997, the FDA asked the manufacturer to withdraw Redux from the market, although it had been approved only the year before. Fenfluramine was also taken off the market. The fen-phen fiasco was certainly a spectacular disaster. Quite a number of people were left with damaged hearts just because they took drugs to help them lose weight.
Despite this uninspired track record, many people were hoping for the FDA to approve a new diet pill. The claims being made about rimonabant (Zimulti) are extraordinary. It is easy to understand why some people might be eager to try it, even if others are skeptical.
The manufacturer, Sanofi-Aventis, is being especially careful to downplay the cosmetic weight-reducing potential of Zimulti. Instead, they are highlighting other benefits, such as the improvement of lipid profiles. In three large clinical trials, Zimulti resulted in promising metabolic improvements.840,841,842
Good HDL cholesterol rose and bad triglycerides dropped. Insulin efficiency improved and blood sugar levels came down. The positive changes were twice what researchers would have anticipated from weight loss alone. Such metabolic effects may be especially beneficial for people with type 2 diabetes.
What really has millions of people excited, though, is rimonabant’s ability to lower weight. After 1 year on the drug, subjects lost approximately 15 pounds, significantly more than those on placebo. In the world of diet pills, such a loss is impressive.
The buzz surrounding Zimulti is enormous. Weight loss and
iW Rimonabant (Zimulti►
Acomplia is different from other prescription diet pills because it works on an entirely new mechanism. It blocks brain CB0) (cannabinoid 1) receptors that respond to natural marijuana-like compounds. It is more effective than any other medication for weight loss, helping people lose more than 15 pounds over the course of a year.
Acomplia also has beneficial effects on good HDL cholesterol, triglycerides, insulin efficiency, blood sugar level, and blood pressure.
Side effects: Nausea, diarrhea, dizziness, headache, sore throat or flu, anxiety, insomnia, and depression. Most of these were mild and transient, although depression is disconcerting and may lead to suicidal thoughts.
Downside: We don’t have much information on the long-term effects of this new medicine.
improvements in blood glucose, blood pressure, and lipids are certainly much needed. In addition, investigators are studying whether rimonabant may help people quit smoking. There is even some hope that the compound may help people deal effectively with other drug dependencies, including the most prevalent one, alcohol.”
The FDA has delayed approval of rimonabant due to worries about anxiety, depression and suicidal thoughts. It could take years to assess whether the drug is safe enough for longterm use.
Conclusions
Losing excess weight is notoriously difficult, but it can have a profound effect on health. Dropping pounds can help lower blood pressure and get cholesterol under control, as well as alleviating the strain on arthritic joints. Weight loss is probably approached best as a long-term change in lifestyle rather than a short-term goal. If Weight Watchers or a similar program that offers social support appeals to you, by all means try it out. Here are some other suggestions that may help.
•    Find a diet plan that appeals to you. The only program that will work is one that you can stick with long-term.
•    Keep a dietary diary. Write down every single morsel that you stick in your mouth and when. Most of the weight loss gurus that we have consulted over the last few decades emphasize that this one behavior is essential for lasting success.
•    Eat a high-protein breakfast. No more bagels and butter. Skip the orange juice and coffee. A low-glycemic-index meal will carry you through to lunch.
•    Find an exercise you like. Get a pedometer and strive for 10,000 steps a day. Plot your progress in your dietary diary or on a computer.
`If you need a pharmacological boost, consider Alli (orlistat). This fat Mocker may help you lose a few pounds, though the side effects might be embarrassing. Don’t forget to take your vitamins if you take this drug.
•    If all else fails, Acomplia (rimonabant) may provide the help you need to lose weight, improve your cardiometabolic risk factors, and quit smoking. Check with your doctor about the benefits and risks of this prescription drug.

TINNITUS
6 Test drive a hearing aid/masking device    ***
•    Take melatonin at bedtime    **
•    Ask your doctor about misoprostol (Cytotec)
Can you imagine anything more annoying than hearing a mosquito buzzing around your head and not being able to catch it? A dentist’s drill might be a close match. Now imagine what it would be like to have crickets chirping in your ear 24 hours a day, 7 days a week.
Experts estimate that more than 30 million Americans hear a constant noise in their ears.807′Roughly one in eight men between the ages of 65 and 74 experiences some form of tinnitus (pronounced TIN-a-tus or tin-EYE-tus).808 Women and children are not spared the unwanted sound effects, which some describe as hissing, humming, chirping, whooshing, whistling, squeaking, or roaring.
Many tinnitus sufferers hear a high-pitched ringing, while others say it sounds more like steam escaping. Others complain of radio static or an electronic whine inside their head. One person described it this way: “I have aff ocean between my ears every day, 24-7.” Whatever the sound, it never lets up—but nobody else can hear it, either.
My husband has a constant buzz in his ears andalso hears a sound he likens to a dishwasher running. This particular sound bothers him most when he goes to bed or wakes up at night, and it wakes him frequently. The doctor says lots of people have tinnitus and the problem isn’t serious, but it has my husband on the ropes.
According to the medical establishment, “Many patients with tinnitus believe that they have a serious medical prob- lem. This is rarely the case.” 8(3) We beg to differ. People with tinnitus look normal, but the affliction can be as crippling as arthritis. Some individuals are so distressed by the sounds they hear that they become severely depressed and contemplate suicide. A study has found that even moderate tinnitus can interfere with cognitive ability, making it harder to focus and achieve peak performance while working on demanding tasks-810
Tinnitus can be caused by many things, including very loud noises. More than 15 years ago, Joe was preparing to cohost a radio show when a student engineer made an error and created a feedback loop through Joe’s headphones (the kind of screech you sometimes hear through speakers in an auditorium). The sound was so loud and so close to his ears that from that day to this, Joe has heard a ringing and hissing sound. Some days the noise is so overpowering that it is hard for him to concentrate. For people who cannot imagine what you are going through, it is difficult to describe how disconcerting it is to have a fieldful of crickets inside your head all the time.
We fear that millions of teenagers and young adults may be setting themselves up for tinnitus and other forms of hearing loss by exposing themselves to high volume levels while listening to iPods and other music devices. There are so many loud noises in our environment that the cumulative effect can damage our ears and increase our risk of tinnitus. We’re talking about everyday things in our lives like blenders, vacuum cleaners, motorcycles, leaf blowers, and lawn mowers. All of them are loud and can contribute to hearing problems.
G. I have just developed a hissing sound in my ears. The onset was very rapid!
The doctor diagnosed it as tinnitus but would give me no reason for the problem. He said there wasn’t anything I could do. I’ve noticed some days it is less disturbing than others, but some nights it awakens me because it has become so loud.
I was drinking large quantities of tonic water, which contains quinine, when this started. Do you have any suggestions to help me?
A. Stop the tonic water! Quinine gives tonic its distinctive bitter flavor, but it can cause tinnitus, especially at high doses. Hopefully the hissing sound will gradually go away once the quinine is out of your system.
Drugs are another common cause of tinnitus. An amazing number of prescription and over-the-counter medications can cause ringing in the ears. Aspirin is one of the most common culprits, but many other arthritis drugs can also contribute to the problem. If you suspect that a medicine is causing ringing, hissing, or whooshing, please discuss this with your physician promptly.
Drug-Induced Tinnitus
A. 1 am desperate to find some way to alleviate my arthritis pain without experiencing unbearable tinnitus. I have taken aspirin for some time, and it has been quite effective. If a joint flares up, l increase the dose for a few days. Then I heard your radio show where you mentioned that aspirin can contribute to tinnitus.
The noises in my head had been getting worse. I was resigned to this, but after listening to your program I stopped the aspirin. The result for my ears was dramatic! But then the joint pain came back. I feel I am walking a very thin line between arthritis and tinnitus.
A. Sadly, you are caught between a rock and a hard place. Aspirin and other arthritis drugs (nonsteroidal anti-inflammatory drugs, or NSAIDs, like naproxen and ibuprofen) can cause ringing in the ears. Some people are susceptible to even low doses. You may need to investigate other options for arthritis pain. (See page 102 for some nondrug approaches.)
In addition to sound-induced injury (like Joe experienced) and drugs, many other things can cause tinnitus. Impacted earwax is probably the most benign and easiest to correct. Some other contributors include head injury, multiple sclerosis, hypertension, infections (otitis media, Lyme disease), and tumors (acoustic neuroma). That’s why it is important-to be seen by a specialist (an otorhinolaryngologist, or ear, nose, and throat doctor) to rule out any treatable condition. Sometimes there is no obvious reason for the ringing or whooshing.
A few months ago I suddenly developed a case of tinnitus in my left ear It sounds like the high-pitched noise the computer makes when logging onto the Internet I am 36 years old and in extremely good health. I have not experienced any head trauma and am not exposed to loud noises.
I had an MRI to rule out a brain tumor Neither my family physician nor an ear, nose, and throat doctor could find anything wrong
DRUGS THAT CAN CAUSE TINNITUS*
GENERIC    BRAND NAME
Aspirin    Alka Seltzer, Ascriptin, Bayer
Bleomycin    Blenoxane
Bumetanide    Bumex
Bupropion    Wellbutrin SR and XL
Cetirizine    Zyrtec
Chloroquine    Aralen
Cisplatin    Platinol
Diclofenac    Cataflam, Voltdren
Erythromycin    E-Mycin, Ery-Tab, Eryc
Furosemide    Lasix
Ibuprofen    Advil, Motrin
Meloxicam    Mobic
Methotrexate    Rheumatrex
Nabumetone    Relafen
Naproxen    Aleve, Anaprox, Naprosyn
Quinine    Quinamm, Quinerva, QM-260
Risedronate    Actonel
Tetracycline    Sumycin
Valproic acid    DepakeRe,
Vancomycin    Vancocin
Vincristine    Oncovir
*This is just a partial list. Hundreds of drugs can contribute to tinnitus.
with me and they have not suggested any remedies. I currentlyiust barely manage it with white noise (a fan) at night
Treatments for Tinnitus
When everything else has been ruled out and you are left with ringing in the ears, what can be done? First and foremost, do not expose yourself to noise pollution. Chances are good you already have some hearing loss. Be cautious around all appliances (blenders and vacuum cleaners, for example) and power tools. When flying, take along hearing protectors (you can buy earplugs that fit in your ears unobtrusively) to block out some of the jet engine sounds at airports or on loud commuter airplanes. Do the same when attending concerts or sports events. Protect your ears from any further damage.
The official word from the medical establishment is that “most treatments [for tinnitus] are unsuccessful.”811 A review of 69 randomized clinical trials published in 1999 concluded that there was no proof that any therapy provides long-term improvement.812 Investigators have experimented with powerful medications that control irregular heart rhythms (intravenous lidocaine, and oral flecainide and tocainide), but the results were disappointing and the side effects scary. Anti-anxiety agents (benzodiazepines) such as alprazolam (Xanax) may help ease the psychological impact of tinnitus, but when the drug is discontinued, the problem can return with a vengeance. The antidepressant nortriptyline has shown more promise than many other approaches, but the benefits still are not overwhelming.813 Acupuncture, biofeedback, hypnosis, and “tinnitus retraining therapy” have all been disappointing and do not make the ringing go away.
Most physicians will say that the primary goal of treatment for tinnitus is “management.” Usually this means things like masking devices. In its crudest and cheapest form, a masking device is an FM radio tuned so that you do not get a signal, just static. The theory is that this “white noise” will mask the sound of the tinnitus. Some people find this helpful, whereas others report that it just intensifies the annoying sounds.
There are also white noise generators or masking devices that can be “tuned” to an individual’s general noise frequency. There are also sophisticated new hearing aids that both amplify sound in the hearing range that is impaired and  Hearing Aid/Masking Device
High-tech hearing aids that combine frequency-specific amplification and masking in one device may be worth consideration. Some folks report both improved hearing and reduced tinnitus with such equipment. Sometimes the tinnitus relief lasts for some time after the device is turned off or removed .814
Downside: These special hearing aids are pricey, costing several thousand dollars. Insurance is not likely to cover the cost. They require professional fitting. Do not expect them to solve the problem, but they may make it more tolerable.
Cost: Approximately $1,000 to $3,000 per ear. Try to work out a “test drive” to make sure they work well and adequately relieve your tinnitus discomfort. Another option: Lease with an option to buy. If they do not solve your problem, you can at least give them back when the lease is up.
use a masking signal that is adjusted to the specific range of the patient.
My husband has suffered for years from tinnitus and hearing loss (due to his time in Vietnam). He recently found great relief with the new technology in hearing aids. Since getting his hearing aids, the ringing, buzzing, etc., has completely gone away and his hearing is now very acute.
Many folks have tried hearing aids in the past without success. know my husband did. He said they just made the ringing louder! He is thrilled with this new technology. I believe this might help many who haven’t tried the devices.
No one should buy these pricey instruments unless they ac-
tually work. That means you should be able to either test the device for a short while or lease it for somewhat longer before shelling out thousands of dollars to purchase it.
Ginkgo Biloba
There has been some interesting research on this ancient Chinese herbal medicine. From the more than 100 clinical
trials that have been published, there seems to be a reasonable amount of data suggesting that standardized ginkgo extracts (Ginkgold, Ginkoba, and Ginkai) improve circulation throughout the body, in general, and may modestly improve symptoms of dementia.’”‘ A 1999 review of clinical studies of ginkgo concluded that “overall, the results of these trials are favorable to ginkgo biloba as a treatment for tinnitus, but a firm conclusion about efficacy is not possible … the body of evidence is small.„816
Since then, there have been two studies that have not found ginkgo to be an better than placebo for relieving symptoms of tinnitus.”11,81′ At this time it would be fair to say that the evidence is mixed at best and probably not very promising. On the other hand, ginkgo does seem to improve circulation and may be worth a try. Do not expect any miracles, though.
Adding a little zinc to the mix (50 milligrams) might be worth consideration since a small study suggested that this mineral produced some modest clinical improvement.”’ If after several weeks there is no improvement, we would give up on this approach.
Melatonin
One of the least studied but most promising new approaches for the treatment of tinnitus may be melatonin. This natural compound is inexpensive and safe. Melatonin is a hormone that is made primarily by the pineal gland in the brain in response to darkness. During the daytime, the blood level is low, but at night melatonin climbs until it reaches its peak between
** Melatonin
Melatonin is natural, safe, and not very expensive. Although there is some controversy about its effectiveness for insornni8, two preliminary studies suggest that it may help people with tinnitus and sleeping problems associated with ear ringing. The dose that has been tested is 3 milligrams.
Downside: The data are not yet strong enough to elicit a ringing endorsement.
Cost: Approximately $2 to $4 per month when purchased in bulk
2:00 and 4:00 a.m. It is crucial for regulating sleep and wake
cycles.
Some extraordinary claims have been made for melatonin. Some proponents say that it can reverse aging, improve immune function, reduce the risk of cancer, control blood pressure, and lower cholesterol. The best-known use of melatonin is as a sleep aid. An extensive review of the existing studies published in the Cochrane Database concluded, “Melatonin is remarkably effective in preventing or reducing jet lag, and occasional short-term use appears to be safe. It should be recommended to adult travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet lag on previous journeys
Despite this good news, two reviews of melatonin’s use for easing insomnia were less glowing. They concluded that melatonin does not work for sleep disorders’ 1,822 Nevertheless, a small preliminary study carried out by the Ear Research Foundation in Sarasota, Florida, in 1998 revealed that a dose of 3 milligrams of melatonin was helpful for patients with tinnitus that interfered with their sleep. 823 Following up on this research, investigators at Washington University in St. Louis also found that a dose of 3 milligrams was beneficial for people with tinnitus: “In summary, our study demonstrates that melatonin use is associated with improvement of tinnitus and Sleep.”824 Although the research to date is preliminary, melatonin seems to be worth a try because of its safety and affordability.
Misoprostol (Cytotec)
Sometimes doctors teach old drugs new tricks.’Tbat might be the case with misoprostol (Cytotec), a medication approved more than a decade ago to help prevent stomach ulcers. It was hoped that Cytotec would be especially beneficial for people taking aspirin or other NSAVDs like ibuprofen or naproxen. This medication has become controversial in recent years because some obstetricians have used it to induce labor. Others have combined misoprostol with mifepristone to induce abortion.
An entirely different use for misoprostol is treating tinnitus. We first stumbled across a pilot study that was published in 1993 in the Archives of Otolaryngology—Head & Neck Surgery.wL’ One of the most prestigious ear clinics in the world (House Ear Institute in Los Angeles) enrolled 24 subjects. These volunteers were given either misoprostol or placebo. Not surprisingly, the placebo did not work. Misoprostol, on the other hand, provided improvement for eight (33 percent) of the subjects. According to the investigators, “Responders reported improvement in tinnitus severity, sleep, and concentration:
More than a decade later, Turkish investigators noted that 13 of 28 patients (46 percent) who were given misoprostol reported a decline in the volume of their tinnitus, compared to only 2 of 14 subjects (14 percent) in the control group. 827 A
Misoprostol (Cytotec)
This prescription medication has FDA approval for the prevention of stomach ulcers. An “off-label” use may ultimately turn out to be for tinnitus. Preliminary studies have found that misoprostol may help roughly one-third to two-thirds ofrr tinnitus sufferers, with those who experienced a sudden onset of tinnitus or who had a history of acoustic trauma getting the most benefit. The dose used by the researchers was “200 micrograms per day for the first week, increased by 200 micrograms every 5 days” to reach a maintenance dose of 800 micrograms per day. This latter amount is also the dosage commonly used in gastroenterology.”828
Downside: Very expensive! Misoprostol must never be taken by a woman who is pregnant or might become pregnant. It can induce premature labor and cause other serious complications. Patients with heart or inflammatory bowel problems should also avoid misoprostol.
Side effects: Common adverse reactions include abdominal pain, indigestion, diarrhea, nausea, vomiting, flatulence, constipation, headache, and menstrual changes. Rare but potentially serious side effects include allergic reaction, irregular heart rhythm, heart attack, high blood pressure, low blood pressure, breathing difficulty, and blood clots.
Cost: Approximately $160 to $300 for a 2-month supply (depending on whether you purchase from a Canadian or US pharmacy)
follow-up study found that 18 of 28 patients “showed improvement in tinnitus loudness, representing an improvement rate of 64 percent. These are all small studies, and larger, more comprehensive, and longer follow-up research is required to prove that misoprostol represents a true advance in the treatment of tinnitus.
Conclusions
Compared to heart disease, diabetes, and cancer, tinnitus seems like a trivial complaint. But ask anyone who suffers from it and you will discover that it can have devastating consequences on the person’s quality of life. The constant ringing or hissing not only affects concentration, it also can interfere with sleep. Many people with tinnitus are depressed, and some even contemplate suicide. There is no cure and no perfect treatment. Nevertheless, there are some options worth considering.
•    Avoid loud noise, including common household appliances like blenders, hair dryers, vacuum cleaners, and power tools. Concerts, sporting events, and airports call for ear protection. Noise can make tinnitus worse.
•    Beware of prescription medicines and over-the-counter remedies that can trigger tinnitus or make it worsee. Even the quinine in tonic water can be a problem for some people.
•    Some people benefit from antianxiety agents like alprazolam (Xanax) or antidepressants such as nortriptyline. These drugs are not without side effects, however.
•    Seek professional advice about new technology that combines a hearing aid with a masking device. This equipment may help improve hearing and reduce the ringing. Try to negotiate for a trial period to test the hearing aid so you can make sure you are satisfied before shelling out thousands of dollars to purchase it.
•    Give ginkgo biloba a try. Although the research is not very supportive, ginkgo may help and it is relatively inexpensive. Make sure that it won’t interact with any other medicine you are taking.
•    Consider melatonin. This natural compound appears to be quite safe and may help tinnitus sufferers get some much-needed sleep.
•    If all else fails, your physician might prescribe misoprostol. A few small studies have found it useful for about one-third to two-thirds of tinnitus patients. Its price and side effects are daunting, however.

•    Exercise regularly to keep bones strong
•    Take vitamin D along with your calcium supplements
•    Experiment with Menostar (estradiol) instead of hormone replacement therapy
•    Consider Evista (raloxifene) to reduce risks of spinal fracture and breast cancer
•    Ask your doctor about the benefits and risks of Fosamax (alendronate)
•    Make Miacalcin (calcitonin) an option if back pain from fractures is an issue
iryt
We tend to think of our bones as hard and unchanging, like the bones we find on our dinner plate. But actually, they are living tissues that undergo constant change and renewal, just like our other organs. Cells called osteoclasts break bone down, and cells called osteoblasts build it back up, just as if you were remodeling your house a room at a time. The osteoblasts build up living tissue and reinforce it with minerals like calcium, magnesium, boron, and manganese.
Normally, these two processes—resorption and formation of bone—are closely linked so that bone stays strong. Quite a few factors can upset the balance, though. If the osteoclasts race far ahead of the osteoblasts, bone density can drop and eventually the bones are not strong enough. A minor fall can result in a broken hip, which can be catastrophic for an older person.
OStevporosis a condition of weakened bone, is responsible for 1.5 million fractures each year, including 300,000 hip fractureS.71 The National Institutes of Health (NIH) estimates that 10 million Americans currently have osteoporosis. Two million of them are men. While osteoporosis is thought of as a women’s issue, it is not limited to women.
There’s no shortage of controversy surrounding osteoporosis. Perhaps the first issue is just how many people should be RISK FACTORS
•    Female
•    Increased age
•    Shortness and thinness
•    White or Asian
•    Family history of bone loss
•    Sedentary lifestyle
•    Irregular menstrual periods
•    Early menopause
•    Low testosterone (men)
•    High level of thyroid hormone
•    Low-calcium diet
•    Low level of vitamin D
•    Cigarette smoking
•    Alcohol consumption
•    Prednisone or similar drugs (long-term use)
•    Certain anticonvulsants
•    Celiac disease
concerned about it. According to the NIH, 34 million people have low bone density. Add that to the 10 million who have been diagnosed with osteoporosis, and you come up with 44 million Americans for whom “osteoporosis is a major public health threat .,,767 That’s more than half of the population over 50 years of age.
Lumping those 34 million who have low bone density together with those who have already been diagnosed with osteoporosis certainly makes for a larger potential market for the drugs that have been developed to prevent or treat bone loss. Some public health researchers have criticized this tactic by calling it “disease-mongering.’,768 Instead of characterizing osteoporosis or low bone density as a risk factor for fracture, calling it a disease implies that it requires treatment. 769 The critics claim that this tactic mobilizes fear (and helps sell IS IT CELIAC DISEASE?
Anyone can break a bone by falling off a horse or out of a tree. But some people break bones without even trying. If you have experienced fractures for no logical reason, you and your doctor may want to figure out why your bones are not as strong as they should be.
One possible explanation is celiac disease. It should be investigated in young people with low bone density measurements. Celiac disease is due to gluten intolerance. If it is not diagnosed and a gluten-free diet is not followed, the resulting damage to the small intestine can interfere with proper absorption of the nutrients needed to build bone.
drugs) rather than promoting understanding and positive action.
The availability of bone density screening is a two-edged sword in this respect. On the one hand, it is helpful for those who are truly at risk to find out before they break a hip or develop debilitating back pain from vertebral fractures. Unfortunately, many of those being screened are not those who need it most. An analysis of nearly 44,000 women on Medicare found that the oldest women, ages 81 to 85, were only half as likely to be screened as women ages 66 to 70.770 The older women, however, are far more likely to have reduced bone density, even osteoporosis, putting them at risk of a fracture.
Increasingly, middle-aged women are being screened for bone density. The scoring system is a bit complicated, since it is based on standard deviations below the bone density of a young person at peak bone mass. Most of us don’t have the grounding in statistics to make much sense of “standard deviations,” so if the doctor does not explain carefully what the numbers mean, women often end up confused and alarmed. Critics point out that defining osteoporosis as bone density that is 2.5 standard deviations (T score –2.5) below the mean for a young person practically guarantees that approximately 30 percent of postmenopausal women will be diagnosed with this condition, whether they are truly at risk for osteoporosis or not.”Reducing the Risk of Fracture with Nondrug Approaches
Although osteoporosis treatment now includes many more options than it did just 10 years ago, each drug that is prescribed for weakened bones has some drawbacks. That’s why it makes sense to start with nondrug approaches and see how far they will take you. If you begin early enough, you may be able to slow bone loss and prevent a fracture. But even if you already have osteoporosis, these tactics may be a good addition to pharmacological treatment to make it more effective.
Exercise
Your doctor may not be accustomed to prescribing a walk around the block,. but getting more exercise should be just what the doctor orders. In so many cases nowadays we must go out of our way to work up a sweat. Few of us do manual labor to earn a living; walking to our jobs or just to the store is almost as rare, especially in many suburbs. So instead of incorporating physical movement into everyday life, we need to find time—and funds—to go “work out” somewhere.This may be too inconvenient for many people.
It has become clear that our bodies adapt to the demands we make of them. Weight-bearing exercise like walking, running, or mowing the lawn encourages bones to grow stronger.
***** Exercise
Moving your bones helps strengthen them. Doing something enjoyable on a regular basis—walking, gardening, dancing, or another weight-bearing activity—acts to delay bone loss as well as strengthen muscles, benefit cardiovascular health, improve mood, and reduce the risk of dementia. Exercise alone may not be enough to reverse bone loss, but it can improve the effectiveness of other treatments.773
Side effects: Sore muscles
Downside: If the exercise program is overly ambitious or too dangerous, a person with reduced bone density may experience injuries, including fracture.
Cost: Too variable to estimate Sitting in front of a computer screen, sadly, does nothing to stress our bones in a healthy way. In fact, differences in traditional patterns of activity may explain why women usually have less bone mass than men, even as young, healthy adults. In the past, boys were expected and encouraged to be active by playing sports and helping with strenuous chores. Girls, by and large, were not. Although these differences are diminishing among today’s children, physical activity has been declining across the board.
A lifetime of activity is ideal for the strength of the skeleton, but it may never be too late to benefit from more exercise. Anyone who has already experienced fractures from osteoporosis should check first with his or her physician, but appropriate weight training or walking may be helpful even for those who are quite elderly or a bit debilitated. The, exercise program should be carefully designed, of course, so that it does not put the person at a higher risk for fracture from a fall or injury.
The Calcium Craze
Calcium supplements are the first thing most people think of for preventing or treating osteoporosis. Although an adequate calcium intake is necessary to maintain strong bones, just taking calcium doesn’t seem to help very much once bone density has begun to decline. Calcium supplementation can make a difference in young people, whose bones are still developing. But in postmenopausal women, the evidence is murky. Some studies have shown that 500 to 1,000 milligrams of calcium a day together with 700 to 800 IU of vitamin D can reduce the number of fractures (though this benefit does not extend to
the spine ).774,175.776
The results of the Women’s Health Initiative on this issue were less encouraging. The study was very large, involving more than 36,000 postmenopausal women. Though supplements of 1,000 milligrams of calcium and 400 IU of vitamin D daily improved the density of bone in the hip, it did not
3    777
reduce the number of hip fractures, Scientists have tried to explain the disappointing results: The women were not in the oldest age category at highest risk for fracture; the women on placebo pills could take calcium on the side if they chose to; many of the women in the active supplement group did not take their calcium and vitamin D, every day.
Calcium is important for preventing and treating osteoporosis—but by itself it isn’t enough. Taken together with adequate vitamin D, it may help reduce the risk of falling as well as improve bone mineral denSity.77,44
Most of the experts who do research on osteoporosis agree that a calcium-rich diet (or a supplement of around 1,000 milligrams daily) and 15 to 20 minutes of sun exposure 3 or 4 days a week (or a supplement of 800 to 1,000 IU of vitamin D3, also known as cholecalciferol) are a sensible approach. Take no more than 500 or 600 milligrams of calcium at a time for better absorption.
Calcium also works with dietary protein to benefit the skeleton.779 Make sure you are getting enough protein.
Side effects: Gas, intestinal bloating, constipation Downside: Too much calcium increases the risk of kidney stones.
Cost: $6 to $10 per month for a supplement that contains both nutrients
In addition, 400 IU of vitamin D, just may not be enough. An analysis of a number of studies concluded that it takes at least 700 IU of vitamin D, a day to make a difference in fracture risk .780 Lower dosages simply aren’t effective.
Human skin can make vitamin D when it is exposed to sunlight. but older people are often careful not to go out in the
VITAMIN D PARANOIA
The recommendation for supplementing with vitamin D. has been set at 400 IU a day because of worries that a person could get too much. Vitamin D in excess is toxic, so taking more than 2,000 IU a day would be foolish. Most people don’t need a lot more than 1,000 IU daily, but that seems to be a more sensible level to aim for than the currently sanctioned 400 IU. That is especially true for older people at risk for osteoporosis, who may be avoiding sun exposure for fear of skin cancer.
sunshine without their sunscreen. Aging skin is less efficient at making vitamin D, so a health-conscious older person may actually be making very little of it. If this is true for you, a supplement may be advisable.
We weren’t as surprised as others may have been at the lackluster results seen with calcium supplements in the Women’s Health Initiative. Walter Willett, MD, DrPH, MPH, the Frederick J. Stare Professor of Nutrition and Epidemiology and chair of the department of nutrition at the Harvard School of Public Health, had told us years earlier that calcium is not the whole story. Women in Scandinavia have the highest calcium intake in the world, but they also have the highest rates of osteoporosis. Women in some parts of Africa get very little calcium in their diets yet rarely have trouble with fractures as they age. Sun exposure is one obvious difference that might account for women having relatively low levels of vitamin D in Scandinavia.
Clearly, other factors are at work here. That doesn’t mean you should cut down on calcium. But don’t count on it to do the job alone.
If you do choose a calcium supplement, keep in mind that calcium citrate may be taken with or without food, but calcium carbonate is absorbed best if taken at mealtime. 783 Many sources recommend taking 300 to 500 milligrams of magnesium with the calcium supplement.
Drugs to Treat Osteoporosis
Calcium supplements may be necessary but not sufficient against bone loss. Joel Finkelstein, MD, of Massachusetts General Hospital, has suggested that supplements of calcium plus vitamin D should be thought of as the ante for a poker game: It’s the bare minimum if you are going to play.784 Most of the drug treatments for osteoporosis work best if a person gets adequate amounts of these nutrients as well.
Low-Dose Estrogen (Menostar)
Women used to be told that once they reached menopause, they needed to take hormone replacement therapy to keep their bones strong. The idea was that they would be on estrogen (plus progesterone, unless they had undergone a hysterectomy) for decades and that this would prevent osteoporosis and the resulting fractures.
The findings of the WHI threw the wisdom of that simple approach into question. Although hormone replacement therapy (HRT) did cut the risk of hip fracture by more than 30 percent, it increased the risk of coronary heart disease, stroke,
785
and breast cancer. After these findings were released, many women decided that they were more concerned about heart attacks and strokes than broken bones. So they stopped taking their HRT.
Since then, clinicians have been trying to find a way to get the benefits of HRT without all the risks. One way to do that is Menostar is a relatively new ultra-low-dose transdermal estrogen patch. It can increase bone mineral density and has been approved for preventing osteoporosis in postmenopausal women. Menostar comes as a patch applied to the belly. Each one lasts a week.
Side effects: Redness or irritation under the patch. Estrogen has a number of side effects, such as blood clots, stroke, increased risk of breast or endometrial cancer, and gallstones. It is not clear to what degree Menostar will cause estrogenic side effects.
Downside: No evidence that Menostar will prevent fractures; no long-term data on cardiovascular safety
Cost: About $50 a month
with an estrogen-receptor modulator such as Evista (see page 517). Another way might be with a different form of estrogen. In 2004, the FDA approved a low-dose estrogen patch to prevent osteoporosis, This transdermal patch, called Menostar, releases 14 micrograms of estrogen as (17-beta)-estradiol a day. This form of estrogen is different from the mixture found in Premarin or Prempro but the same as that found in some other estrogen pills for postmenopausal women. Estrogen is absorbed well through the skin, so the dosage delivered in a skin patch can be a lot lower than the dosage in a pill.This dose is quite a bit lower than those of other commonly prescribed estrogen patches used to treat menopausal symptoms.”
Menostar is not for treating menopausal symptoms such as hot flashes or vaginal dryness. It is not for use by women who already have osteopOCOSis with vertebral fractures. But for women whose bone mineral density is low or who are at risk for developing osteoporosis, Menostar might be one way to try to get the bone benefits of estrogen while sidestepping the cardiovascular risks.
The research done on Menostar indicates that it is not likely to cause problems in the uterus, even though there is no progesterone in the regimen to protect the uterine lining.” It does increase bone mineral density, particularly in the spine, better than placebo. 718 There are not enough data to indicate whether women using Menostar are less susceptible to fractures, either of the spine or of the hip.
The bottom line on Menostar is that women who choose to use it at this time should recognize that in some respects they are experimenting. There are still some important facts about its potential long-term benefits and risks that need to be clarified.
Raloxifene (Evista)
Raloxifene (Evista) was specifically designed to be as much like estrogen as possible in its effects on bone and unlike estrogen in many other ways. The researchers who developed this selective estrogen receptor modulator, or SERM, were hoping that it would strengthen bone and prevent fractures as hormone replacement therapy seems to, but that it would not increase the risk of uterine or breast cancer as HRT does. They were largely successful in their efforts. This medication does reduce the risk of fractures in the spine, although it does not seem to have much impact on hip fractureS.719
Because any osteoporosis drug must be taken for many years, a study considered the safety of raloxifene over a period of 8 years and found that it did not increase the risk of heart attack, stroke, uterine cancer, or ovarian cancer.7 90 Like HRT, raloxifene increases the risk of blood clots forming in
.,
**** Raloxifene (Evista►
This pill strengthens bone and is especially effective at preventing fractures in the spine. It is approved both for preventing and for treating osteoporosis. In addition, raloxifene can reduce the risk of invasive breast cancer in high-risk (postmenopausal) women by approximately 50 percent.
Side effects: Blood clots, vaginal dryness, hot flashes, joint pain, leg cramps
Downside: Raloxifene does not appear to have a significant effect on hip fractures. In addition, it does not reduce the risk of noninvasive breast cancer.
Cost: Approximately $75 for a month the veins. In fact, this drug increases the risk of fatal strokes as well as dangerous blood clots.19′ As a result, doctors and patients need to weigh its benefits—reducing the risk of spinal fractures and of invasive breast cancer—against the possibility of a blood clot or a stroke.
In the spring of 2006, scientists announced that Evista had performed well in the STAR trial, the Study of Tamoxifen and Raloxifene for preventing breast cancer.The women who had volunteered for this National Cancer Institute–sponsored study were at increased risk of developing breast cancer. Both drugs reduced their likelihood of a breast cancer diagnosis by about 50 percent. Women who took raloxifene were less likely to experience blood clots, cataracts, or uterine cancer than those given tamoxifen.
‘Me investigators concluded that women who had already taken tamoxifen for 5 years following treatment for breast cancer would get no further benefit from taking raloxifene. Women who had not taken tamoxifen but were at high risk of breast cancer could get two benefits—breast cancer prevention and osteoporosis treatment—in one pill if they took raloxifene instead.
Actonel, Boniva, and Fosamax
All three of these osteoporosis drugs fall into the category called bisphosphonates. Alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel) work by slowing down bone resorption. They zip to places where bone remodeling is going on and mess with the osteoclasts so that these bone-wreckers work more slowly. Usually, that is enough to give the osteoblasts a chance to catch up a bit on bone formation.
Fosamax was the first bisphosphonate to be developed and approved by the FDA for treating osteoporosis. It has been available for more than 10 years in this country. Women who have taken it for that long have Continued to increase their bone mineral density. Although it was originally prescribed as a once-daily pill, the inconvenience of getting up early enough to take it an hour before breakfast or even coffee and juice, as advised, cut down on its popularity.Taking Fosamax with anything other than plain tap water reduces the amount that is absorbed and lessens its effectiveness. Changing the regimen so that it is taken only once a week, and only half an hour before breakfast, has made it easier for women to follow the doctor’s orders.
The effectiveness of all of the bisphosphonate medicines is clearest in people who are at highest risk: those who already have osteoporosis, particularly those who have experienced one or more fractures. The bisphosphonates are not hormones and don’t work through the same mechanisms as hormones. As a result, presumably they would be equally effective for men and women with osteoporosis.
Many of the studies that have been done on the bisphosphonates involved only women. Among a group of women who’d already had one vertebral fracture, Fosamax cut the number of hip fractures in hal E792 A head-to-head trial of Fosamax against Actonel showed that Fosamax had a slight edge. Subjects taking once-a-week Fosamax had higher bone
*** Alendronate (Fosamax)
Alendronate works by slowing bone resorption. It is commonly given once a week. It must be taken with 8 ounces of plain tap water, not mineral water, at least 30 minutes before eating or drinking anything else. The patient must remain standing or sitting during that time to keep the pill from lodging in the throat, where it can cause damage.
Side effects: Digestive disturbances, including heartburn, esophageal irritation or inflammation that can become severe, stomachache, and diarrhea; severe bone, joint, and muscle pain; osteonecrosis of the jaw, a rare but serious complication following tooth extraction, root canal, and other significant dental procedures; inflammation of the eye, resulting in blurred vision, eye pain, conjunctivitis, uveitis, or scleritis
Downside: Although alendronate has been around for more than 10 years, some of the more worrisome side effects are just now coming to light. No one knows how this drug will affect bone in the long term. Could the increased mineralization of bone end up making bones more brittle instead of stronger? As yet, there are no good answers to this ques- tion.’93
Cost: Approximately $77 per month, a little more than Actonel ($72) and Boniva ($74)
mineral density scores and were less likely to have lost bone than subjects taking once-a-week Actonel. ‘9′
A 3-year study of more than 9,W) women with osteoporosis found that Actonel reduced hip fractures significantly, from 3.2 percent in the placebo group to 1.9 percent in the Actonel group!95′Ibis study found no significant benefit among women who did not actually have osteoporosis but were included because of their age or other risk factors. Boniva, which is given just once a month rather than once a week, can increase bone mineral density. In a study that included nearly 3,000 women with at least one vertebral fracture, Boniva significantly reduced the number of new vertebral fractures.7 It did not reduce the rate of hip fractures or fractures elsewhere besides the spine, however.
A few complications of bisphosphonates that are especially worrisome have been getting significant attention lately. Some people taking Actonel or Fosamax have developed osteonecrosis of the jaw, a condition in which part of the jawbone dies. This seems to be an uncommon side effect, but it is frightening because there is no good treatment for it. Most of the cases reported so far have occurred after tooth extraction or some other major dental procedure. There is no indication that Boniva would be exempt from this issue.
If you are taking any of these drugs for osteoporosis, be sure to tell your dentist and your endodontist about it. We don’t know yet if discontinuing the medication for some months before a dental intervention would reduce the risk of this unusual adverse reaction.
TWo other concerns that have come up with the bisphosphonates are severe joint, bone, or muscle pain, and eye inflammation. ‘Me eye inflammation may affect vision. In one case, 7 the only way to control it was to discontinue the medica- tion. 97 Be sure to discuss your osteoporosis medication with your eye doctor, particularly if you notice any problems with ynx VWion.
The joint or muscle pain required narcotic pain relievers in some cases. The confirmation that it was related to the osteoporosis drug came when drug treatment was stopped and the pain went away—but when the drug was restarted, the pain returned.
Teriparatide (Forteo)
Currently, there is no other osteoporosis drug like teriparatide (Forteo). It is a genetically engineered copy of the active part of parathyroid hormone. This hormone, which is produced by a gland in the neck right next to the thyroid, governs the body’s utilization of minerals such as calcium. Like most of the human endocrine glands, it operates on a feedback system and shuts down when it senses there is enough calcium in circulation. If it senses too little, it stimulates bone breakdown to liberate calcium.
If the hormone stimulates bone breakdown, how can it help treat osteoporosis? Forteo—which is given by injection—is active for only a short time, reaching maximum concentration after about 30 minutes and disappearing completely within about 3 or 4 hours. 799 When the hormone is administered in this kind of short pulse, the body responds by building bone. Forteo is the only osteoporosis drug currently in use that stimulates bone formation.
Studies have shown that Forteo can increase bone mineral density in the spine and the hip. It also reduces fractures in the spine and elsewhere. It performs significantly better than placebo in men as well as women. In a small head-to-head trial against Fosamax, Forteo increased the bone mineral density of the spine by about twice as much and reduced fractures in places other than the spine significantly more than Fosamax did.8w
The FDA has approved Forteo to treat osteoporosis in men and women. It sounds great, but of course there are drawbacks. Side effects with Forteo are mostly mild: nausea, dizziness, headache, and leg cramps. It is given by injection, so redness and swelling may rarely occur at the injection site. A patient just starting on Forteo may experience “orthostatic hypotension,” or dizziness if she stands up suddenly. Fortunately, this side effect usually goes away within a couple of hours.
The big worry with Forteo involves its long-term use. Studies in rats have shown that this drug increases the rate of a bone cancer called osteosarcoma. This may have factored in to the FDA’s decision to limit use of Forteo to 2 years. The medication is so new that no one has a good handle on what the long-term. effects will be, but so far no cases of osteosarcoma have been reported in humans using the drug. 801
Another disadvantage of Forteo is that it must be in-jected every day. It comes in a self-injectable “pen,” and the shot is administered in the thigh or belly. Each pen lasts for a month and needs to be kept in the refrigerator.
In comparison to other treatments for osteoporosis, Forteo is extremely expensive. A single month’s treatment can cost $750 to $800. Given all these negatives, we think Forteo might best be reserved for people whose risk for adverse events with other osteoporosis treatments is too high.
Calcitonin (Miacalcin)
Another hormone that may be prescribed to treat osteoporosis is calcitonin. It, too, is made by the thyroid gland. It binds to osteoclasts and slows down their bone munching. It also helps regulate the action of vitamin D and works together with parathyroid hormone to control the balance of calcium and phosphorus within the body.
Salmon calcitonin can be given either as an injection or in a nasal spray. It can reduce fractures of the vertebrae significantly more than placebo. Some scientists have suggested that it may relieve back pain, which is frequently a serious problem for women whose osteoporosis has caused numerous fractures of the vertebrae. There is no solid consensus on this issue, however. 802,803
** Calcitonin (Miacalcin)
Calcitonin is given not to prevent but to treat osteoporosis. In women who already have at least one fractured vertebra, Miacalcin is significantly better than placebo at preventing additional spinal fractures. Some studies suggest that it helps alleviate back pain by stimulating production of beta-endorphins, the body’s natural opiates.
Side effects: Nausea and vomiting, flushing, redness or soreness at the injection site, rash, reduced appetite, severe allergic reaction; runny nose and nosebleed may occur with the nasal spray
Downside: Expensive. It does not appear to have a substantial effect on preventing hip fractures.
Cost: Nasal spray, $95 per bottle; injection, $45 for 2 milliliters (a 4-day supply)
Conclusions
When it comes to preventing broken hips and painful spinal fractures, there is no single treatment that stands head and shoulders above the rest. Each has benefits and disadvantages. People at risk for osteoporosis will need to think about the issues that might affect their treatment and their ability to stick with the program.
Even when the primary goal is prevention by getting adequate calcium and vitamin D together with exercise (and we strongly encourage that for everyone who can do it), the studies show that nutritional supplements are effective only if people actually take them all the time. Surprise! So consider whether you will take a pill or an injection every day, or if you’re better off with once-a-week or even once-a-month therapy.

NAIL FUNGUS
Over the last several years, nail fungus has garnered public attention completely out of proportion with its seriousness. The medical term, onychomycosis (oh-nick-o-my-CO-sis), is long and scary, but it just means fungal infection of the nail. Perhaps so many people are curious about this topic because nail fungus is very common. In addition, the development of
•    Soak your nails in a solution of one-third vinegar to two-thirds water
•    Prepare a cornmeal suspension and soak nails for an hour a week
•    Apply Listerine to infected nails daily
•    Coat the nails with Vicks VapoRub
•    Soak the nails in tea tree or vitamin E oil
•    Try Pau d’Arco tea soaks
•    Ask your MD about a prescription for urea paste 40 percent to remove the infected nail
•    Apply prescription Penlac (ciclopirox)
•    Consider the pros and cons of Lamisil (terbinafine) and Sporanox (itraconazole)
new antifungal drugs that can treat (dare we say cure?) nail fungus has encouraged the pharmaceutical industry to advertise in magazines, in newspapers, and on television.fbe popularity of sexy sandals as footwear may also have contributed to the interest in treating nail fungus.
For diabetics, nail fungus is a medical issue.fbey need to be extremely vigilant about foot care and attend promptly even to things that may seem minor. For the rest of us, though, thick, yellow toenails that are crumbly or hard to cut are more of a nuisance than a serious health concern. They look ugly, and if they get very thick, they may be uncomfortable as well. Sometimes they split, which can be quite painful.
In our opinion, though, it would be a mistake to put your life on the line to clear up your funny-looking nails. Mat’s why we have collected so many home remedies for this problem. They probably won’t work for everyone, but they shouldn’t be very risky, either.
Q. My husband took Lamisil to treat toenail fungus, The drug worked but was ultimately responsible for his death.
The fine print for this prescription drug noted that it might cause neutropenia. For my husband, it did. This led to MDS (myelodysplastic syndrome), which was followed thereafter by AML (acute myeloid leukemia) and his subsequent death.
He had suffered with periodic flare-ups of toenail fungus and athlete’s foot for most of his life. Neither condition was life threatening. The Lamisil was!
Even though serious side effects mentioned in prescription drug labels may affect only 1 percent of users, anyone could be in that I percent. People should ask themselves if it is worth taking that chancel
A. We are so sorry to hear of your husband’s tragic death. In rare cases, Lamisil may trigger serious blood disorders such as neutropenia, a lack of white blood cells. This drug can also damage the liver; there have been deaths associated with this problem. This is a high price to pay to cure toenail fungus.
Patients must always take into account not only common side effects but also the possibility of rare but deadly adverse reactions.
Home Remedies
It’s hard to say just where nail fungus comes from and why some people appear to be more susceptible than other-, Occasionally readers report that they first noticed nail fungus after going for a manicure or a pedicure. Presumably, it is possible to pass the organism that causes nail fungus from one person to another, and surely from one nail to another.To minimize that likelihood, we suggest that any tools such as scissors or clippers that have been used on a nail that might be infected be soaked in rubbing alcohol for 15 minutes before being used on an uninfected nail.
We think home remedies are the place to start for treating nail fungus, whether it affects the toenails or fingernails. (”This does not apply to people with diabetes, who should seek medical care for this problem.) Needless to say, some doctors are not fond of the idea of using home remedies for nail fungus.
Some time ago, we heard from a podiatrist who was very unhappy with our recommendations. “Home remedies hardly ever work,” he wrote. “The unproven treatments you mentioned are little more than urban legends. In 23 years of practice, I have never seen even one patient who responded favorably to Vicks VapoRub, dilute vinegar soaks, or vitamin E oil. Don’t make me waste time dispelling these myths.” He recommended that people take FDA-approved prescription drugs like Lamisil, Penlac, or Sporanox instead.
We certainly heard from readers who disagreed with him. One person who had success treating nail fungus with vinegar soaks expressed this opinion: “If a treatment is relatively harmless, as this is, and there’s even a chance it can work, I believe doctors should encourage alternative methods instead of high-priced medicines laden with potential side effects.”
A pharmacist also weighed in with some information on the effectiveness of the prescription medications:
I would like to point out some facts about the FDA-approved drugs the podiatrist prefers (Lamisil, Penlac, Sporanox). Does this doctor know that Penlac’s success rate for a complete cure, accord-ing to the manufacturer’s prescribing information, is only 5.5 to 8.5 percent after 48 weeks? When using Sporanox, the percentage of overall success rises to a dizzying 35 percent.
Also, does he know the costs of these medications? A bottle of Penlac costs $72.99. To reach 48 weeks of treatment once a day to a single affected nail, I conservatively estimate that the patient will need six bottles of the lacquer (one bottle approximately every other month), So Penlac will cost the patient, without insurance, 5437.94 to reach an outstanding 8.5 percent cure rate.
For Sporanox, one pulse-pak costs ME99. This is a 14-day supply. The manufacturer recommends 12 weeks of treatment, bringing the patient cost, without insurance, to $1,535.94! No wonder people are looking for alternatives to these medications.
Oral medicines such as Sporanox can occasionally trigger serious reactions as well. No wonder some people are willing to spend time and effort—but not much nioney—trying a low-risk home remedy.
I assumed toenail fungus was a fact of life forme. khad spread to five or six toenails when I finally saw a dermatologist The prescribed treatment was costly, and after it began, the dermatologist told me the odds of reinfection after treatment were about 50 percent
I had a nightmare reaction to the pills a week later I was in remote Finland, of all unlikely places, when I developed hives and severe itching. After 24 hours of nonstop, nonsleep itching, I got through to my doctor and was told to stop taking the pills.
When I got home, / decided to try the vinegar treatment I applied a drop of distilled white vinegar to my toenails with a cotton swab each time I got out of the shower As the nails grew out the fungus was completely gone, along with slight traces of athlete’s foot
Cost: under $ZOO over 9 months.
Side effects: none.
Effectiveness: 1019 percent (or 200 percent it you include the athlete’s foot).
Vinegar
One of our favorite home remedies is a vinegar soak. It is surely, one of the cheapest remedies for nail fungus. People who sit still to read, use the computer, or watch television could soak the foot with the affected toenails or hand with the affected  Vinegar
Use two parts of water to one part vinegar for a soaking solution. It does not seem to matter whether you use white vinegar or apple cider vinegar, so we suggest the cheaper
white vinegar.
Downside: Your toes may smell of vinegar.
Cost: $1.60 to $2 for 64 fluid ounces—enough for at least four treatments, and possibly eight
fingernails in a solution of one part white vinegar to two parts water. Vinegar is acidic, and acid makes the environment inhospitable to nail fungus. Because it is a home remedy, there is no “prescribed” method. Some people have had success soaking for an hour each week, all at one go; others soak once a day; and still others use the technique of daubing undiluted vinegar on the affected nail with a cotton swab every day. Persistence is needed with any home remedy. Nails grow slowly, especially toenails, and you need to give them time to grow out healthy and fungus free.
Cornmeal
Another natural fungus fighter may be cornmeal. We first learned of this approach from a public radio listener: “Put about an inch of cornmeal in a plastic dishpan. Pour in hot water, stir it so the cornmeal gets dissolved, and when it is cool enough not to hurt, soak your feet for an hour. If you do this regularly, it will get rid of the fungus.”
When examining me my doctor noticed that I had nail fungus affecting toes on each foot He recommended that) make a batter by mixing cornmeal and water in a shallow pan, let it sit for an hour, and then soak my feet for an hour He told me to do this once a week for a month. I did the cornmeal therapy for 3 weeks and the fungus was gone. I don’t know why it works, but it’s cheap, harmless, and it worked for me.
We haven’t found any scientific support for cornmeal as a nail fungus treatment, and fewer people have written us regard-Cornmeal
A footbath of cornmeal mush is neither expensive nor dangerous, and it takes just 1 hour a week. Put about an inch of cornmeal in a shallow pan and add enough hot water to dissolve it. Let it cool to a comfortable temperature and soak your tootsies for an hour.
Downside: This treatment could be somewhat messy. Don’t spill it on the carped
Cost: $2 to $4 for 5 pounds of cornmeal—enough for at least five treatments, and probably more
ing their success with cornmeal than with vinegar, but some have used it to eliminate their nail fungus.
Cornmeal does seem to be a popular home remedy in the garden, though. Gardeners claim that working some cornmeal into the soil around a rose bush will discourage black spot disease, a fungus that affects roses.
Vitamin E
We are always impressed by our readers’ ingenuity. We would never have thought of putting vitamin E oil on fungus-infected toenails, for example. We can’t think of a good reason why vitamin E in particular would be useful against fungus, and yet a number of people have tried this approach with some success.
I keep reading about treatments for toenail fungus so I thought I would pass on my solution. When I had this problem several years ago, I used a simple approach. I kept my toenail soaked with vitamin E oil and the fungus disappeared completely. I can’t recall exactly how long it took but it wasn’t too long.
As we understand the vitamin E tactic, a capsule that you would take as a vitamin—any dose will do—is pierced with a needle or a pin.’Iben the contents are squirted out all around the edge of the nail and particularly under the nail, between it and the skin. The key here, as with most nail fungus treatments, is patience and persistence.
Listerine
The old-fashioned mouthwash Listerine is one of America’s favorite all-purpose home remedies. (The other is Vicks VapoRub; more about it in just a bit.) Amber-colored original flavor Listerine contains a mixture of herbal extracts that can fight fungal pasties from dandruff to jock itch. Some people have also reported having good success with soaking infected nails in Listerine.
0. 1 cured my toenail fungus using a fifty-fifty mixture of vinegar and Listerine. I kept the mixture in a quart jar with a screw-on lid and used a clean paintbrush to apply the liquid to the affected toes morning and night. I wore socks to protect the bedsheets at night.
The fungus took about 3 months to clear up. It is slow growing but is also slow to cure. I hope this helps someone else.
A. You combined a couple of favorite remedies. Many people have reported success with soaking infected - nails in one part vinegar to two parts water. Others got good results soaking their toes in Listerine. Such remedies won’t work for everyone and take several months to produce results.
*** Listerine
This amber-colored mouthwash contains a fair amount of alcohol along with a mix of herbal oils including thymol, eucalyptol, methyl salicylate, and menthol. The thymol and the eucalyptol, at least, seem to have antifungal activity, and the other two may fight fungus as well. Soaking the nail in Listerine (original flavor) or daubing on a bit of Listerine after the daily bath has worked for some people.
Side effects: None known
Downside: Your nails may smell like Listerine. Cost: Approximately $5 for a liter  Vicks VapoRub
This ointment contains herbal oils such as camphor, menthol, thymol, eucalyptol, cedarleaf, nutmeg, and turpentine. Some of these have antifungal activity, and they may work synergistically. Apply Vicks VapoRub all around and under the affected nail or nails once or twice a day. Putting it on right after a shower or bath seems to help. If you apply it at night, wear socks to bed to protect the sheets. It may take 6 months to see results.
Side effects: Allergic rash is possible. In addition, we heard from a few people whose fungus-infected nails came off with this treatment. This might increase the effectiveness of the remedy, but it could be painful.
Downside: Inconvenience
Cost: Approximately $12 for 6 ounces. You could probably treat several toenails twice daily for 6 months with this much Vicks.
People have conjectured why Vicks seems to be beneficial against nail fungus. There is a compound in Vicks—thymol—that is now listed as an inactive ingredient.
When I was a premed student at UCLA in 1951, 1 met a mycologist (an expert on fungus). During World War It he devised a preparation to treat fungal infections that were common among the troops in the North African campaign. ft was an ointment that relied heavily on thymol as the most effective antifungal agent and reeked of thyme.
Vicks contains three active ingredients and 22 considered inactive. One or more of these might help thymol penetrate the tissues. I suspect that a pure preparation of diluted thymol, without other ingredients except a solvent, would be a good antifungal nail treatment
Vicks VapoRub certainly does not work for everyone. But we have heard from a great many people who have tried it and gotten a positive response. Some could see the results within a few weeks; others needed to keep applying it for month-s. Even prescription drugs take quite a while to clear toenail fungus, however, because the toenails grow so slowly. The infected nail must grow out completely and be replaced by uninvolved nail.
I had nail fungus fora long time. Medicines recommended by my doctor didn’t work. Then I read about using Vicks VapoRub. I applied it to the nail every day for about 5 months and now the fungus has disappeared. I’ve been cured.
Tea Tree Oil
Tea tree oil comes from an Australian tree, melaleuca. It has long been used to treat skin problems, particularly fungal infections. You don’t need to go to Australia to get it, though. It is marketed widely in stores and on the Internet in the United States. Applying tea tree oil to the infected nails daily can overcome some cases of nail fungus. Some people do develop allergic rashes in response to tea tree oil, however, so be alert for any itching or redness.
Q. Some years ago I was diagnosed with a fungal infection on one toenail. The intense throbbing pain made it difficult to wear a shoe.
My podiatrist said the only way to treat the toenail was to remove it. I had several more months of pain while the toe healed.
After the surgery I was alarmed when another toe showed signs of fungus. I asked about a natural treatment at the health-food store and was told to try tea tree oil.
I applied it liberally several times that day. Within 10 hours, the pain had diminished. I continued using tea tree oil on the nail daily for a few months. The base of the nail grew in pink and healthy.
I am angry that my podiatrist chose to operate on my toenail rather tha” recommend a natural, pain-free tMMYnent.
A. Tea tree oil (derived from the Australian melaleuca tree) has antifungal activity. It has long been used to combat skin and nail problems. Your podiatrist may not know about this herbal product, however.
Pau d’Arco Tea
The lure of the exotic can be seen not only in tea tree oil but also in Pau d’Arco, also called taheebo. This product is the inner bark of a South American tree that has been used medicinally by the natives of Brazil. Argentina, and Paraguay. It contains at least one compound with antifungal activity. Some readers report that using an infusion of Pau d’Arco to soak toenails, much as one would use vinegar or Listerine, can help clear the infection.
Oregano Oil
Oregano oil doesn’t come from a tropical rain forest, but it is hardly a common household staple. Nonetheless, some people have used it topically for fighting athlete’s foot, and others have reported success in using it against nail fungus. Like Listerine and Vicks VapoRub, oregano oil contains thymol. It also contains carvacrol. These two herbal oils together seem to have some antifungal action. Some people are allergic to oregano oil. Anyone who has experienced a reaction to basil, sage, lavender, marjoram, or mint probably should steer clear of oregano oil.
Can you stand another toenail fungus cure? I have found one that works for me, and I have tried them all, including prescription Lamisil pills.
I read somewhere that oil of oregano will kill anything, so tried putting a drop down between the nail and the skin every day. Slowly but surely the toenail is growing out normally! I hope someone else can benefit from this as well.
Lemon
Some years ago, we heard from a reader who maintained that sleeping with a lemon attached to the toe for 3 nights running would clear up toenail fungus. Only a few others have tried this -and reported back to us. It did not work for at least one person, though it seemed to help another.
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0. Many people write to you about toenail fungus, but you have never mentioned a remedy I learned from an elderly lady in South Carolina. This remedy requires three fresh lemons. At night cut a hole in the top of one and scoop out a hollow just large enough for the toe.
My mother had a great toenail so thick and hard that she could hardly wear a shoe on that foot. I used duct tape to hold the lemon on Mother’s foot, and put a sandwich bag over it to protect the bed. Do this for 3 nights in a row. The toenail becomes so soft that it can be peeled right off, and the new nail that grows in is normal. It worked for my mother!
A. We have been collecting nail fungus remedies for years, but this is the most unusual. Fungus doesn’t thrive in an acidic environment, which may be why dilute vinegar soaks are so effective. The citric acid in the lemon may work in a similar manner.
Prolonged exposure to pure lemon might be irritating for some people, so we suggest that anyone who wants to try such an approach test it first. Removing a
toenail should be done only with medical supervision,
because there is a risk of infection.
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Prescription Treatments
Unlike home remedies, prescription medications for nail fungus have been scientifically tested and have performed better than placebo. That is the criterion applied by the FDA before approving any prescription product. Don’t expect too much from these medicines, though: They don’t work for everyone, even though they might be more effective than home remedies. Before beginning a prescription medicine for nail fungus, make sure you understand the risks.
Urea Passe
One treatment for toenail fungus is to remove the nail surgically and then treat the underlying skin with an antifungal cream while the nail grows back without fungus. Many people are understandably reluctant to undergo surgery for nail fungus. Infection is always a risk. We hate it when the cure is worse than the condition it’s intended for.
Dermatologists have studied a different approach that is Urea Paste
The high-strength 40 percent urea paste that dissolves infected nails is available only by prescription. Its use should be supervised by a physician who is familiar with the treatment.
Side effects: Irritation, itching, or burning
Downside: Many doctors are not familiar with this approach. Cost: Approximately $75 for an 85-gram tube
far less traumatic. Urea paste at a 40 percent concentration will dissolve infected nail and leave healthy nail alone. It is essential to work together with the prescribing physician, however, as removing a nail is not a trivial issue. Please do not do this at home by yourself.
0. 1 have ugly, thick, yellow toenails that are hard to clip. My doctor says they are infected with fungus but he doesn’t want to prescribe Sporanox because it could interact with other medicine.
I have tried home remedies, including Vicks VapoRub, and none has worked. The podiatrist wants to remove the nails surgically. I know you have written about urea paste to dissolve away the infected nail. Where do I get it and how do I use it?
A. Surgical removal of nails can be painful and there is a risk of infection. Stanford dermatologist Eugene Farber, MD, discovered the urea treatment many years ago while traveling in Russia. 761 Urea (40 percent) is available only by prescription (Ureacin-40, Carmol 40, Gordon’s Urea 40). Your doctor should supervise the treatment.
Penlac
A lot of people are reluctant to take an oral antifungal drug. Some worry about side effects, others are concerned about potential interactions with other drugs they take. Both are valid concerns.
One manufacturer came up with a topical prescription antifungal medicine that is applied like nail polish. Penlac (ciclopirox) was approved by the FDA for the treatment of mild to moderate nail fungus. Like most of the home remedies we’ve already discussed, Penlac requires a lot of persistence. It needs to be applied to the affected nail, including between the nail and the skin, every day. It can cause redness or irritation, and it may take up to 6 months to produce results.
When people use Penlac, they need to see a health-care professional on a regular basis to have any unattached, infected nail removed so it won’t continue to spread the infection. We have no way of comparing Penlac’s effectiveness to that of other treatments. Presumably it is as good as most of the untested home remedies, but it is not really too astonishing. About 12 percent of the patients treated with Penlac in clinical trials were able to clear their toenails of fungus. One of the biggest differences between Penlac and a home remedy is the cost. A little bottle (6.6 milliliters) costs $130 or more.
Sporanox or Lamisil
The heavy artillery for treating nail fungus is an oral antifungal medication. If it is crucial to eliminate the infection, the physician will prescribe a drug such as itraconazole (Sporanox) or terbinafine (Lamisi)). (You may have seen magazine or television ads for Lamisil that feature a cartoon character, Digger the Dermatophyte.)
In a long-term head-to-head study, patients with toenail fungus were given either terbinafine or itraconazole according to the recommended dosing procedure for 3 to 4 months. 762 At the end of that time, 46 percent of the people who had taken Lamisil and 13 percent of those who had taken Sporanox had no detectable fungus in their nails. The follow-up extended for another 4 years or so. The investigators (some of whom worked for the maker of Lamisfl) found that relapse rates were significantly higher among those who had taken Sporanox.
An analysis of cost-effectiveness found that terbinafine is the most cost-effective treatment a doctor can prescribe. 761 Penlac was judged to be at least three times more expensive than the others, considering cost per cure. This analysis did not take any of the home remedies into account. If there were scientific data on them, they might well demonstrate low effec-tiveness, but because they are cheap, their cost-effectiveness might compare well to some of the standard treatments.
Another advantage of home remedies is the low likelihood of serious side effects. Lamisil is considered fairly safe, even for children and the elderly.764 Nonetheless some people taking Lamisil have developed liver failure.’W~ People who already have liver problems should not be given this drug. Other people taking Lamisil have come down with a very serious skin reaction, so anyone who develops a rash should get in touch with the doctor promptly. People who have lupus could get worse while taking Lamisil, so it’s generally not recommended for them.
As we mentioned at the beginning of this discussion, Lamisil occasionally can lower white blood cell counts to dangerous levels. Usually, the count comes back up once the person stops the drug. This drug may interact with other prescription medicines, including antidepressants. beta-blockers, and certain other medications that regulate the heart’s rhythm. By now, we hope we have convinced you to stay in very close touch with the doctor who prescribes Lamisil for your toenail fungus. It’ll probably run you more than $800 for the 12 weeks of treatment, but because it works so well, it is quite cost-effective.
Conclusions
Nail fungus, particularly toenail fungus, is usually more of a nuisance than a serious medical problem. (For diabetics, however, nail fungus or any other foot problem qualifies as serious and requires medical care.) As a result, we feel comfortable in recommending that most people try home remedies first. We don’t have any data on how well they work, but the testimonials we have received indicate that they do work for some people. In addition, they are inexpensive and don’t cause dangerous interactions or reactions.
A palm) who needs a higher likelihood of cure may need a prescription for Lamisil. It is the most cost-effective of the prescription nail fungus drugs. Even so, it does not work for everyone, and it is not always appropriate. Some people may be taking other medicines that could interact with Lamisil. Others may be at risk of liver problems or complications such as lupus. Most of the time, nail fungus is a problem you can live with; some of the rare side effects could be deadly.
•Toenails grow slowly. It takes a year to a year and a half for them to grow out completely, so be very patient and persistent.
•    After cutting fungus-infected nails, soak the clippers or scissors you used in alcohol for 15 to 20 minutes so you don’t spread the infection.
•    Soak your feet in a footbath of one part vinegar to two parts water for 20 minutes a day.
•    Mix cornmeal with hot water, allow it to cool to a comfortable temperature, and soak the affected nails for 1 hour once a week for at least a month.
•    Squeeze vitamin E oil or tea tree oil around the cuticle and under the nail once or twice a day.
•    Soak the feet in original Listerine or apply it daily to the affected nails.
•    Smear Vicks VapoRub around and under the nail every day.
•    Brew an infusion of Pau d’Arco for soaking the affected nails every day.
•    Stick your toe in a lemon overnight to soften the infected nail for removal.
•    If the nail needs to come off, ask your doctor about prescribing urea paste (40 percent).
•    Lamisil is the most effective prescription pill for fighting nail fungus.

Black Cohosh
One of the most popular herbal supplements used to alleviate hot flashes is black cohosh. This plant is native to North America and was used by Native Americans for a range of medicinal purposes. The botanical name has been changed in recent years, so some references refer to this plant as Cimicifuga racemosa whereas others use the current term, Actaea racemosa. The famous 19th-century patent medicine promoted for “women’s problems,” Lydia E. Pinkham’s Vegetable Compound, contained black cohosh as a prominent ingredient.
A standardized extract of black cohosh called Remifemin has been studied in Europe and found to effectively reduce Remifemin
This standardized extract of black cohosh is consistent and widely available. The recommended dose is 40 to 80 milligrams per day.
Side effects: Digestive upset
Downside: Not to be taken during pregnancy; monitor for liver toxicity
Cost: Approximately $15 to $30 per month
hot flashes.739 Physicians who scoff at herbal remedies appreciate that this research was published in a highly respected peer-reviewed journal, Obstetrics and Gynecology (May 2005). In one trial, Remifemin was compared to a low-dose transdermal estrogen preparation.”O The treatments were equally effective in reducing hot flashes, and neither one was associated with serious side effeCtS.141
Most reviews suggest that the side effects of black cohosh are infrequent and generally mild—mostly digestive upset with some headache or dizziness reported. 42 Just the same, we think that women should discuss this supplement with their doctor. Although recent studies of black cohosh have monitored liver enzymes and found no changes, there are reports of liver toxicity among women taking black cohosh.741 Women who have had hepatitis or other liver problems might want to consider a different approach. For most healthy women, 6 months or so of black cohosh may be worth trying, and it seems fairly safe.744 Unfortunately, black cohosh does not relieve hot flashes that result from breast cancer treatment with tamoxifen.
The Soy Solution
One of the other popular approaches to managing hot flashes is soy. Isoflavones such as genistein and daidzein are phytoestrogens, estrogen-like compounds derived from plants. Even though they are far weaker than the estrogen a woman’s own ovaries make before menopause, it seems logical to use these compounds to ease hot flashes. Studies from cultures like Japan, where women consume soy products such as tofu and ** Soy
The results of studies on soy have been inconsistent. Soy may be consumed as shakes, bars, or more traditional soy foods such as tofu or tempeh. Women who have more hot flashes may derive more benefit.
Side effects: Unpalatable taste, digestive distress Downside: Not advised for women being treated for breast cancer; excess soy may interfere with the production of thyroid hormone
Cost: Approximately $15 to $50 per month
tempeh as part of their normal diet, suggest that hot flashes and other menopausal symptoms may be less common there. 745
Despite the epidemiological promise, research on soy against hot flashes has been disappointing overall.746.747 One review of many trials, however, found that women who began the studies with frequent hot flashes got more relief from soy foods or isoflavone supplementation than did women who rarely had hot flashes.’ 48 A different systematic review delivered a lessthan-ringing endorsement of the effectiveness of soy preparations against hot flashes, but the authors did conclude that the risks appear to be low. 74″ As the authors of one pilot study concluded, a soy extract (they were testing Phytosoya) appears to reduce hot flashes and night sweats and is probably worth a try if women don’t want to take standard HRT.750
Red Clover
Another source of isoflavones that is marketed for perimenopausal women is red clover (Trifolium pratense). Although this plant is native to North America, its extracts are sold by an Australian firm as Promensit and Rimostil. Most of the research on red clover isoflavones has been funded by the manufacturer Novogen. Nonetheless, the results vary. One small Dutch study found a significant effect, with Promensil reducing hot flashes by 44 percent more than placebo.”‘ But a larger, multicenter trial in the United States found no clinically significant effect on hot flashes with either Promensil or out of the study, and no side effects were significantly more common among those taking red clover extracts than among those on placebo. Analyzing the data for subgroups uncovered a trend toward heavier women getting more benefit from Promensil.153 Overall, however, red clover does not seem very impressive.
Vitamin E
-the North American Menopause Society suggests taking vitamin E along with keeping cool, exercising, not smoking, eating soy isoflavones, and taking black cohosh as inexpensive,.probably helpful nonprescription measures to alleviate hot flashes. Quite a few women have heard that vitamin E can be helpful for this symptom, and some have passed the advice along to their friends.    9
A. I’m 53 and haven’t had a period for a year. I have no problems other than hot sweats.
I recently started taking 400 IU of vitamin E each day and, much to my amazement, it really works. Is there anything I should know about this vitamin?
A. Many women tell us that vitamin E can be helpful for hot flashes. Don’t count on it to protect you against cancer, though. Smokers should probably not take vitamin E supplements, because there is some fear it may actually increase their risk of lung cancer. For others, moderate doses of vitamin E seem safe for short periods of time.
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Unfortunately, there appears to be very little research on the effectiveness of vitamin E. Some of the buzz may have come from a study done more than 50 years ago.7-14 Usually we would like to see more recent research to back up a recommendation, but little seems to have been done.— Nonetheless, the North American Menopause Society considers vitamin E, like black cohosh and isoflavones, safe enough to be worth a try.
Vitamin E has performed poorly in several recent studies of cancer prevention, and women who are at particularly high risk of lung cancer—smokers, for example—should probably avoid taking large doses of vitamin E without other antioxidant nutrients. But healthy women planning to take vitamin E for a year or two to ease hot flashes probably will not notice any unpleasant effects. The best product is a combination of natural tocopherols. As with other products, start with the lowest dose available and gradually increase it to find the lowest dose that helps with your symptoms.
It is disappointing that vitamin E has received so little scientific attention over the years. That hasn’t stopped women from trying it, though. Of course, we frequently hear about other interesting nutritional supplements that have worked for a few women but have no scientific evidence to support or refute their effectiveness. If they are otherwise safe, we see no harm in experimenting.
/ can’t help but wonder why most doctors do not treat hot flashes and night sweats with bioflavonoids. As a retired registered nurse, I have found that daily use of bioflavonoids will relieve both the hot flashes and the night sweats. It saves the worry of cancer threats from hormones and is much less expensive. I use Citrus Bioflavonoid Complex, 1,9W milligrams, providing 35 percent hesperidin, 350 milligrams. [Hesperidin is a compound found in citrus fruits that has anti-inflammatory activity.]
At one time, I was hesitant to suggest this to my daughter-in-law because she had been successfully treated for breast cancer When we were visiting and she was showing the lack of sleep front hot flashes and night sweats, I finally bought bioflavonoids for her She often thanks me for the relief that it has given.
Nonhormonal Therapies
For years, women have worried about the possibility that estrogen and progesterone could increase their risk of breast cancer. Women who have already been treated for breast cancer can’t take these hormones safely. As a result, and in light of the negative results from the WHI research, physicians have been looking for other ways to alleviate hot flashes. One approach that seems to help is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) family.
PAXII.
Some doctors now prescribe antidepressants like Paxil (paroxetine) to help women deal with hot flashes. A recent study found that Paxil was significantly better than placebo in reducing the number of hot flashes and easing their intensity. 755 Low-dose Paxil (10 milligrams per day) was also better than placebo in preventing nighttime awakening, presumably due to night sweats. Women in this study did not have to be depressed to get benefit. That also seems to be the case for drugs such as Effexor (venlafaxine).71
Such medications are not without their own drawbacks, though. They can cause sweating, nausea, dry mouth, constipation, insomnia, jitteriness, and sexual problems such as difficulty achieving orgasm. Both Paxil and Effexor also can be difficult to discontinue. Stopping suddenly can lead to odd and distressing symptoms such as dizziness, sensations similar to electric shock, and a peculiar feeling that has been described as “brain sloshing” or “head in a blender.” If antidepressants are taken for hot flashes, they should be taken at the lowest dose that works for the shortest time needed, just like hor-
** Paxil (paroxetine)
Paroxetine eases hot flashes due to menopause or associated with breast cancer drugs such as tamoxifen. The effect on hot flashes is independent of its antidepressant activity. Women found a lower dose easier to tolerate.
Side effects: Nausea, digestive problems, weakness, sleep disturbances, dizziness, nervousness, sexual difficulties, hyqe.m )siio% we*ig1ht gain
Downside: Paxil can be hard to stop taking. You may need your doctor to switch you to a longer-acting drug such as Prozac and then decrease the dose gradually over several weeks or months.
Cost: Approximately $75 to $90 per month move replacement therapy. And, also like HRT, they may need to be tapered off gradually.
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Q. 1 have been having hot flashes, night sweats, mood swings, and other change-of-life problems for more than a year. I had hoped these problems would eventually go away, but so far they haven’t.
My doctor wants me to consider Premarin, but I worry about side effects, especially breast cancer. It runs in my family.
The other drug my doctor has suggested is Zoloft. But I am not depressed and don’t want to deal with side effects from that drug either. Do you have information on natural alternatives that might help me withstand hot flashes, night sweats, and interrupted sleep?
A. Black cohosh extract has been recommended for hot flashes. A double-blind study published in Obstetrics and Gynecology (May 2005) showed that the standardized product Remifemin was significantly more effective than placebo.
Another reader shared her experience with a different herb: “I have been using St. John’s wort since discontinuing hormone replacement therapy. It has relieved many symptoms, including sleeplessness, stress, and fits of temper.”
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NEURONTI N
Anoffier approach that may help some women who are suffering with hot flashes is an anticonvulsant drug called Neuron-tin (gabapentin). Pilot studies show that 900 milligrams daily of Neurontin reduces both the frequency and intensity of hot
flashes, and that it works better than placebo.757 Because Neurontin, like the SSRI antidepressants, does not have any estrogenic activity, it may be especially helpful for women who have had breast cancer and must avoid HRT. This medicine * Neurontin (gabapentin)
Gabapentin eases hot flashes due to menopause or associated with breast cancer drugs such as tamoxifen. The effect on hot flashes is not related to its anticonvulsant effects.
Side effects: Drowsiness, dizziness, problems with balance, fatigue, swelling of the feet, nausea or vomiting, depression, reduction in white blood cells
Downside: Neurontin should not be discontinued suddenly. You should ask your doctor for help in reducing the dose gradually over several weeks or months.
Cost: Approximately $60 to $150 per month, depending on whether you get a brand-name or generic product
has been associated with some potentially serious adverse reactions, such as a reduction in white blood cells that could leave a woman susceptible to infection. We recommend having a thorough discussion of its likely benefits and risks with the prescribing doctor. This is good advice for any medication, of course, but especially for one being used for an “off-label” condition like this.
Relieving Vaginal Dryness
Hot flashes may be the most obvious symptom of menopause, but for many women, vaginal dryness is just as troublesome. And despite our culture’s greater acceptance of public discussion of sexual issues such as erectile dysfunction, for example, vaginal dryness is often too personal and too embarrassing to bring up. When the WHI highlighted the potential dangers of long-term use of oral estrogen, millions of women stopped their HRT and then searched high and tow lot a personal lubricant that would be safe and effective.
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Q. 1 know this is a sensitive issue, but it affects a lot of women. Vaginal dryness is ruining our sex lives. I had breast cancer, so hormones are out. I’m embarrassed to ask my doctor about this.
My husband works long hours, and our opportunities for intimacy are unpredictable. Is there any natural lubricant I could use just at that time?
A. Readers have suggested olive, almond, and vitamin E oils. Some people are allergic to topical vitamin E, though, and it can cause a nasty rash. In addition, using any oil in combination with latex condoms may weaken them. One woman breaks a leaf off her aloe vera plant and uses the slippery gel that oozes out.
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For some women, this problem is an issue only for sexual relations, but others find that dryness is uncomfortable throughout the day. Oral HRT generally relieves this symptom along with hot flashes, but just as sudden sweats may return when HRT is stopped, so can vaginal dryness.
Olive Oil
No studies have identified diets, exercises, or other lifestyle approaches that work for vaginal dryness. We. have heard from many women who have found remedies that work for them, however. One of the simplest is olive oil. Other women have found that almond oil has a more pleasant aroma and that it still helps with everyday moisturizing.
*** Olive Oil
If it’s safe to eat, it’s safe enough for vaginal lubrication, too. The oil is applied to the vagina with a fingertip. At first, daily application may provide the best results. Later, lessfreqxiem applications may be eileefive.
Side effects: Some women notice oily spots on their underwear. If this happens, apply less.
Downside: Some women are squeamish about fingertip application. In addition, using any oil in combination with latex condoms can weaken them.
Cost: A few dollars, or less, per month I would like to suggest a natural lubricant that is not greasy but is good for your body. It is pure olive oil. (it can be edible, too.) I have been using olive oil for this purpose for a couple of years. When my doctor did a pelvic exam, he thought I was taking hormones although I am not. I think olive oil has natural compounds to keep women youthful.
There is, unfortunately, no research to show whether any kind of oil applied topically will moisturize vaginal tissues. Our reader got a lot of other people interested in using olive oil for this purpose, though, and some of them contacted us to tell us that it helped. We really don’t know of any hazard to this one except for people who are allergic to olive oil. It doesn’t take very much, so use the best-quality extra-virgin olive oil you can find, or substitute almond oil or another vegetable oil if you
prefer.
Vitamin E
The underground popularity of vitamin E capsules taken orally for hot flashes has apparently inspired some women to try this dietary supplement “off-label.” We don’t think any vitamin manufacturer envisioned women using the contents of a vitamin E capsule for personal lubrication, but some are enthusiastic about it. They prick the capsule and squeeze out the oil for application by hand. Others use the capsule as a vaginal suppository. We caution, though, that some people are sensitive to vitamin E and might develop a rash. In addition,
** Vitamin E
Squeeze the vitamin E oil out of the capsule and apply it to either partner for lubrication “at the moment.” A capsuke may be used as avdiffinal suppository for lasting lubrication.
Side effects: Rash. Test the oil on your inner arm first, to make sure you aren’t sensitive to it.
Downside: Effectiveness has not been scientifically tested. Also, using oil in combination with latex condoms may weaken them so that they aren’t effective.
Cost: Approximately $2 to $5 per month using any oil in combination with latex condoms may weaken them.
Improbable Lubricants
Whoever said “necessity is the mother of invention” must be smiling at the ingenuity of women who have taken common, inexpensive cleansers or moisturizers and tried them to combat vaginal dryness. But some household products have been especially popular. Some years ago, we heard from a couple in their seventies who were using Corn Huskers Lotion, an old-fashioned hand lotion, as a sexual lubricant. Other readers were interested in their experience and tried the product out.
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A. 1 suffered for years from vaginal dryness and tried a lot of treatments for it. Then I read about using Corn Huskers Lotion. The results have been incredible! The lotion is inexpensive and works better than a progesterone cream my doctor prescribed. .
A. We’ve heard from others who have found that this old-fashioned hand moisturizer can be helpful for vaginal dryness. Some of the ingredients are identical to those in pricier personal lubricants.
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Corn Huskers Lotion contains glycerin, guar gum, and methylparaben, as well as a few other ingredients. It is not dissimilar to K-Y Jelly (glycerin, hyd roxymethylcel I u lose, methylparaben), Astroglide (glycerin, propylene glycol, parabens), or Replens (glycerin, mineral oil, methylparaben). All of these drugstore products are designed specifically as vaginal lubricants. Although they are a bit pricier, such products are certainly worth a try. Corn Huskers is promoted as an oil-free hand treatment lotion. The manufacturer makes no claims regarding this “off-label” use. Do keep in mind that mineral oil, as found in Replens, could compromise latex condoms.
We have also heard from many readers who sing the praises of an old-time facial cleanser for this purpose.
Q. My husband and I have used Albolene as a sexual lubricant since the early 1970s. I’m not sure how we heard about it, but it’s great: odorless, tasteless, slick, but not messy.
It comes in a white tub you can keep by the bed without embarrassment. A 12-ounce jar costs about $11, but a little goes a long way. We’ve purchased five jars in 27 years of marriage. I haven’t seen this anywhere else and wanted to share our secret.
A. Thanks for the tip. Finding a sexual lubricant that suits both partners can be challenging.
Albolene is a moisturizing cleanser that contains mineral oil, petrolatum, paraffin, ceresin, and beta-carotene. It should not be used with condoms or a diaphragm since petroleum jelly degrades latex.
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Albolene is certainly cost-effective. Although it is solid in its container, a small amount applied to the skin soon liquefies and becomes slippery. One drawback, though, is the mineral oil and petrolatum base. These petroleum products will destroy latex, so they must not be used with barrier contraceptives such as condoms or a diaphragm. (The postmenopausal woman may not need to worry about contraception, but many perimenopausal women still need to be vigilant.) Alboleneis available in pharmacies and online: for more information, you can contact the manufacturer, Numark Laboratories, at 800-338-8079.
I’ve been using a product from New Zealand named Sylk for over a year ear now and find it does a great job in lubricating and relieving pain associated with vaginal dryness during relations.
Quite a few people these days are reluctant to introduce petroleum-based products into their bodies, and they also worry about the effect of such products on latex condoms. Many of them have been pleased to learn about Sylk, a natural lubricant from New Zealand. It contains kiwifruit vine extract and, more importantly, does not contain petroleum products. As a result,  Sylk
This natural personal lubricant contains kiwifruit vine extract, citrus seed extract as a preservative, and vegetable glycerine. It is water-based, so it can be used with condoms. It is not sticky.
Side effects: None known
Downside: Effectiveness has not been scientifically tested. Cost: One bottle costs $22 to $23 and lasts 3 to 4 months.
it is safe to use with barrier contraceptives. Sylk is not available in most drugstores, but it can be ordered by telephone at 602957-7955 or on the Web at www.sylkusa.com.
People have devised a number of other clever ways to use natural products as lubricants. Some people have found that the gel from an aloe plant is ideal. It certainly is inexpensive! A few drugstore lubricants contain aloe as one of the ingredients, so presumably this is usually well tolerated.
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O. My husband and / can’t use K-Y Jelly or any other brand of lubricant we have tried. They make me itch and burn.
We have found, though, that the slimy gel that oozes from an aloe leaf when you break off a piece is a very good lubricant. I hope this will add to your uses of aloe vera and help another couple.
A. This is a most unusual sexual lubricant. Aloe vera get has been used for centuries to help burns heal and ease skin irritation.
Others who would like to try this should test the gel on the inside of the elbow first. If there is no allergic reaction, the slippery texture should make it a surprisingly effective sexual lubricant.
Hormonal Approaches
For decades, when women complained of vaginal dryness as a symptom of menopause, doctors prescribed estrogen, often as a vaginal cream. Most of the time when a vaginal cream or tablet was prescribed, the doctor would point out that it would have local effects and would not be absorbed into the bloodstream. Although vaginal estrogen creams can often help alleviate dryness, the dogma that the estrogen in the cream stays put and doesn’t get into the rest of the body is bogus. The delicate tissue of the vagina is quite efficient at absorbing estrogen and passing it into the bloodstream.758
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Q. I have been reluctant to take estrogen because I worry about possible side effects, in particular breast cancer. The worst thing about menopause has been the lack of vaginal lubrication, which makes sex very uncomfortable.
My doctor prescribed a vaginal estrogen cream for this problem. He has assured me that it is locally acting with negligible absorption.
It certainly has helped the vaginal dryness, but my hot flashes have also dropped off considerably. Is this cream getting from the vagina to the rest of my body to control the hot flashes? And if so, what about the risk of breast cancer?
A. Estrogen is easily absorbed from the vaginal lining. In fact, one study of Premarin and Estrace creams published in the Journal of the American Medical Association (December 14, 1979) found that “estrogen vaginal cream preparations, as widely used in clinical practice for their local effects on the vagina(mucosa, actually result in sus126ned high estrogen levels in the systemic circulation.”
We suggest that you discuss your risk factors for breast cancer with your physician. If oral estrogen is inappropriate for you, a cream formulation is not likely to be much safer.
There are certainly times when a vaginal cream or tablet is :appropriate. When other approaches aren’t effective, an estrogen cream often will help. As with oral estrogen, the idea is to use the lowest effective dose for the shortest possible period of time. Frequently the prescription cream will be dispensed with an applicator. Ask the doctor if you should fill the applicator or use less cream than that. It may be possible to apply just a small dab on the tip of your finger and get adequate relief with less overall exposure to estrogen. Topically applied estradiol (a form of estrogen) is available as Estrace cream and Vagifem vaginal tablets.
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Q. A couple of years ago vaginal dryness was causing me a lot of discomfort. I am prone to blood clots, so I can’t take oral estrogen.
My doctor prescribed Estring, an estradiol vaginal ring that is inserted every 3 months. It has only 2 milligrams of estrogen and has solved my problem. Please tell others about this approach.
A. Estring has been available in Sweden since 1993 and in the United States since 1996. The 2-milligram dose of estrogen is very low, especially since it is released gradually over 3 months. This approach may solve the problem of vaginal dryness with fewer side effects than oral estrogens.
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*** Estring
Estring is a vaginal silicone ring that contains estradiol that is released at a steady, low rate over 3 months, which minimizes fussing. It is placed in the vagina, usually so that it is comfortable or almost unnoticeable.
Side effects: Stomachache, nausea, vaginal discharge, headache, insomnia
Downside: Must pay for 3 months’ treatment up front Cost: $100 to $150 for a 3-month ring There is one more way to apply estrogen topically to the vaginal tissues—with a vaginal ring. This silicone ring is inserted into the vagina, where it releases estradiol at a low but steady rate for 3 months. Like other forms of estrogen, it’s not appropriate for women who have or have had breast cancer. Because the dose at any given time is lower than if a woman were taking estrogen orally, it might be used even by women who are nervous about using estrogen.
Conclusions
Although menopause is a natural process, hot flashes and night sweats can be bothersome. Vaginal dryness also may be uncomfortable. The ideal treatment for these symptoms should be used at the lowest effective dose for the shortest possible period of time, since most symptoms will eventually fade away on their own.
Here is an overview of our recommendations.
•    Keep cool by turning down the thermostat and wearing layers that can be easily removed if you start to sweat. A tall, cool (nonalcoholic) drink is less likely to trigger a hot flash than a steaming cup of coffee.
•    Keep exercising to minimize your hot flashes and help you sleep. Then follow up with relaxation and deep breathing.
O    Try Remifemin. Black cohosh can help with hot flashes if they are not too extreme.
•    Eat moderate amounts of soy products with isoflavones. They may help reduce hot flashes.
•Take vitamin E capsules. Up to 400 IU daily should be safe and might help.
•    If nothing else helps with the hot flashes, try hormone replacement therapy at the lowest effective dose for the shortest possible time. Transdermal estrogen might be worth considering.
•    An antidepressant such as Paxil (paroxetine), Effexor (venlafaxine), or Prozac (fluoxetine) may calm hot flashes even if you are not depressed. Don’t take any of these drugs for longer than you need them; you may need help getting off them.
•7be antiseizure drug Neurontin (gabapentin) may ease hot flashes and does not have the same risks as hormone re-placement therapy. Do not stop this drug suddenly, though, since that could trigger withdrawal symptoms.
•    Vaginal dryness may respond to olive oil, almond oil, or the oil from inside a vitamin E capsule.
•    Corn Huskers Lotion or Albolene offers slippery lubrication for sexual relations.
•    For more natural lubricants, try the gel from a broken aloe vera leaf or Sylk, which has kiwifruit extract. •Estring is the most convenient form of vaginal estrogen. The need for Estring should be reevaluated every 3 or 6 months so you won’t use it for longer than necessary.

MENOPAUSE
*Turn the thermostat down to reduce hot flashes
•    Use the lowest-dose estrogen and progesterone therapy for the shortest time possible
•    Try Remifemin for hot flashes    ***
•    Eat tofu or tempeh or drink soy shakes    **
•    Ask your doctor about Paxil (paroxetine) or Effexor (venlafaxine) for hot flashes
•    Inquire about Neurontin (gabapentin) for hot flashes
•    Apply olive oil topically for vaginal dryness
•    Squeeze vitamin E out of a capsule as a sexual lubricant
•    Experience slippery sex with Sylk
•    Experiment with aloe vera gel
•    Get a prescription for Estring (estradiol)    ***
Decades ago, menopause used to be referred to in whispers as The Change. The mystery surrounding the event gave it a sinister aura. Now, though, more than 5 000 women enter menopause every day in the United States. ~21 That’s because the baby-boom generation is aging. We are not a bashful bunch, and female boomers have brought menopause out in the open. Women refer to hot flashes, somewhat jokingly, as power surges. But few women relish them. Most would like some way W ease this symptom, even it it is the consequence of a perfectly natural biological process.
We ought to begin with some explanation of menopause. Most people know this refers to the time when a woman’s ovaries stop making the hormones that support the ripening and release of eggs. It is a gradual process that may be spread out over years, perhaps even a decade, and is properly referred to as perimenopause. Menopause itself is technically just one point in time: the day when an entire year has passed since the end of a woman’s last menstrual cycle.722 The average age on this day is 51 years, but women may be as young as 40 or as old as 58 and still be within the normal range for menopause.
Just as the timing of this change in ovarian function differs from one woman to another, so do the timing and intensity of menopausal symptoms (yes, we should be calling them perimenopausal symptoms). Some women barely notice a hot flash or two. We’ve even spoken with women who had “cold flashes” rather than hot flashes. Others are distressed by intense heat waves that may plague them daily for years. Most fall between those extremes but would still welcome some respite from the sweating, the flushing, and the distracting feeling that they might spontaneously combust. (Not to worry—that has never happened!)
I hope you can recommend something for my wife, who feels like she is about to burst into flames. Her doctor suggested Premarin, but she refuses to take it because she is worried about the increased risk of breast cancer What other options are there?
If it is any comfort, this period of discomfort lasts about 4 years, on average. That means, though, that some women zip through it much more quickly, whereas others take longer, sometimes much longer, to get through to relief.
The Hormone Controversy
For years, women suffering from hot flashes and other menopausal discomforts were told that their doctors had the magic solution: Just take hormones to replace the ones their ovaries were no longer making. Hormone replacement therapy, or HRT, has had its ups and downs over the decades, beginning with Premarin’s approval in 1942. Since then, more than 30 billion doses of this h101MIOnt di Wled from pregnant mares’ urine have been dispensed.
When doctors discovered that women taking Premarin were at greater risk of developing cancer of the uterine lining, this prescription went out of vogue for a while. But then researchers found that adding progestin, a synthetic form of progesterone (usually prescribed under the brand name Provers), could reduce this risk. In the 1990s, Premarin became the most prescribed pill in history. Besides easing hot flashes,night sweats, and other menopausal problems, HRT was supposed to save women’s lives by reducing their risk of heart disease, colon cancer, osteoporosis, and other serious health
threats.
These days, though, the story has changed, and a lot of menopausal women are feeling confused and betrayed. For years, they were told that they were suffering from an estrogen deficiency syndrome. Replacing the hormones their bodies no longer made was supposed to ease menopausal symptoms. Women who resisted a prescription for HRT were sometimes treated as difficult cases. Some were told that though HRT might raise the risk of breast cancer, it was a much less significant concern than heart disease, which HRT might protect against.
After I was operated on for breast cancer, I was told that I could no longer take estrogen, because my tumor was ‘estrogen-dependent’ My primary physician actually had the gall to tell me: The benefits of estrogen far outweigh the threat of breast cancer, and besides, we can cure breast cancer’
Women have a right to be furious. The hormone hype that lasted for several decades represents one of the biggest scams in modern medicine. Millions of women were guinea pigs in an uncontrolled experiment. Physicians who pride therpselves on practicing “evidence-based medicine” prescribed drugs that were unsupported by data. Many women who expressed their fears to their physicians were told in no uncertain terms that the benefits of HRT outweighed the risks.
When the National Institutes of Health announced a huge, long-term study of hormone replacement therapy, advocates of HRT were thrilled. They anticipated that the best available science would support their convictions that HRT had many health benefits, far beyond simply easing hot flashes. Thousands of women were recruited to the study and randomly assigned to take either Prempro or a look-alike placebo pill.
When the results of this study—called the Women’s Health Initiative (WHI)—were announced in 2002, many physicians were surprised and women were shocked to learn that instead of protecting women from heart disease and cardiovascular complications, HRT actually increased their risk. A few doctors had anticipated that the study might show an increased risk of breast cancer. As early as 1995, the Nurses’ Health Study, which followed more than 100,000 women, had confirmed that estrogen replacement therapy significantly increased the risk of breast cancer in postmenopausal women and demonstrated that progestin did not diminish that risk 723 If anything, the data suggested that adding progestin could increase the risk .721
Although there had been hints from previous research that estrogen, with or without progesterone, might increase a woman’s risk of breast cancer, such concerns were mostly downplayed. Opinion leaders reminded physicians that the leading cause of death in postmenopausal women is heart disease. (Breast cancer  comes in second.) Some eminent gy- necologists opined that if breast cancer was a risk, it was a minimal one, associated only with long-term HRT use. Such cancers were thought to be “good” cancers in that they were “early” cancers, easily detected and treated and not associated with increased mortality.
Further results from the WHI gave the lie to that claim. The investigators found that women taking combined HRT (Prempro) were more likely to be diagnosed with breast cancer than those on placebo and were more likely to have invasive, more advanced cancers. They concluded, “These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis.”115
As a result of these new findings, doctors may also be feeling betrayed. They too were sold a bill of goods that did not turn out to be as advertised. It is now clear to all that HRT is not a panacea for the miseries of menopause. But what remains unclear is exactly how women should cope with hot flashes, night sweats, sleep disruption, and vaginal dryness. Finding out that estrogen doesn’t really prevent heart disease still leaves women with plenty of options for reducing their risk of heart trouble. And there are other possible treatments for osteoporosis, another condition for which women were given long-term estrogen treatment. But what can be done for those annoying, sometimes debilitating hot flashes?
Alleviating Hot Flashes
Certain simple lifestyle adjustments might be all that some women need to make hot flashes tolerable. First, turn down the thermostat. This seems too simple to work, but many menopausal women are less uncomfortable when the temperature is cooler.726 Second, dress in layers that can be easily removed. ‘Ibis is simple common sense.Third, follow the Southern belles’ example and keep a fan and a nice coot (nonalcoholic) drink handy. Fourth, keep exercising. Or if you are not already walking, swimming, or dancing, start. It’s not a miracle, but women who exercise regularly seem to have fewer hot flashes or find them less bothersome. Besides, exercise eases depression and anxiety and is beneficial for the heart and the bones as well.
Hormone Replacement Therapy
When it comes to taming hot flashes, estrogen is undeniably the gold standard. Estrogen, either alone or in combination with progestin, clearly reduces the frequency and severity of hot flashes by about 75 percent.727 This is significantly better than placebo, although women with hot flashes are susceptible to the placebo benefit.
In most studies of HRT or herbal alternatives, women taking the placebo had nearly 60 percent fewer hot flashes per week at the end of the studies, on average, than at the beginning. 721 Women on HRT, either estrogen alone or estrogen together with progesterone, also seem to have less trouble with night sweats that awaken them and disturb their sleep. There’s little evidence that herbal treatments have much effect on menopausal sleep problems, which many women find extremely disdirbing.
If it weren’t for the WHI, doctors would still be prescribing Prempro (a combination of Premarin and Provers) to virtually every menopausal woman who would take it. And they would still be encouraging women to keep taking it long after menopausal symptoms faded away, as a general-purpose “health and beauty aid.”
The characteristics of the women who were willing to use HRT before the WHI results were available probably accounted for many of the benefits seen with HRT in earlier, observational studies. Women were told that HRT was good for their health, so those who chose to take it were more likely to be the health-conscious, careful eaters, regular exercisers, nonsmokers, and occasional drinkers. Their healthy behaviors, rather than the HRT per se, are now believed to be responsible for their lower rates of heart attack, stroke, and many other problems.
The WH I put the issue of HRT and heart attack prevention to  Estrogen and Progesterone
Hormone replacement therapy reduces hot flashes significantly for most women. Women who still have a uterus need to take progesterone along with estrogen to protect themselves from endometrial cancer.
The risks of this therapy rise significantly at 5 years of use. For most women, intense hot flashes last less than 5 years. Ask for the lowest possible dose, and increase the dose only if that does not adequately relieve the hot flashes and night sweats. Hot flashes may return if HRT is stopped abruptly, so gradually tapering off it may be more successful. Transdermal estrogen (Climara, Estraderm) may be less likely to trigger nausea, but there haven’t been good headto-head comparisons.
Side effects: Breast tenderness, nausea, gallbladder problems, migraine headaches, intolerance to contact lenses, elevated blood sugar. If progesterone is given only 1 week a month, vaginal bleeding resembling a menstrual period is common.
Downside: HRT increases the risks of breast cancer and blood clots that could trigger heart attacks and strokes. These risks increase over time. HRT should be used only as long as it is needed for perimenopausal symptoms.
Cost: Approximately $40 to $75 per month for brand-name HRT; generic is available for $12 to $20 per month
the test with more than 16,000 postmenopausal women. Unfortunately, HRT did not pass. Women who had never undergone hysterectomy were randomized to Prempro or placebo, but the study was stopped early when it appeared that the women taking HRT were at greater risk than those on placebo .129 Although Prempro had been expected to protect women from heart attacks and strokes, the results showed that women taking this HRT were nearly 30 percent more likely to develop coronary heart disease and twice as likely to come down with a pulmonary embolism, a dangerous blood clot in the lung.730
None of this has much bearing, though, on the use of hormones to treat hot flashes. The risks are primarily for women who take Prempro or other forms of estrogen and progester-one for extended periods of time.The most recent recommendations, based on subanalyses of the WHI data, suggest that women just entering menopause (ages 50 to 54 in particular) may be more resistant to the dangers of estrogen and might even get some protection from heart attacks by taking it. 31 Short-term use (for a few months up to a couple of years) to get through the worst of the hot flashes doesn’t seem to pose an excessive risk for most women. Those who have previously had dangerous blood clots or breast cancer or who have a strong family history of breast cancer should probably avoid estrogen even in the short term, however.
O. 1 took hormones for 4 years and then discontinued them for a year. Now I have started again, at the urging of my doctor. While I was not taking hormones, I had hot flashes, night sweats, and vaginal dryness.
I stopped taking hormones because the progesterone component made me irritable and depressed. (I was taking Premarin and Provera.) My doctor put me on Estrace and Prometrium this time, but I still feel prickly and sad.
I’m convinced progesterone is the problem, so I wonder if I can take the estrogen alone. I recently read that estrogen has heart benefits.
A. The hormone controversy has heated up again. A study showed that women between the ages of 50 and 59 taking estrogen alone were not at increased risk of heart attacks (Archives of Internal Medicine, February 13, 2006►. These women had previously undergone hysterectomies, so they did not need progesterone.
Estrogen alone is not safe for a woman who still has her uterus since it increases the risk of endometrial cancer. Progestins like Provera protect against this kind of cancer. When added to estrogen, however, they may increase the risk of heart attacks and strokes and possibly breast cancer as well. For some women, progesterone lowers libido and leads to depression.
Doctors have followed the practice of prescribing progestin along with postmenopausal estrogen for many years, since research determined that estrogen alone increased the risk of cancer of the lining of the uterus (the endometrium). Endometrial cancer is not an issue for women with no uterus, and in the WHI study, these women were randomized to Premarin (estrogen alone) or placebo. This works just fine for hot flashes. Don’t count on it to provide any cardiac benefits, though. Overall, women in the WHI study were not protected from heart attack or stroke by HRT whether they took Prempro or Premarin alone.32
Some critics of the WHI have objected to the use of Premarin or Prempro, and suggested that other forms of postmenopausal estrogen replacement therapy would be preferable. There aren’t studies to prove or disprove that idea. Epidemiologists at Group Health Cooperative, a big health maintenance organization in Washington, compared rates of heart attack and stroke among women taking Premarin and those taking another form of estrogen such as Estratab or Menest. They found a hint that the other forms of estrogen might be somewhat less likely to trigger a heart attack or stroke, but these data need to be confirmed.733
Bioidentical Hormones
0 0 0
Q. I am a family physician. Back when we were prescribing HRT regularly, I used to offer women the option of plant-based estrogens instead of synthetic hormones. Since we learned the results of the Women’s Health Initiative (WHI), though, I’ve viewed all estrogens as carrying similar risk until proven otherwise.
There are practitioners who are saying that bioidentical hormones are safer. They encourage women to use them as an alternative for treating menopausal symptoms. Is there any research that shows that the risks are lower for plant-based HRT than for synthetic?
A. There is no comparable study of plant-based estrogens, and there is not likely to be one. The WHI was a very large and expensive study funded by the National Institutes of Health. Women were randomly assigned to receive Prempro or placebo. The results showed that postmenopausal hormones increased the risk of breast
cancer, heart attack, and stroke.
Women’s health expert Susan Love, MD, responded
to a question like yours: “I think that it is very unlikely that bioidentical hormones, as they’re called, will be any safer than Prempro.”
0 * *
The American College of Obstetricians and Gynecologists (ACOG) came out with a very strong caution about bioidentical hormones in 2005. Michele Curtis, MD, is associate professor of obstetrics and gynecology at Houston’s University of Texas Medical School. On behalf of ACOG she said. “There are a growing number of women who are seeking therapy with bioidentical hormones, but there is a lot of misinformation about the assertion that these are plant-derived and therefore more closely mimic the estrogen that is in a woman’s body….. These are hormones. They act just like estrogens that are 34    commer-
cially produced.,,7
The obstetricians and gynecologists of ACOG are concerned that plant-based hormones are unregulated and, as a result, women may not be informed about risks. In addition, lack of oversight may mean that it is hard to guarantee quality. Many of these products are made in small compounding pharmacies that act like micro–drug companies but escape the kind of regular FDA inspections one might expect a bigger manufacturer to undergo. When the FDA did check on samples from 12 compounding pharmacies, ACOG reports that “34 percent of them failed one or more standard quality teStS.!,131
Progesterone
Kau Nwmnwe intrigued by the possibility that a progesterone cream derived from plant sources can be applied to the skin to relieve hot flashes naturally. Although wild yam can be used as a raw material for the manufacture of progesterone-like compounds, the human body can’t convert wild yam to progesterone. A controlled study suggests that a cream containing wild yam extract is not much better at reducing hot flashes than a placebo.736 Other creams formulated to contain progesterone can provide a dose comparable to taking progesterone by mouth.”‘ Progesterone pills or long-lasting injections such. as Depo-Provera can ease hot flashes, but questions remain about the long-term safety of this hormone for postmenopausal women. 738
0 0 0
0. A nasty divorce has left me feeling slightly depressed, despite the relief of being out of a bad marriage. At times my heart races and then I break out in a sweat. I don’t know if these episodes are just anxiety or if they are hot flashes, since I am menopausal.
I am reluctant to take estrogen because I’ve heard about negative effects. IV rather use a more natural approach. Would a progesterone cream be safe?
A. Many women experience hot flashes much as you have described them, with an accelerated heart rate, a vaguely anxious feeling, sweating, and feeling too warm. Progesterone cream may help reduce hot flashes. Women’s health expert Susan Love, MD, points out, however, that high levels of progesterone are not natural after menopause. She worries that potential side effects might arise with long-term progesterone use. In addition, progesterone has been linked to depression.

Hamstring Stretch (back of thigh): Sit on a chair with a footstool in front of you omnicef price . Place your left foot flat on the floor and your right heel on the footstool so that the right leg is fully extended and your toes point to the ceiling tranexamic acid in gi bleed . Flex your right
foot, drawing the toes back towardyour body clomid making period late . With your backstraight
hips and reach toward your right toes lovegra . Take a full second to reach toward your toes and a full second to return to the starting point discount pet rx medicine clindamycin . Repeat about 15 times zoloft sponsor nascar . Repeat with your left hamstring buy viagra online netscape com . For a static stretch, reach toward your toes as far as is comfortable and without pain implant birth control norplant . Hold for 15 seconds, repeat three more times on each leg vitamin b12 and metformin .
Active Quadriceps and Shin Stretch (front of thigh and shin): Hold on to a chair or table for support counsel on salmeterol . Stand erect without leaning forward no prescription advair diskus . Bending one leg at the knee, curl your heel behind you toward your buttocks ciprofloxacin uses . Take 1 second to curl your leg behind and 1 second to return your leg to the straight position metformin advantages . Repeat about 15 times on each leg side effects topamax permenant .
Static Quadriceps and Shin Stretch: Stand close behind a sturdy chair that allows you to stand tall without leaning forward better than zoloft . Place a second chair with a seat that is no higher than your knee about a foot behind you swine omeprazole . Bend your right leg at the knee and place the top of your right foot on the seat of the chair behind you viagra free sites results . Your right knee should be directly under or slightly behind your hip steroids prednisone . Gently press the top of your right foot down against the chair to stretch the entire front of the leg antiemetic metoclopramide . The knee of the supporting leg should have a slight bend in it mechanism of caffeine on inducing lipolysis . Hold for four sets of 15 seconds, or a total of 1 minute antidepressant lamotrigine . Repeat with left leg procyclidine onset peak duration .
Other exercises may also be useful in helping to stretch muscles that tend to cramp testosterone replacement therapy patch women . Some people use a stair step to stretch the back of the leg zoloft side effects dry skin . Stand close to the edge of the step with the ball of one of your feet and drop your heel below the level of the step to stretch out the leg plantronics blue tooth 340 lithium battery .
I am often bothered with foot cramps that are annoying and uncomfortable at night and during dance class what lithium looks like . A physical therapist friend suggested a small rubber ball, about the size of a tennis ball paroxetine cod . I put it on the floor and roll each foot on it firmly, especially the arch and ball of the foot, to prevent the cramps amoxicillin dosage kittens .
Minerals
Over the years our readers have offered us dozens of suggestions for preventing nighttime leg cramps marlin prilosec sterling . Many of them involve minerals what does robaxin feel like . Some people swear by potassium cymbalta phentermine . Others are mhusiamie about calcium cats itchy skin prednisone dosage . Another contingent insists that magnesium is the magic mineral medic alert bracelet and coumadin . There’s no way to predict which mineral (or combination) will work best for you, so experiment until you find the right approach class of drug is primidone .
Before you start popping pills, though, why not start with food? Eight ounces of low-sodium V8 vegetable juice provide 840 milligrams of potassium at only 50 calories gen ranitidine ranitidine hcl .
For many years I was plagued with severe muscle cramps, usually in the middle of the night Several months ago one of your readers suggested low-sodium V8 juice, noting that it has more potassium and fewer calories than bananas withdrawal symptoms from verapamil .
I decided to try it and began drinking 8 ounces daily, In 4 months I have not had a single muscle cramp piroxicam for dogs to treat cancer . Quite a relief, to say the least! I heartily recommend it to anyone who has nighttime leg cramps lithium ion data sheet samsung .
Other foods that are rich in potassium include vegetables such as artichokes, asparagus, beets, bell peppers, broccoli, cabbage, cauliflower, chard, mushrooms, spinach, squash, and tomatoes pay pal buy nexium . A banana has about 400 milligrams of potassium, and so does a medium-size sweet potato claritin and blood pressure . Other fruits packed with potassium include apricots, blackberries, cantaloupe and other melons, nectarines, oranges, peaches, plums, pomegranates raspberries, and strawberries is celebrex a teratogen . Fish is generally rich in potassium, and many flavorings, such as ginger, onions, paprika, parsley, and red pepper, also contribute potassium to the diet scleroderma clindamycin . So do chicken and pork fosamax and gerd . Don’t forget molasses, especially blackstrap molasses, which has about 500 milligrams in a tablespoon does prozac cause selfishness . The Food and Nutrition Board of the Institute of Medicine has determined that for adults, 4,700 milligrams of potassium a day is adequate diflucan mexico .712
A word of warning patents loratadine .- Potassium can interact with many prescription drugs, particularly blood pressure medications wellbutrin verses paxil . Quite a few of these medications could boost the potassium level dangerously if a person on one of these drugs also took a potassium pill or used a potassium chloride salt substitute xyzal compare to zyrtec . Older people and those with reduced kidney function might be especially vul-
**** Magnesium
This essential mineral may help with cramps and main other 1pti3bti8M-t what invented the soma cubes . ag well the uses for paxil medication . Usual dose: 300 to 500 milligrams at bedtime—some people report it is gently sedating diovan yeast .
Downside: May cause diarrhea discount pet medication amitriptyline hci . Not for those with kidney failure rimonabant vietnam .
Cost: Approximately $4 for 100 pills, or about a 3-month sup-
ply tacrolimus ointment over counter .
nerable vantin and esbl . Too much potassium can lead to cardiac arrest, so be wary if you are taking any of the following: benazepril
moexipril
(Univasc), quinapril (Accupril), spironolactone
Maxzide), trandolapril (Mavik), or valsartan (Diovan) diflucan duration .
Magnesium is another mineral that is frequently overlooked and in short supply in the diet buspar and substance abuse . People on diuretics may be especially low in this crucial nutrient health net viagra non-formulary cost . Not only is magnesium essential for normal muscular contraction, it also plays a crucial role in heart health, blood pressure control, and hundreds of enzymatic reactions in the body captopril time to lower hypertension . It also helps reduce the risk of kidney stone formation enzyme immunoassay celecoxib .
People have been using magnesium for decades (as milk of magnesia) to counteract constipation amoxicillin causes liver . The normal dose ranges between 300 and 500 milligrams daily dosage for lexapro . One study demonstrated moderate effectiveness in battling nighttime leg cramps at 300 milligrams” Pregnant women are especially vulnerable to leg cramps adderall aciphex zoloft heartburn . Another study concluded that “magnesium supplementation seems to be a valuable therapeutic tool in the treatment of pregnancy-related leg cramps maxolon side effects .”"‘ Be aware that too much can cause diarrhea, and people with kidney problems should take magnesium only under medical supervision hair loss and cymbalta .
Some people are equally enthusiastic about calcium for preventing leg cramps panasonic br2330 lithium cell . The research that has been done on this remedy has been equivocal lithium manganese oxide . In one study, pregnant women with nighttime leg cramps were given calcium supplements or vitamin C as a “control paroxetine brain zapps .” Since there is no evidence that vitamin C can reduce leg cramps, it seemed that the difference between the two groups would be readily apparent if calcium worked well nasal decongestant risperdal . Both groups did equally well, however, suggesting that
715
calcium really didn’t make much difference ipratropium bromide long acting . A systematic review of the research on calcium for nocturnal leg cramps concluded that the evidence for its effectiveness is weak, at least in pregnant women how amoxicillin is produced . The reviewers found more support for supplemental magnesium tofranil pm for fibromyalgia . 716
One way to get extra minerals is with a special pediatric formulation called Pedialyte avandia problems . It was developed to “quickly replace fluids and electrolytes lost during diarrhea and vomiting to help prevent dehydration in infants and children quitting effexor weight .” Pe-Pedialyte
This rehydration solution for babies and children provides a balance of electrolytes that may help adults avoid muscle cramps trazodone and lung problems . Drinking about 4 ounces after exercising should help,
Downside: Somewhat expensive
Cost: Approximately $8 for a liter, or about $1 per “dose”
diatricians frequently recommend this ready-to-use liquid for sick children instead of juice or other beverages effect of clomid on progesterone . Ingredients include water, dextrose, potassium citrate, sodium chloride, sodium citrate, and citric acid zyprexa anorexia . Pedialyte is sold in drugstores and supermarkets in the baby section cyclosporine lipid emulsion . One athlete offered an amazing testimonial for its benefits against leg cramps coumadin interaction with foods and vitamins .
I have experienced a fair amount of cramping in my legs at night after I play tennis man dies from viagra overdose . The cramps occur more during the hot summer months when I perspire more melatonin while on zoloft .
I tried a lot of the sports drinks, but they didn’t seem to help with the cramping methotrexate ectopic . Someone suggested that I either eat bananas or drink tomato juice doxazosin mesylate msds . Unfortunately for me, I don’t like either food blood cozaar pressure .
I was told that the cramping was due to a loss of potassium in the body hsv i treating with valtrex . An assistant tennis pro suggested I try drinking the infant solution called Pedialyte rimonabant indication confusion . I thought that was a crazy idea, but I tried it because I didn’t like waking at midnight with a leg cramp depot provera pregnancy . To my surprise, the Pedialyte has worked like a charm and has eliminated my cramping micronase diabeta .
Pedialyte has one other unexpected benefit I usually play singles tennis, and I am usually pretty worn out after / play order viagra without prescription . Like a lot of people my age, my middle-aged body is usually pretty darn sore after playing, particularly the next day national geographic caffeine . Like everyone else, I take Morin for sore muscles phenergan injection adverse reaction . The Pedia(yte has substantially reduced The Soreness that I experience, and I don’t need to take Motrin the next day n1 3 lithium battery tester 3v .
B Vitamins
B vitamins have become the superheroes of nutrients cefuroxime axetil and symptom relief . Not only do compounds like folic acid, B6, and B12 have cardiovascular benefits, folic acid and niacin may help reduce the risk A combination of B vitamins may reduce nighttime leg cramps relicore zantac dieting combo . Keep the dose of vitamin B trileptal withdrawal how to .,below 100 milligrams per day to avoid nerve damage from long-term use cocaine and lexapro .
Downside: The B-complex formulas available are not specifically designed to prevent leg cramps generic viagra available .
Cost: Approximately $11 for 100 tablets, or a 3-month supply
of Alzheimer’s disease paroxetine and 5ht . One study from Taipei offers evidence that a B-complex vitamin formulation can reduce nighttime leg cramps tranny taking viagra . “After 3 months caffeine drinks . 86 percent of the patients taking vitamin B had prominent remission of leg cramps, whereas those taking placebo had no significant difference from baseline,”71 reported the study’s authors lipitor zocor news . This study used a formulation that is not available in the United States fosamax d generic . It contained vitamins B, (50 milligrams), B, ~5 milligrams), B6 (30 milligrams), and BIZ (250 micrograms) fda topamax warning .7 8
My husband has suffered horrible leg cramps at night all his life kidney infection and ibuprofen . He would writhe in pain amiodarone blood levels .
/ read that 8 vitamins might help uk imitrex . He now takes multiple B-100s every day and has no leg cramps naproxen and nursing babies .
We found a “dose-response curve caffeine makes me panic now .” With B-50s, he’d still have cramps, but they were less severe toradol and orange urine . With B-75s, he wouldn’t have cramps, just twinges in his legs ultram the medicine . At the 100 level, he has not even a twinge how to make prednisone .
A B-complex with 100 milligrams of vitamin B6 may be too much zetia buyback . We worry that regular consumption of th, s nutrient may lead to nerve damage lamisil side effects for women . Anyone who contemplates taking, more than 50 milligrams of vitamin B, should be under medical supervision synthroid phentramine .
Quinine
If you tell your physician that you suffer from frequent leg cramps at night, you may be offered a prescription for quinine depakote with tramadol . This botanical medicine (derived from the bark of a South American tree) has been used against malaria since a monk
B Vitamins sent a sample to Spain in 1633 avapro with dieuretic . (At that time, the diagnosis was probably “fever” or “the ague” rather than malaria gi lithium batteries .)
Doctors began using quinine against leg cramps in 1940 experience with lexapro . Despite this long history, there is still some controversy over whether its effectiveness outweighs the risks of side effects 19 In the 1990s, the FDA determined that the possibility of a susceptible individual experiencing a life-threatening blood reaction (idiopathic thrombocytopenic purpura, or ITP) was just too great cheapest diflucan online w o prescription . OTC sale was banned home coumadin testing . Now the FDA has forbidden doctors to prescribe quinine for leg cramps rifampicin isoniazid pyrazinamide ethambutol . One reader reported that a single glass of tonic water (which contains quinine) put her in the hospital with an almost fatal anemia flomax dosages .
It is hard to predict ahead of time whether a person might react to quinine by developing severe anemia erythromycin resistance peptide . Pregnant women should stay completely clear of quinine (even though they may suffer leg cramps) because it could cause birth defects and induce premature labor about penicillin capsules . Other side effects from quinine include ringing in the ears, rash, changes in color vision, headache, nausea, diarrhea, liver damage, low blood sugar, life-threatening anemia (ITP), vomiting, and trouble breathing prescribed premarin . Anyone experiencing such symptoms should get medical attention promptly meloxicam tab .
The amount of quinine in tonic water may vary from one brand to another discount digoxin . Some brands contain as much as 80 milligrams in a quart of tonic pseudoephedrine hydrochloride tablets canada . The dose that proved effective in preventing muscle cramps in one placebo-controlled study was 400 milligrams cialis tadalafil cialis tadafil tal .720 That suggests that a person would have to drink more than a gallon to get an effect, but many readers report that they notice a benefit from one or two glasses of tonic why hairloss with zetia . The
* Quinine
This traditional prescription for leg cramps is probably effective zocor causes ed . One or two glasses of tonic water may contain enough gui(xi(
Downside: Tinnitus (ringing in ears), rash, changes in color vision, headache, nausea, diarrhea, liver damage, low blood sugar, life-threatening anemia (ITP), vomiting, and trouble breathing are possible reactions atomic model of lithium .
Cost: Approximately $65 in the United States for 100 pills or $33 from a Canadian pharmacy prescription dose used to be 260 to 300 milligrams-, older people should generally start with a’lower dose warfarin graph .
I used to take quinine, but then it became unavailable over the counter My doctor recommended that I drink a glass of Schweppes Tonic Water lasix diabetes . It has enough quinine that it might help long terra omeprazole .
I tried it and it works methanphetamine ephedrine or pseudoephedrine . I have recommended this to others bothered with cramps after exercising, and they have been pleased procardia sr .
One word of caution is probably unnecessary triamcinolone .1 . Even though some people are accustomed to putting gin in their tonic water, the alcohol does nothing to prevent leg cramps resonance caffeine . If it is taken shortly before bedtime, alcohol can disrupt sleep—the last thing a sufferer wants swelling that is helped by prednisone .
Conclusions
Health care professionals generally consider leg cramps more of a nuisance than a serious health problem free live online zoloft help . Nonetheless, anyone who suffers from nighttime leg cramps knows that they can disrupt sleep, and that can eventually have consequences for health as well as mood is prazosin compatable with prozac . Finding the remedy that suits you best may require some trial and error increase free testosterone females . Don’t be afraid of the home remedies: They may seem silly, but since the only prescription treatment, quinine, can have such serious adverse effects, we think they are worth considering teva pantoprazole december .
I had terrible leg cramps, and nothing helped prozac action . Then my husband got some liquid calcium, and that worked immediately olympus li 10b lithium batteries . I have not had another leg cramp women’s international testosterone .
He decided to try mustard for leg cramps, but he still had leg cramps and really did not savor the mustard cat soma . He decided to try turmeric, an ingredient in mustard lithium batteries for electric automobiles . He took’/, teaspoon at bedtime and ‘/;, teaspoon at breakfast xenical side efftects . BINGO! This worked great price of prevacid . Not only did it cure his leg cramps, but it also eased the pain in his hip and feet
He recommended I try it for my awful loot problems valtrex capl . It felt like an ice pick was stuck in the ball of my foot As soon as I started taking the turmeric, I had no more pain ephedrine caffeine stack . I can now wear my lovely high-heeled shoes on Sunday without suffering celebrex qoclick .
e Ibck a bar of ordinary soap under the bottom sheet when you make the bed tricor side . It should be near your legs, and may need to be replaced every 6 weeks or so buying generic zoloft . We don’t know why it would prevent leg cramps, but many readers report success—and we know of no side effects naproxen and methylprednisolone .
• Swallow a teaspoonful of yellow mustard—the inexpensive kind sometimes dispensed in individual packets cyclosporine ointment . We think it may be the turmeric in the mustard that helps lexapro peak . This remedy can work very quickly, though some readers have reported heartburn as a result wellbutrin xl prozac weight loss .
• Sip about an ounce of pickle juice medroxyprogesterone acetate anorexia . Some pickles may contain turmeric, so perhaps that explains why this helps some people fight off muscle cramps so quickly procardia sr . Or, it may provide some missing minerals salbutamol inhaler medication information . Pickle juice is high in sodium, so this home remedy is not for anyone on a low-sodium diet buy viagra on line .
• Baking soda, ‘44 teaspoon in 8 ounces of water, is reputed to fight painful leg cramps quickly prozac video for dogs . Baking soda contains sodium, so it is not for anyone on a low-salt regimen viagra sports .
• Pinch your upper lip firmly between your thumb and forefinger until the cramp eases veterinary ranitidine pricing . This may have the effect of providing a distracting pain that is under your control testosterone injections chronic fatigue . Many readers claim it is helpful, although we have not been impressed information lipitor prescribing .
• Stretch leg muscles for several minutes before bedtime toprol xl 50 mg .
• Consume plenty of potassium-rich vegetables, especially low-sodium V8 juice doctors give shots of penicillin . Increasing potassium intake seems to help prevent leg cramps hydrid technologies lithium power .
• Take a supplement of 300 to 500 milligrams of magnesium a day atacand picture . Reduce the dose if this gives’you diarrhea viagra gif . Avoid magnesium if you have kidney disease can i take accutane and bactrim .
• Try 4 ounces of Pedialyte after vigorous exercise to replenish minerals and prevent muscle cramps decadron vs prednisone .
• Consider B-complex vitamins to prevent cramps oxycoton compared to tramadol . Keep the dose of vitamin B,, under 100 milligrams per day to avoid nerve damage cialis patent expiration wikipedia .
• Ask your doctor about quinine beers effect on levitra . it is available by prescription (or at low doses in some brands of tonic water) how long before wellbutrin kicks in . Severe side effects are uncommon but may be life-threatening, especially a blood disorder called ITP carafate suspension pets .

LEG CRAMPS

I tried massaging my calf free gift from zyrtec allergy medication . That didn’t work celebrex absorption . The pain doesn’t quit until I can flex my calf muscle title acomplia . During a leg cramp, my foot is in a position as it I had an high heels e citrate de clomiphene . Forcing the foot into a more normal position by pushing the toes and heel onto the floor usually stops the pain tegaserod maleate in switzerland . This hurts, but it works cyproheptadine for feline .
Every time I have gotten this kind of cramp it was because I was dehydrated griseofulvin cat . Any sports trainer will tell you that cramps are a sign of dehydration hives and valtrex .
Although dehydration may lead to mineral imbalances that could contribute to muscle spasms, doctors don’t always know why some people develop nighttime leg cramps alternative to celebrex . They often don’t have good treatments, either viagra wal-mart . Many physicians prescribe quinine, a natural medicine derived from the bark of the cinchona tree side effects of lexapro slurred speech . It has been used for centuries to treat fevers, especially those due to malaria medication amoxil . While this drug can be effective against leg cramps, there are a number of potentially serious side effects associated with quinine mrsa and zithromax . They include ringing in the ears, rash, and, rarely, liver damage or life-threatening anemia stimulus drugs prozac .
Consequently, it makes sense to try home remedies or dietary supplements first to see if they work penicillin g potassium rt . That’s true even though some of the home remedies may seem a little strange propecia buying . What works like a charm for one person may be totally worthless for someone else motrin infants drops nightmares . This is truly a case of trial and error ramipril can it cause impotence .
Soap Under the Sheets
One of the strangest home remedies we have ever encountered requires nothing fancier than a bar of soap clarithromycin tablets maximum daily dose . When we first heard about this approach, we assumed it had to be a placebo effect e coli ampicillin resistance antibody . That’s because we have no scientific explanation for why it would work i love celexa . Because it defies logic, we almost wrote it off as too weird zoloft 50 mg and pregnancy . But so Many Of OUT readers have shared their successes with us that we can no longer ignore one of the cheapest and easiest ways to prevent leg cramps alliance lipitor .
How someone came up with the idea to put a bar of soap under the bottom sheet is a mystery coumadin medical id pendant . Whoever came up with the idea, however, was a creative genius and now has a lot of devoted followers where can i find lithium . Basically, the instructions are to take an ordinary bar of soap, unwrap it, and stick it under the bottom (fitted) sheet about where your calves would be fosamax recommended dosage . The
Soap
Any soap except Dove or Dial should work tamoxifen research . Inexpensive, without side effects, and amazingly effective, according to many readers prednisone and nocturnal urination . Place a bar under the bottom sheet near your legs zelnorm long term effects .
Cost: Approximately 70 cents for a bar that should last up to 6 weeks
cheaper the soap, the better it seems to work rate of absorption of glipizide . Folks tell us that even a small bar of hotel soap works just fine does rooter have caffeine . Every so often, someone will report that she had concluded that the soap had stopped working until she discovered that it had fallen out of the bed zocor and vioxx . ‘The bar does need to be replaced from time to time, perhaps every month or 6 weeks prozac wellbutrin suicide . And we have been told that it may take from a few days to a week for the full effect to take hold celecoxib effects lawyer side .
I read that a bar of soap under the bottom sheet near the bottom of the bed might help prevent leg cramps at night and decided to give it a try john prozac flutes . I have been plagued with terrible leg cramps several times a night for months wikipedia ampicillin . None of the many remedies I’ve tried helped—until the soap premarin for children .
It is hard to believe that a simple bar of soap could possibly make a difference, but it did pretzel on prozac . Not a single cramp in over a week mg of caffeine in espresso . I was desperate for a good night’s sleep and finally got it doxycycline feline dosage ml mg . One bonus: There are no side effects!
My physician husband was having severe leg cramps at night, and when he’d wake with one, I would wake up as well phenergan elderly . He tried tonic water and quiti(at, W They didn’t help carvedilol 125 mg .
Under cover of darkness, so he wouldn’t see, I placed a soap bar under the sheets on his side zocor generic . He’s had no more cramps since then bad celebrex effects side . It was 2 nights before he even noticed the soap depakote labs to watch .
I used one of your ridiculous remedies (the soap under the bedsheet) to stop nighttime leg cramps can ramipril cause irregular heartbeat . Sufferers of leg cramps will try anything synthroid dogs . I didn’t fell my friends about trying this dumb suggestion coumadin log . But what do you know, it worked!
By the way, while you are messing with your sheets, make sure that the top sheet is not tucked tight- A military-style bed with sheets so tight that a quarter will bounce off them may contribute to foot or leg cramps by pulling the foot into an awkward position castrol hd lithium . Even your average hotel bed can be improved by loosening the top sheet overnight loratadine .
Mustard
Soap might not prevent all leg cramps order pravachol . An inexpensive option for relieving the pain quickly is to swallow a teaspoon of mustard—the cheap yellow kind, not a fancy French or German variety zyloprim promethius . Again, we have no idea how someone discovered this astonishing remedy prozac lyrica .
We cannot tell you why yellow mustard seems to work so well for so many people lamictal cost price . Presumably, the turmeric added for coloring and flavoring plays a role rechargeable lithium tactical led flashlight . The active ingredient in turmeric is curcumin, which has been shown to have anti-inflammatory properties cold sores accutane . How it could work so fast mystifies us singulair air program card .
Most people who have tried this remedy report that they get quick relief, but some complain that mustard in the middle of the night, with no sandwich, is unpalatable or, worse, gives them heartburn what foods change coumadin levels . Be sure to wash it down with water if this is a problem depression medication celexa long term effects . Other folks have found that the packets of mustard distributed in fast-food restaurants are easy to keep on the nightstand and deliver just the right dose levaquin 500 mg .
Clearly, the mustard remedy for leg cramps has been around for a very long time topical estradiol . Many readers tell us it works great for either daytime or nighttime cramps uses for hydroxyzine . What is so astonishing is that people report such quick results free viaga cialis . That makes no sense pharmacologically we ship brand name nolvadex . If this were a druglike effect, the active in-
*** Mustard
A teaspoonful or the amount in a self-serve packet should be enough what is altace used for .
Downside: It might cause heartburn lipitor sex drive .
Cost: Approximately $1 for a 9-ounce jar that will last for weeks prozac and ocd . You can get little packets of yellow mustard for free at fast-food restaurants flavored caffeine .
gredient or ingredients in mustard would have to be absorbed from the digestive tract, circulate through the bloodstream, and eventually relax the muscle causing the cramp oral ivermectin for dogs . That could take anywhere from 15 to 30 minutes generic cialis tadalafil price comparison .
My mother has leg cramps almost every night Because of your reports on yellow mustard, I got a huge supply of individually wrapped mustard packets coreg and managing blood sugar . She keeps them on her nightstand and in her purse pseudoephedrine log forms . When a leg cramp starts, she takes the mustard and the cramps disappear immediately lexapro side effects and children .
She got a cramp recently in a doctor’s office hyperglycemia and prednisone . Since she had used all her packets up, I asked the nurse to get some mustard from the break room amoxicillin and pediatric dose . She’d never heard of the remedy but was impressed when the cramps went away viagra box . The turmeric in the mustard is the lifesaver
Not everyone agrees that mustard is marvelous negative side effects of pravastatin . One reader reported that “a spoonful of mustard did not do anything to alleviate my cramp, but it kept me up the rest of the night with indigestion cardizem causing chf side effects . My esophagus burned all night long ultram extended release . What a terrible remedy buy ramipril in the usa .” Interestingly, some folks tell us that yellow mustard actually relieves their heartburn, proving once again that everyone is different!
Pickle Juice
Another odd remedy for leg cramps is a sip or two of pickle juice paxil and zantac ingredients . A former pro football player who played with the San Francisco 49ers and the Dallas Cowboys wrote to tell us that yellow mustard is not his favorite remedy for leg cramps antidepressant works with paxil . And if anyone should know about leg cramps, it is someone who had to run around the football field at maximum exertion in the Dallas heat clomid days 5 10 . He praised prescription quinine but also said that by far the best home remedy for leg cramps is a ftgzy of pickle juice (about an ounce) is sodium saliclate in asprin .
Ws remedy may be especially popular in his home state of Texas, where an entrepreneur sells Pickle Juice Sport lamisil sales volume . He claims the electrolytes in this drink help reverse leg cramps celexa lack of emotion . (His Web site, for those who are interested, is www dangers of doxepin .goldenpicklejuice testosterone prostate carcinoma . com metoprolol 50 mg by caraco .) Most people just use the liquid from a jar of pickles caffeine addiction withdrawl .
With pickle juice, as with mustard, those who experience relief do so very quickly estrace with prometrium . Who knows what mechanism is at work? Perhaps the pickle juice replenishes minerals, espe-Pickle Juice
About an ounce of dill pickle juice, with no seeds or spices,
may quell cramps stopping citalopram cold turkey .
Downside: Pickle juice is high in sodium and so is not appropriate for those on a salt-restricted diet reaction of amoxicillin .
Cost: Approximately 10 cents an ounce from a pickle jar cheap paxil . A 16-ounce bottle of Pickle Juice Sport sells for $1 haldol risperadal depakote cocktail .50,
cially sodium, that are lost during exertion thyroxine stimulating hormone . Aside from having too much sodium for those who need to watch their salt intake, though, there is no downside how to stop taking wellbutrin .
My favorite remedy for leg cramps is pickle juice buy disulfiram . When my youngest son was in school, the track coach used to get the leftover pickle juice after the band boosters had sold all the dill pickles in a jar He kept it to give to an athlete when he cramped lotrel 10 20 alternatives . I use it myself (when I can find it) during long bike rides cipro tamiflu drug interaction .
Baking Soda
Athletes often complain of leg cramps after vigorous exercise claritin chapped lips . Pickle juice may restore the sodium lost in sweat zelnorm replacement . Another remedy that may work on the same principle is baking soda, a time-honored remedy for indigestion urso brothers inc . The dose for treating cramps is about half as much as that for treating indigestion, according to one reader:
A neighbor of mine has a remedy that I find very helpful buy tramadol without . He was an avid skier in his younger days and advocates taking 114 teaspoon of baking soda in a glass of water after a day on skis or doing other strenuous activities clozapine classifications . He claims the soda neutralizes the lactic acid that forms in muscle upon heavy exercise vit k and coumadin .
Lip Pinch
One of the more unusual approaches to leg cramps is a home remedy that many people find helpful drink alcohol celexa . The idea is to pinch the upper lip, hard, for several seconds until the cramp lets up flomax in usa . We have never been successful with this approach, but many readers are enthusiastic about it tizanidine medication .
For 15 years I suffered agonizing leg cramps, usually at night warfarin first effects factor 9 . I couldn’t sleep and would almost panic at the thought of having one paxil pill description . I found relief with quinine, but this drug had some unpleasant side effects, mainly ringing in the ears compare seroquel and trazadone for insomnia .
Then one day I read an article about a coach who would tell his players to pinch the upper lip right beneath the nose when they had leg cramps testosterone standards . The cramps would ease stronger than caffeine . I thought it sounded odd but decided to try it ivermectin cattle pour on . When the cramps started, I pinched my upper lip, and the cramps gradually went away demeclocycline and siadh . I did this every time the cramps started for several months, then finally they quit altogether
Preventing Symptoms with Exercise
Anyone who suffers recurrent leg cramps will be anxious to prevent them long terrm tramadol abuse . Many people are aware that strenuous exercise during the day may trigger nighttime cramps zantac or ranitidine . But so can inactivity mail order arimidex . Reader Ruth Mannish of Oxford, North Carolina, teaches exercises to seniors and offered the following instructions for stretching before bed sideaffects of prozac .
Calf Stretch: Stand close behind a sturdy chair or other stable support bupropion and lexapro interaction . With your feet about hip-width apart, hold on to the chair back start taking xenical weight fat meal . Shift your weight to your left leg prednisone and sunshine . Move your right foot about 12 inches back, placing your toes on the floor and elevating your heel nausia with flagyl . Keep your left knee over your left ankle (left knee will bend) as you slowly ease your right heel down and up (no faster than 1 second moving down and 1 second moving up) about 15 times testosterone cypionate alternatives . Repeat with your left calf ranitidine precautions and anemia . For a static stretch, hold the heel down for 15 seconds at a time rather than moving it fluconazole prescription drugs .

Sleepy-Time Smells
Smelling yourself to sleep seems like a pretty strange concept macrodantin doses . We have to admit that aromatherapy for insomnia seemed like a stretch to us, too metabolising caffeine . Most people are used to swallowing medicine, not smelling it nizoral anti-dandruff shampoo . Nevertheless, scientific research supports the idea that soothing smells may be relaxing and actually enhance sleep chronic daily headache tizanidine .69′ Lavender and jasmine are the two scents that seem to promote sleep half life of cymbalta . Sleep researchers at Wesleyan University in Middletown, Connecticut, found that lavender increased deep sleep in both men and women paroxetine formula . and they concluded that lavender aroma has sedative and sleep-promoting activity albuterol swollen epiglottis .691
Some people put a sachet u”dty their pillow is metformin a sulfonylureas . Others spray 1hle pillowcase with scented sandoz recall toprol . water metronidazole fish treatment .
Several friends and I have discovered a wonderful natural way to help insomnia zocor and muscle breakdown and pain . It is called “lavender and vanilla pillow mist” It can be purchased at the bath shops found in a shopping mall hyzaar astra zeneca .
When I first heard a friend tell me that she had been using sleeping pills for several years, and then did not need them once she discovered the lavender pillow mist, I originally thought it was all in her head using doxepin in treating ezema . But I gave it a try and found it most relaxing wall street journal zocor .
You just spray a little on the corners of your pillow, where your face will be isotretinoin substitutes . It even seemed to help my stopped-up nose!
To brag a little more, I sprayed some on my dog’s pillow, and she slept about an hour longer in the morning can viagra be taken with norvasc . I have been told that the Egyptians have used lavender for relaxing for more than 500 years mix bendryl claritin . Perhaps this will help those who are having insomnia and want a natural way to go to sleep amiodarone hcl wikipedia .
Those who don’t find lavender appealing may want to consider jasmine instead order cheap ranitidine . Researchers at Wheeling Jesuit University compared sleeping environments infused with jasmine, lavender, and no smell at all achat libre viagra . Twenty subjects were tested for 3 nights each and then given mental function tests price pseudoephedrine . Those who slept under the influence of jasmine woke up more refreshed and alert duloxetine torrent pharma . They scored better on the tests by responding more quickly and accurately grand mercure apartments allegra hervey bay . Lavender also seemed to help, but not as much as jasmine arava folic acid .69′ Scientists have found that both jasmine and lavender odors have measurable effects on nerve activity, mood, and heart rate caffeine addiction physical addiction . 693 A caller to our national radio show also reported that the scent of eucalyptus helped her sleep asprin asa classification .
Breaking the Vicious Pill Cycle
It may be difficult for people with chronic sleep problems to break out of the medication merry-go-round flomax litigation . Anyone who has relied on sleeping pills like diazepam (Valium), lorazeparn (Ativan), or temazepam (Restoril) will discover that stopping suddenly may lead to several sleepless nights topical ethynyl estradiol . Often, this sets in motion a vicious cycle in which the insomniac reverts to the medication just to get a little sleep but finds once again that when he or she stops the medicine, rebound insomnia kicks in how long diflucan stays in system .
It is not likely that natural sleep aids will be able to counteract this effect timing intercourse while taking clomid . Instead, you may need to discuss such a drug dependency problem with your physician to develop a withdrawal strategy buy promethazine . It may take several weeks (or longer) to wean yourself off a traditional sleeping pill habit wellbutrin overnight . Once “clean,” though, it may be possible to substitute an herb or a dietary supplement to get a decent night’s sleep without creating another vicious circle of rebound insomnia nutrients that lipitor diminishes . Because melatonin is a natural chemical created in the brain and is essential for normal sleep, it seems logical that taking melatonin in a pill would be helpful for insomnia synthroid or armour thyroid . Many peo- ple believe that melatonin is a wonderful natural sleep aid tadalafil no consultation . Unfortunately, the studies that have been done have produced mixed results comparison between effexor and lexapro . One careful review of clinical trials concluded, “There is evidence to suggest that melatonin is not effective in treating mostary sleep disorders with short-term use (4 weeks or less) azor olmesartan .”694
People taking melatonin did fall asleep more quickly-11 minutes on the average—not enough to write home about affect allegra d side . ‘Me authors concluded that melatonin appears to be safe, at least in the short term uses of triamcinolone acetonide . Another meta-analysis of 17 sleep studies reached a different conclusion diflucan works in 24 hours . Those investigators found that melatonin reduced the amount of time it took for people to fall asleep and increased the amount of time they spent sleeping flagyl avntis .’95
‘Me one condition for which melatonin appeared to work well is “delayed sleep phase insomnia aldactone and male pattern balding .” People with this problem go to bed very late (perhaps 3:00 or 4:00 a withdrawal schedule for prozac .m prandin percent compostion of carbon .) and get up late (around 10:30 a information on drug spironolactone .m does paxil raise cholesterol level . or later), haye trouble going to sleep at a normal time, and experience morning grogginess medicine called aleve . “Taking 5 milligrams of melatonin 3 to 4 hours before bedtime allowed such people to go to sleep more easily around midnight diflucan for diabetes .
** Melatonin
Taken 30 minutes before bedtime, melatonin may help a person get to sleep faster and improve sleep quality vermox contraindications . The dose is controversial 2d6 enzyme produce tamoxifen . As little as 1/3 milligram (300 micrograms) may be optimal (this dosage is available from Nature’s Bounty) crying while on alesse . Most supplements provide 3 Milligrams, which is DTDbably too much compare claretin and allegra .
Side effects: Tiredness, dizziness, headache orthostatic hypotension warfarin . Don’t mix with warfarin (Coumadin) demeclocycline for sale .
Downside: Finding 0 weight loss hair loss finasteride .3-milligram doses is hard online pharmacy soma no rx . You may have to split a 1-milligram tablet three ways low female testosterone .
Cost: Approximately $2 to $3 for a month’s supply
Melatonin
Acupressure
We never considered acupressure a viable sleep aid until we received a most unorthodox home remedy from one of our readers converting from coreg cr to coreg . He suggested taping a dried bean to the inside of the wrist between the two tendons risperdal law prolactin . He measured three finger-widths from the crease of the wrist lumiracoxib naproxen chan . The point he described is known in traditional acupuncture as the Inner Gate altace online . Pressing on it is supposed to relieve anxiety, slow the heart rate, and promote sleep cialis does it work for everyone .
I read in your column about an acupressure point on the inner arm to aid sleep viagra how long side effects . You suggested taping a kidney bean between the two tendons, three finger-widths from the wrist mefloquine and pregnancy .
My husband and I tried it, and it’s been amazing! The tape was uncomfortable on our skin, so we’re using plastic “marbles” (for arranging flowers in vases) instead of a kidney bean, and we secure it with an elastic hand cozaar hypotension at night . ft has improved our sleep tremendously, and we wanted to thank you ortho micronor birth control .
Other ingenious readers devised wristlets with buttons to exert pressure on the proper point what causes multiple pregnancies clomid . Apparently, though, the acupressure point our reader described is not the only one that could be used cipro hc otis dosage . A commercial product, 1st Choice Sleep Band, from the makers of Acuband, exerts pressure at a spot on the heart meridian (Ht7) metformin sodium . The manufacturer claims that wearing the bands on both wrists promotes restful sleep (for more information, go to www do robaxin and naprosyn contain aspirin .acuband mirtazapine dose sleep .com) taking zoloft and luvox together .
There is relatively little research to support acupressure for treating insomnia prednisone cancer pain . Not surprisingly, most of what there is has been done in places where people are familiar with the concepts behind acupuncture and acupressure cialis affiliate program . A Korean study found that acupuncture of the ear assisted elderly people in getting to sleep engles urso follmer .697 A Taiwanese study found that acupressure improved the quality of sleep in older people what is avodart side effects .698
Herbal Solutions
Compared to pharmaceuticals, herbs get no respect cocker spaniel skin yeast ketoconazole . Physicians think they are wimpy at best and ineffective and dangerous at worst ibuprofen combined with . This is despite the fact that the sleeping pills they have prescribed for decades carry substantial risks of their own abilify and adhd . More about sleeping pill problems in a moment,though suzanne sommers estrace 2mg . The question is whether it would even be worth trying an herbal approach to insomnia side effects of stopping prednisone .
VALERIAN (VALERIANA OFFICINALIS)
Do you remember the story of the Pied Piper of Hamlin? He used music to rid the town of a rat infestation diflucan dosage ringworm . Some herbal experts suggest that he may have used valerian as well arms ache on prednisone . It was popular in medieval times to flavor soups and stews blood pressure ibuprofen . Because dried valerian root smells like sweaty socks or stinky cheese, presumably the aroma would be appealing to rats wellbutrin xl 300mg generic . Some even suggest he could have given valerian to the town’s children to quell their fears before playing his pipe for them lithium 9v duracell . That would have made it easier for him to lure them away after the town fathers refused to pay him what they owed him for ridding the town of rats sides effects prozac .
Regardless of whether this legend has any basis in fact, the herb has long been used as a mild sedative prilosec compaired to aciphex . A number of small trials suggest that valerian reduces the amount of time it takes a person to fall asleep and may improve the quality of sleep how much does prozac cost .699 In one 6-week study, standardized valerian extract proved just as effective for mild insomnia as the Prescription sedative oxazepam (Serax) lithium’s alchemists symbol . Do not expect valerian to work instant magic amoxicillin clavulanic dose for pig . Unlike traditional sleeping pills, it appears that valerian is more effective when taken nightly for at least 2 weeks alprax caverta calcutta drug .
The biggest advantage of this herbal approach over antihistamines like diphenhydramine (Benadryl or Tylenol PM) and prescription sleeping pills like tema7epam (Restoril) is that va-
*** Valerian
Taken 30 minutes to 2 hours before bedtime for at least 2 weeks, valerian can help a person get to sleep faster ranitidine . It may also improve sleep quality drug interaction valium and prilosec . The dose is 300 to 600 milligrams daily neurontin for children . For tea, use 2 to 3 grams of dried root and steep for 10 to 15 minutes penicillin aqueous .
Side off ects: Digestive upset, rare headache muscle builders with testosterone . Don’t mix with prescription sedatives such as barbiturates or benzodiazepines discount viagra furthermore cheap adipex reviews .
Downside: Smells bad; quality variable
Cost: Approximately $8 to $12 for a month’s supply lerian does not affect coordination or make you woozy celebrex attorneys pennsylvania .100 This is critical if you wake up in the middle of the night to go to the bathroom ndc for toradol . Anyone who is a little unsteady could fall if taking standard sleeping pills discontinuing 300 mg tegretol .
OTHER SLEEPY-TIME HERBS
Other herbs that people have used to treat insomnia include hops, chamomile, lemon balm, passionflower, St withdrawal symptoms from effexor xl . John’s wort, kava, and fennel seeds hyzaar 50 12.5mg . There are, unfortunately, few large, randomized, controlled studies to verify the effectiveness of any of these natural prodUCt&70′ Kava works, but concerns have been raised that it might cause liver toxicity california discount pharmacy tramadol .This may have to do with how the kava is manufactured, but until this issue is resolved, we cannot recommend the long-term use of this herb purchase and viagra soft .
Chamomile tea is what Mrs lexapro cramps . Rabbit gave Peter to ease his tummyache and help him get to sleep after his mischief in Farmer MacGregor’s garden can i take reglan being pregnant . (In one of her other books, Beatrix Potter suggests that lettuce can make little rabbits sleepy, though she doesn’t find it affects her that way prozac reduce headaches .) Chamomile has traditionally been suggested to be a very gentle sedative, but there is hardly any evidence that it would have an effect in insomnia paxil ativan . On the other hand, a cup of chamomile tea might settle the stomach and be a nice way to calm down before climbing into bed wellbutrin for percocet withdrawl .
Sleeping Pills
Like Rip Van Winkle, the sleeping pill business is waking up after a long period of hibernation name of man who discovered penicillin . During the 1990s, sleeping pills fell out of favor coumadin activated . Triazolam (Halcion) was extremely popular after coming on the market in 1983 imipramine pm . Here was a sleeping pill that worked quickly to put people to sleep and would not leave a morning hangover like its predecessors (Dalmane finasteride and proscar cheap . Restoril, or Valium) does acai have caffeine . Since the, drug was rapidly eliminated from the body, it was believed to have no measurable effect the following day actress in viagra commercial . Halcion quickly became the market leader herbal med comparable to lasix .
Then odd reports started cropping up paxil treating delayed orgasm . Scientists taking Halcion to prevent jet lag while traveling to international conferences noted bizarre lapses in memory concerning events that happened the following day periactin to treat nausea . These people appeared normal to friends and relatives while they were giving speeches, recovering lost luggage, and sightseeing the day after taking Halcion amoxicillin with milk . But sometimes they later could not remember having done any of those things medical diagnosis for low testosterone . It was as if a piece of their memory had been erased, like words from a blackboard evista rod . There were also reports of depression associated with Halcion use and even some suggestions that it was linked to violent and aggressive
behavior advil versus aleve .
With all the bad press, Halcion in particular and sleeping pills in general fell into disfavor j-tube and prevacid . A lot of insomniacs worried about drug dependency, morning grogginess, and memory lapses buy aquazide esidrix online ezide hydrochlorothiazide . Instead, they chose to toss and turn rather than rely on benzodiazepines like estazolam, flurazepam, quazepam, temazepam, and triazolam order cheap viagra .
Then along came zolpidem (Amblen) in 1993 caffeine plant growth cafeine growth plant . It gradually captured the sleeping pill market cheep generic viagra . Eventually zaleplon (Sonata) showed up, but the real competition didn’t arrive until 2005 in the form Of eszopiclone (Lunesta) and ramelteon (Rozerem) how to shop for tadalafil online . Sleeping Pills were aggressively marketed directly to consumers wellbutrin xl sr . The Lunesta commercial featured a beautiful green Luna moth gently fluttering through a bedroom claritin and benadryl . But just because the ads are alluring doesn’t Mean a prescription is the best approach clomid when should we have intercourse .
An in-depth analysis indicated that for the elderly, at least some sleep medications are more likely to hurt than help zyrtec can be purchased from canada .7R The medications may help some older individuals fall asleep more quickly can boniva cause tooth pain . But the overview found that, for the most part, sleeping pills have only a modest effect zoloft at night .
The prospect of dangerous side effects is especially troubling depakote gain weight . Older people taking a sleeping pill were nearly five times more likely to become confused or forgetful as those taking an inactive placebo mg caffeine sparks .703 Dizziness that might lead to a fall and daytime drowsiness that could lead to an accident were also significantly more common singulair information . These risks should lead an older insomniac to ask lots of questions about possible problems if his physician offers a Prescription fenofibrate pictures . The, authors of the review suggested that Cognitive behavioral therapy or other nondrug treatment might be preferable for some elderly people with sleeping difficulties drug effectiveness wellbutrin and cymbalta . 704
As is so often the case, there are few head-to-head clinical trials comparing the effectiveness or safety of the newer sleep aid&705 As a result, ranking them requires a certain amount of guesswork and judgment abilify obesity . Here is our overview levaquin reaction symptoms .
** Lunesta (Eszopiclone)
Eszopliclone helps people fall asleep and stay asleep tricor 145mg directions . it probably lasts a little longer than Ambien but likely is comparable to Ambien CR lithium floride glow curve . Because the manufacturer submitted a 6- month study, Lunesta is approved for long-term use prednisone half-life .
Side effects: Unpleasant taste, headache, next-day drowsiness, dizziness, dry mouth, next-day memory impairment (anterograde amnesia), difficulty with coordination Downside: Possible memory difficulties new fda drug name acomplia . Sudden discontinuation can lead to worse insomnia during the first night or two minocycline calcium interraction . Lunesta can be very dangerous if taken in combination with alcohol or other sedatives nystagmus tremor celexa 40 mg . Avoid itraconazole (Sporanox), clarithromycin (Biaxin), and ritonavir (Norvir) cymbalta falling . Cost: Approximately $100 to $110 for 1 month (30 pills)
more than a few nights at a time, this labeling is likely to propel Lunesta to becoming the most successful sleeping pill in the United States tramadol hcl dosage . Whether it deserves this marketing edge remains to be seen info on celexa . Lunesta works in a manner similar to that of Ambien and Sonata, but it has a longer-lasting effect lamisil side effects .
One study suggested that Lunesta could be used for up to 6 months without losing its effectiveness or leading to dependence tamoxifen and lamisil . Nevertheless, the FDA classifies it as a Schedule IV controlled substance, which means “limited dependence liability ibuprofen kids .” When Lunesta is stopped, rebound insomnia is a distinct possibility flagyl and macrobid .
Rozerem (Ramelteon)
This is the first truly unique sleeping pill to come to market in years seroquel defined . It targets melatonin receptors to help people fall asleep nitrofurantoin macro . Unlike all other prescription sleeping pills, Rozerem is not classified as a “controlled substance prilosec and liver side effects .” That means there are no restrictions on the length of time it can be used and no fears about abuse or dependency caffeine at night symptoms .
On the surface, it might seem as if Rozerern represents a wonderful new solution to insomnia osmolite and warfarin . Unfortunately, we are not overly impressed with its effectiveness average cost per day risperdal . In clinical trials, it reduced the amount of time it took people to fall asleep by 8 to 16 minutes norvasc aleve . 707 That may be helpful for some, but Rozerem Rozerem I(Ramelte0qW cheapest viagra and regalis .
Ramelteon helps people fall asleep baclofen and tizanidine . It works differently from all other sleeping pills and poses no risk of dependency reglan without prescription . Take it 30 minutes before retiring and not with a high-fat
meal omeprazole drugs .
Side effects: Next-day drowsiness, dizziness, nausea, fatigue, and headache
Downside: Not safe for people with liver problems what is nifedipine used for . Avoid fluvoxamine (Luvox), fluconazole (Diflucan), and ketoconazole (Nizoral) crookd penis from levitra . Safety during pregnancy has not been determined herb zyrtec . Cost: Approximately $80 to $85 for 1 month (30 pills)
did not reduce nighttime awakenings or help people get back to sleep once they had awakened cyproheptadine anti-serotonin depression . In addition, there is one side effect that bothers us vioxx celebrex bextra . The manufacturer reports that this compound lowers testosterone levels and increases a hormone called prolactin sainsburys caffeine level . This change in hormone balance may be associated with reduced libido, infertility, and osteoporosis fluconazole infants stomachs .
Sonata (Zalepion)
Sonata is a very short-acting sleeping pill that works in a manner similar to that of Ambien and Lunesta actos lawsuits . Because its effects wear off quickly, it can be used when someone wakes up in the middle of the night and cannot get back to sleep asprin and vitamin e acne treatment . The only caution, though, is that you need at least 4 more hours of sleeping time for the effects to wear off charging cr2032 lithium . If you wake up at 5:00 a ultram withdrawal symptoms .m dangers of atenolol . amoxicillin long term use for kidneys . take a Sonata, and then expect to be able to hit the ground running at 7:00 a too much synthroid medication .m what is feldene drug ., you could be in trouble aciphex and hip fracture . If Sonata is taken at bedtime, it is less RV,6y than other sleeping pills to rwist morning hangover dr affect driving ability the next day coreg varices . The downside to this short effect is that some people may wake up early in the morning because the drug’s effect has worn off synthroid and antidepressant metabolism .
For people who wake up too early in the morning, there is another trick to try cialis dreampharmaceuticals online . Bright light exposure in the evening may help them reset their body clock so that they can sleep through the night zantac picture .” Those who cannot fall asleep until the wee hours may benefit from bright light in the morning robaxin damages .
Sonata (Zaleplon)
Zaleplon is a good choice for people who wake up in the middle of the night and cannot easily fall asleep again motrin dosa . At least 4 hours of sleep time are needed levitra duration . Do not take after a fatty (heavy) meal because the food will delay absorption citalopram and duloxetine .
Side effects: Headache, stomachache, dry mouth, constipation, back pain, and occasional next-day drowsiness Downside: Sonata’s very short effect may mean that the drug wears off during the night and results in early morning awakening viagra home made . People with liver problems should avoid Sonata aleve back and body . Cost: Approximately $100 per month
Diphenhydramine
This antihistamine, the active ingredientin Benadryl, is noto- rious for causing drowsiness japanes green tea caffeine . During the daytime, this side effect is a real liability if you want to drive or do anything that requires alertness does medicaid cover zoloft . But at bedtime, drowsiness might be a good thing prednisone horse dosage . ‘There are many over-the-counter sleeping pills that contain diphenhydramine (Nytol, Simply Sleep, Sominex, Unisom Sleepgels, etc lipitor radio control car .) zocor benefits side effects . The manufacturers of nighttime pain relievers like Alka-Seltzer PM, Exedrin PM, and Tylenol PM have been successful at getting consumers to buy into the need for a combination analgesic and sleep aid synthroid maintentance dose based on weight .
• • •
O diclofenac tabs . Several years ago I developed severe dry eyes celebrex pill photo . About a year later, my husband developed the same condition ivermectin liquid compounded . The only common denominator our doctors could find is that we were both taking Tylenol PM to sleep at night lexapro celexa .
The ingredient that helps one sleep in that product is an antihistamine, which can be drying premarin pronounced . Your readers should be told topamax warfare .
A prescription drugs lexapro . Diphenhydramine, which puts the PM in Tylenol PM and many other nighttime pain relievers, can dry out mucous membranes lariam side effects class action . Sensitive individuals could notice dry mouth benadryl with singulair . This is the first time we have heard that this antihistamine may also cause dry eyes clomid and follistim .
• • •
The main problem with diphenhydramine as a steep aid is that some people experience next-day grogginess 5 cheapest sildenafil citrate 56 . As a result, driving performance may be impaired; In addition, some peo- ple may experience dry mouth or difficulty with urination indian sildenafil without prescription . The sleep-inducing effect can wear off after a few days cytoxan metabolism speed .”O Older people may be especially vulnerable to side effects such as cognitive impairment viagra enhancements .
Conclusions
Getting a good night’s sleep is crucial for good health does medicare pay for viagra . We never cease to be amazed that health-conscious people who exercise, eat carefully, and take their vitamins often skimp on sleep lyme disease treatment with azithromycin . We hope you will make getting adequate sleep an important health priority doxycycline for rosacea . If you can find a psychologist who specializes in cognitive behavioral therapy for sleep disorders, this approach may be the safest and produce the longest-lasting benefits ultram er 300 mg .’”
Here is an overview of our other recommendations pre emptive analgesia etoricoxib .
• Practice good sleep hygiene itraconazole liver function tests . Try to go to bed at the same time each night social anxiety disorder celexa . Avoid alcohol and caffeine geodon anit-psychotic dangers . Keep the bedroom dark, and do not watch TV in the bedroom ths soma in the nervous system .
• Exercise during the day (not in the evening) and take a hot bath about an hour before bedtime zocor with chantix .
• A high-carb snack before bedtime may raise serotonin levels, helping you fall asleep levaquin tablet cost . Relax with soothing music or a relaxation CD tramadol vicodine taken together .
*Cognitive behavioral therapy is one of the most cost-effective approaches to insomnia azithromycin stomach flu . Finding a practitioner with experience will be your biggest challenge soma 78 restaurant tucson .
*Try magnesium supplements before bed rx board viagra . As long as your kidneys are healthy, 250 to 500 milligrams may help atorvastatin pravastatin simvastatin rosuvastatin lovastatin . If you develop diarrhea, reduce the dose glaucoma topamax .
• Aromatherapy may be helpful side effects of levora . The scents of jasmine or lavender can be relaxing and facilitate sleep buy cheap viagra prescription online .
• If a nondrug herbal approach appeals to you, valerian is our first choice buy online prilosec . We would recommend a standardized ex- tract of 300 to 600 milligrams before bed attack mefloquine panic . Several days to 2 weeks may be needed to see results lithium manganese battery 123a .
• If a sleeping pill is your last resort, we suggest zolpidem loperamide dose dogs . Because it is available as a generic, it will be the most cost-
effective citalopram side afects .

INSOMNIA
• Avoid late-night TV, alcohol, and caffeine
• Exercise during the day
• Take a hot bath 1 hour before bedtime
• Listen to soothing music or a relaxation CD
• Seek cognitive behavioral sleep therapy ***
• Eat a high-carb snack before bedtime
• Take magnesium before bedtime ***
• Scent your bedroom with lavender or jasmine
• Try melatonin
• Use acupressure
• Consider valerian ***
• Ask your doctor about Ambien CR (zolpidem) **
• Check with your doctor about Lunesta (eszopiclone) **
• Inquire about Rozerem (ramelteon)
• Ask your doctor about Sonata (zaleplon)
Whoever coined the phrase “sleeping like a baby” must have been childless makita 18v cordless drill lithium . No parent who has ever walked the floor for hours with a fussy infant or gotten up for numerous nighttime feedings would imagine that babies sleep well zocor and mlik thistle .
At the other end of the life span, sleep problems are just as common side effects plavix . Older people frequently have trouble getting to sleep wellbutrin xl effecacy . Another common complaint is that they wake up far too early nabumetone arthritis medicine . Some have to get up to visit the bathroom and then have diffi-culty falling back to sleep tizanidine vs lorazepam for muscle spasm . Others find that they are wide-awake at 3:00 a bactrim ds package insert .m coumadin risks for taking . and toss and turn until mornin~ i Up to half of all elderly people report trouble with insomnia
Babies and senior citizens are not the only ones who suffer aripiprazole product monograph . The number of people who have intermittent or chronic sleep problems is enormous, perhaps as many as 70 million 672 That means that one in five of us is all too familiar with sleeplessness chloresterol drug tricor . 673
Perhaps people slept better in past centuries st johns wort metformin . Back before Thomas Edison invented the electric lightbulb, even adults slept an average of 10 hours a night raleigh lithium bicycle . But average sleep time has been dropping ever since chemistry and penicillin . A poll in 2002 showed that the average American gets fewer than 7 hours of shut-eye on weeknights pepcid drug guide . And the deficit can’t all be made up on weekends or holidays albert glyburide .
Think about a sleep debt as you would a financial debt omeprazole is the generic for .The more it grows, the harder it is to pay oft Eventually your body rebels nexium blood sugar . Chronic sleep deprivation is associated with high blood pressure, weight gain, diabetes, reduced immunity, daytime drowsiness, poor performance, traffic accidents, falls, memory problems, and cognitive impairment sustention testosterone despo . But lying awake in bed worrying about these possible consequences won’t help parlodel treatment in ivg .
NIGHT LIGHT
Epidemiologists have found that too much light at night may increase a woman’s risk of breast cancer discount vardenafil hydrochloride .”‘ Light
suppresses the production of a natural brain hormone called melatonin xenical acne . Blood levels of this hormone naturally rise at night purchase celecoxib on the net . When you are exposed to a computer screen or bright light at night, the body cannot make enough melatonin metformin 500 mg half . A low level of melatonin is associated with cancers of the prostate, lung, stomach, and breast ivf protocol estrace mid-cycle .675 To minimize disruption of melatonin, body-clock researcher William Hrushesky suggests the following sensible guidelines:
• Have a consistent bedtime generic mestinon .
• Darken your bedroom remeron tab .
• Get regular exercise during the day alternative health caffeine .
• Abstain from alcohol before bed (it blocks melatonin) prothombin time coumadin .
Inviting Sleep
Have you ever climbed into bed exhausted after a stressful day, only to discover that your brain won’t slow down? The events of the day just keep replaying like an endless movie perscription drug stores ultram tramadol . Figuring out how to let go of those worries can be challenging preventive treatment doxycycline . Watching the clock tick off the minutes or the hours just makes things worse glimepiride allergy sulfonamide . The later it gets, the more anxious you become, especially if you are concerned about being fresh the next day evista benefits com .
It’s hardly any wonder that so many people get into the habit of reaching for a sleeping pill “just in case generic allegra online .” They assume they will have difficulty falling asleep and pop a pill to prevent trouble cyclophosphamide and pulmonary hypertension and denton . Of course, this leads to an endless cycle keyword prozac controversy . Without the sleeping pill, they have rebound insomnia, which reinforces the fear of not being able to fall asleep, which triggers another round of pills zanax and buspar . What else can you do to avoid tossing and turning for hours?
Cut Out Caffeine
Most people know that caffeine is a stimulant that can keep them awake maker of flomax . They avoid that evening cup of coffee, thinking that will solve the problem diflucan over . But some people are so sensitive to the effects of caffeine that they should stay away from coffee, tea, and caffeinated soft drinks at any time in the afternoon discontinuation of bupropion . And don’t assume that decaffeinated coffee is the solution to your insomnia problems evista cod . If heartburn is contributing to your nighttime sleep woes, the culprit could be decal coffee, which can trigger acid reflux that may wake you up ic tramadol hlc .
Beware Drugs That Can Keep You Awake
Caffeine is not the only drug that can interfere with aood night’s sleep lithium polymer batteries uk . A surprising number of prescription and
over-
the-counter medications can contribute to nightmares, insomnia, or disrupted sleep using hibiclens while on accutane . Many of these drugs would not necessarily be expected to cause problems crestor vs zocor . Beta-blockers such as atenolol, metoprolol, and propranolol, which are prescribed for high blood pressure or heart trouble, may cause nightmares and insomnia lipitor child labor . The osteoporosis medicine Actonel (risedronate) can interfere with sleep vitamin b 12 deficiency nexium . So can many antidepressants, such as Effexor (venlafaxine), Prozac (fluoxetine), Wellbutrin (bupropion), Zoloft (sertraline), and others, and allergy medicines that contain decongestants such as phenylephrine and pseudoephedrine long term luvox use .
The list of drugs that can cause sleeplessness is so long that we cannot possibly include it in its entirety here guarana seed caffeine content . If you suspect that your medication may be interfering with restful sleep, discuss this issue with your pharmacist and your physician what is a cyclosporine challenge test . There may be alternatives avalide while pregnant .
Forgo the Nightcap
And don’t forget alcohol getting a tattoo on penicillin . An evening glass of wine or a nightcap may seem relaxing and even make you drowsy solubility cefuroxime acetone . But alcohol can affect melatonin levels and interfere with dreaming sleep ship free viagra sample . Waking too early is a common consequence of having an evening cocktail dristan sinus pain with ibuprofen .677 If you’re having trouble sleeping, don’t drink after dinner meloxicam for tendonitis .
Exercise
Exercise is not only good for the heart and bones, it is also a great stress reliever will prednisone make blood sugar elevate . If you can take a brisk walk, play a couple of sets of tennis, or play a round of golf (without the golf cart), you will find that your level of anxiety will diminish allergic reactin prednisone . Do it in the afternoon and you may get some sun on your face sore leg muscles and lipitor . Bright light combined with exercise can relieve depression and insomnia buy soma online usa .678 The sun exposure can also affect melatonin levels that have an impact on sleep quality and could reduce the risk of breast cancer in women tried both diflucan and vaginally . 79
Tai chi is an ancient Chinese exercise program can you get preganant taking provera . This gentle form of activity is actually quite beautiful to watch risperdal zoloft interaction . Researchers at the Oregon Research Institute in Eugene recruited 118 men and women over 60 years old importation viagra . Half were taught tai chi and the other half had a low-impact exercise session tramadol apap opinion . The tai chi students reported that after 6 months, it took them less time to fall asleep (18 minutes less on average) and they slept longer (48 minutes longer) ivermectin injection scabies .’
Timing is everything when it comes to exercise and sleep aleve drug interaction . If you exercise in the morning or early in the day, you should have less trouble sleeping amoxicillin bloating side effect . But if you exercise in the evening, just before bedtime, you’re likely to have more trouble sleeping clavulanic acid ampicillin oral dose .681
Hot Bath
Another simple, inexpensive, and pleasant way to ward off insomnia is to take a hot bath viagra us drugs stors . Here again, though, timing is critical clindamycin for prostatitis . A hot bath or shower just before bedtime could be counterproductive naproxen complications . The trick is to schedule it about an hour before you plan to go to bed risperdal children anger .(’82 A hot bath raises the core body temperature viagra after prostrate surgery . As it drops, the signal that goes to the brain is “sleepy time dipyridamole shortage .” Body temperature normally drops in the first part of a night’s sleep, so pushing it up with a 30-minute soak, then allowing it to fall tricks the body into thinking it may already be asleep zoloft versus efflexor side effects . Combined with a regular bedtime ritual, this can really help monohydrate in cephalexin .
Winding Down
Turning off the internal dialogue is especially hard for some folks cabergoline studies . “If only” is a dangerous game effects imitrex side . People who replay the day’s events, complaining to themselves that they should have done things differently, are destined to toss and turn lamictal side effects in children . How can you stop obsessing? One way is to set aside time specifically for worrying much earlier in the day lipitor and diarrea . It sounds odd, but some people find that it helps tavist smiley atlanta .
Another way to quiet your mind at bedtime is to keep the television out of the bedroom viagra berocca cocktail . Not only will this make it easier to get to sleep, it might improve your love life liquid femara . According to an Italian researcher, Serenella Salomoni, -if there’s no television in the bedroom, the frequency (of sexual intercourse) doubles viagra slump .”683 Satisfying sex can lead to deep relaxation and make it easier to fall asleep order propecia propecia .
If your bedroom clock has a bright face that allows you to watch the minutes tick past, turn it away from the bed buy lasix from a us pharmacy . Watching the time go by is a recipe for staying awake and increasing your anxiety about falling asleep generic versions of tramadol .
Another way to relax is to listen to gentle music or guided imagery depo provera hormones . Our favorites are by Emmett Miller, MD boards clomid message . Dr herbal alternatives to paxil . Miller is one of the founding fathers of the mind-body movement caffeine effects on the bodys tissue . He is a poet, a philosopher, a musician, and a healing, caring physician is prednisone otc . Nis voice, is so soothing and reassuring that you will find yourself relaxing without even trying medlineplus cozaar . To find out more about his CDs and tapes, visit www nash trial pioglitazone .drmiller does fluconazole treat chlamydia .com or call 800528-2737 lithium quartz tumbled brazil min . Our Dr warfarin and priapism . Miller Eaves are Easing into Sleep, Letting Go of Stress, 10-Minute Stress Manager, Healing Journey, and Rainbow Butterfly slur word speech celebrex .
Lest you think this is all touchy-feely New Age nonsense, we promise you that there is actual research to support these nondrug approaches disulfiram implants visotskij . One study offered insomniacs a selection of soothing music to be played for 45 minutes at bedtime low testosterone level boys . 684 The participants selected the music they preferred and were instructed to relax in bed while listening to it gene amplification dihydrofolate reductase methotrexate . Measurements showed that they had less trouble getting to sleep, fell asleep more quickly, and had better sleep quality buy zanaflex no prescription .
Another study compared progressive relaxation to anxiety management training for 9 weeks prozac and ecstasy . Both groups of insomniacs benefited side effects remeron rare . They fell asleep faster and slept more soundly keflex and blood clotting . 685 Such behavioral training can be a little pricey, which is why we like Dr kytril billing . Miller’s CDs norm shealy lithium oxalate .
Cognitive Behavioral Therapy
People who have persistent problems with insomnia may find it well worth their while to consult a counselor who offers cognitive behavioral therapy (CBT) genetic viagra mastercard . A study compared this nondrug approach to a sleeping pill similar to Lunesta (eszopiclone) that is commonly used in Europe motrin coupon . Investigators found that CBT was more effective than either the placebo or the sleeping pill mucinex vs claritin .’ The intervention included instruction on using the bedroom only for sex and sleeping, sticking to a regular schedule for rising and retiring, avoiding naps during the day, progressive relaxation, and discussion of beliefs and fears about sleep loss recurrent utis and macrobid .

Cognitive Behavievai ‘Therapy
In a study, learning about sleep ‘hygiene, sleep restriction, and progressive relaxation and discussing fears about losing sleep worked better than a sleeping pill against insomnia how much caffeine can cause miscarriage .
Downside: It is difficult to find a trained counselor testosterone raw powder suppliers .
Cost: Approximately $125 to $140 per session is alli the same as xenical . Six sessions should last a lifetime actonel appetite suppression .
are big fans of a low-carb approach for weight loss and blood sugar control, this principle does not hold in the evening albuterol side effect erdicaria . Protein can be energizing, which is the last thing you need before bed atazanavir omeprazole interaction . Instead testosterone levels determine facial hair growth . we would recommend eating carbohydratess septra bactrim side effects . According to Judith Wurtman, PhD, a research scientist at Massachusetts Institute of Technology, “If you eat carbohydrates when your internal clock wants you to sleep, the food will act like a sleeping pill shipping lithium ion battery .”687
Relaxation foods include caramel-coated rice cakes, Cheerios with frozen fruit and honey, toasted waffles with maple syrup and half a banana, a handful of pretzels, graham crackers, fig bars, and a blueberry muffin singulair and skin test . We would never recommend this dietary approach for someone with blood sugar problems (diabetes or prediabetes) low testosterone and erectile dysfunction . And it obviously is not for someone who is trying to lose weight testosterone at home test . But such high-carbohydrate foods can boost serotonin levels in the brain and make it easier for you to relax and fall asleep when you consume them 15 to 30 minutes before bedtime pnuemonia and cephalexin .
Magnesium
A simple mineral may be just the ticket for a good night’s sleep research study risperdal conduct disorder . Magnesium is essential for good health, but often it is in short supply in the American diet ketoconazole rx . One reason many people are deficient is because of their medicine depo provera side effect . Diuretics that deplete the body of potassium also can eliminate magnesium celexa 40 mg 30 pills . Although physicians are usually good about monitoring the blood’s potassium level, they may be less diligent when it comes to magnesium estrace cream pregnant .
Several years ago, we began hearing from readers of our newspaper column that magnesium is helpful for insomniacs pravastatin muscle pain . With some searching, we discovered that there is at least a
Magnesium
This mineral is helpful for bones, nerves, muscles, and brain function evista test . The recommended dose ranges from 250 to 500 milligrams daily tetracycline calcium . If you develop loose stools, reduce the dose mixing tadalafil and sildenafil citrate .
Side effects: Diarrhea
Downside: Not safe for people with poor kidney function Cost: Approximately $2 to $3 per month little scientific basis for this benefit 6m Magnesium appears to be especially helpful for those who suffer from restless leg syndrome breastfeeding and aleve .”Mis condition can make it hard to fall asleep or can awaken you once you are sleeping sweetly caffeine and dpression .
0 caffeine nut . 1 have suffered from episodes of insomnia for years nimotop online purchase . Cutting down on caffeine didn’t work cafergot tablet . Over-the-counter sleep aids such as Benadryl made me groggy the next day prior to the introduction of penicillin . Even prescription drugs like Ambien didn’t help how to stop taking wellbutrin xl .
Then a friend suggested I try taking magnesium at bedtime levaquin lev pack . I started taking magnesium (250 milligrams) at night lithium ion battery components . Magnesium has helped my insomnia more than anything else I’ve ever tried tardive kenesis caused by lithium carbonate .
A imitrex half life . Magnesium is essential for good health effects of low testosterone on conception . This mineral plays a role in more than 300 biochemical reactions in the body and is crucial for the proper functioning of nerves, muscles, bones, and blood vessels thyroid synthroid .
Magnesium is used in some laxatives (milk of magnesia) and antacids (Maalox, Mylanta, etc fluconazole lactation .) wellbutrin side effects achole effects . This nutrient may also be helpful in preventing osteoporosis and migraines and alleviating premenstrual symptoms strattera weight loss . We’ve not heard of magnesium being used to treat insomnia, however dosges liquid cialis . We’d be interested to learn if anyone else finds this mineral helpful against insomnia interaction between acetyl l-carnitine and warfarin .
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In response, we heard from several readers wellbutrin arthritis . Some found that they could eliminate over-the-counter sleeping pills M-,eistarting magnesium supplements tetracycline treatment of acne . One reported, “I started takiIlg Citracal Plus with Magnesium at bedtime natural alternative for coumadin . Ever since, I’ve been sleeping like a baby (a lazy one, mind you, not the colicky kind) lamictal directions .” But here is a cautionary tale cipro prescribed for what infection . Timing is everything:
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0 tired on famvir shingles . You asked if anyone has had success taking magnesium for insomnia ketoconazole gel . Years ago I was visiting my sister, who urged my husband and me to start taking magnesium in addition to vitamins dosges liquid cialis . We took the first dose the
morning we left for home nervous testosterone .
We usually split the driving side effects elavil . I drive in the evening, when I am most alert, and my husband drives in the daytime while I drowse risperdal educational video . That trip neither of us could keep our eyes open clomid succcess . We nearly pulled into a rest stop to steep, but somehow we managed to get home imigran inhalt sumatriptan .
I told my sister, who responded, “Sleepiness is a side effect amoxicillin for dental infection . We take magnesium at night boost natural testosterone levels .” I’ve used it for insomnia ever since msds samsung lithium ion batteries .
A brethine preterm labor law firm . You’ve confirmed what some other readers noted: Magnesium makes them sleepy altace pdr . Magnesium can cause diarrhea, usually at doses above 350 milligrams daily allegra medicine . People with kidney problems must avoid magnesium, because it could be harmful dizziness coumadin .
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