Staying Healthy Archive

Q. Is the chemical BPA just another health scare, or is it really something we should be worried about?

A. BPA, which stands for bisphenol A, is estrogenic. That means that in some respects it behaves like the hormone estrogen. Although BPA was first developed as a synthetic estrogen, it was never used as a pharmaceutical because diethylstilbestrol (DES), another synthetic estrogen, was more potent. DES was pulled from the market in the 1970s after it was discovered that the daughters of the women who took it (extra estrogen was thought to reduce the risk of miscarriages and premature births) were more likely to have a rare type of vaginal cancer, and later studies found they also had a variety of fertility and other health problems.

There are many ways to play it safe while gaining the health benefits of exercise.

Whether it comes after a broken bone or a low bone density reading, a diagnosis of osteoporosis spurs you to rethink your relationship with exercise. Do I need to take it easy or change my current activities to avoid falls and fractures? What exercises will help protect my bones? If I haven't been very active in the past, how should I start?

Q. Should I have my magnesium level checked regularly to make sure I'm getting enough for my bones?

A. You need adequate magnesium, and not just for bone health. It's central to hundreds of biochemical reactions throughout the body and essential for proper nerve, muscle, heart rhythm, and immune function. It also helps regulate blood sugar levels and promotes healthy blood pressure. We get most of the magnesium we need in food (good sources are whole grains, legumes, and dark-green leafy vegetables). Most multivitamins also contain some magnesium.

Our Healthy Eating Plate alternative to the government's MyPlate.

Several months after the U.S. Department of Agriculture released the latest version of its Dietary Guidelines, the department unveiled the icon that's supposed to convey the main points. Dietary guidelines go back to the 1910s, and wheels, boxed groupings, and pyramids have been used to illustrate the prior versions. The government was smart to pick a plate this time. Pyramid imagery can show priorities and proportions, but no one — not even the ancient Egyptians — has ever eaten off a pyramid. The MyPlate icon is also easy to remember with just four categories: fruits, vegetables, grains, and protein. In that way, it harkens back to the four basic food groups — meat; milk; vegetables and fruit; bread and cereal — that many of us grew up with.

Several screening tests have been developed to assess whether a person might have a drinking problem. Among these are the CAGE and AUDIT tests, as well as a questionnaire from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

If either of these test results suggests that you have an alcohol problem, contact your doctor, a psychotherapist, a substance abuse rehabilitation program, or a self-help group.

Here is the problem: we Homo sapiens evolved to cope with conditions that predominated during the Paleolithic period, when humans hunted and gathered, and fat, salt, and sugar were in short supply. To ensure that we ate adequate supplies of each, we evolved a craving for them. In fact, some of the brain mechanisms involved in our pleasurable response to sugar and fat are the same as those involved in our response to opioid drugs like morphine and codeine.

But now we live in an environment that is brimming with food and drinks that satisfy these cravings — and, in the process, make us overweight, cause illness, and shorten our lives. An adult can get by on as little as 500 milligrams (mg) of sodium a day; the average American intake is about seven times that amount, or 3,400 mg. Humans can certainly live without sugar (and, in fact, without any kind of carbohydrate as long as some fat and protein are available), but Americans now consume, on average, about 20 teaspoons of added sugar daily — and that's above and beyond the sugars found naturally in fruit, vegetables, and dairy products.

Q. My 61-year-old mother plans to take a long plane trip. Her legs usually become swollen when she flies a long distance. Should she wear elastic stockings or take any other precautions so she doesn't develop a blood clot in her legs?

A. Developing mild swelling in the feet, ankles, and lower legs is common during long-haul flights. Sitting still is the culprit — blood and fluid pool in the lower extremities because they aren't aided in their return to the heart by contractions of the leg muscles. When the swelling occurs in both legs, it is benign, though annoying (especially when it is difficult to put your shoes back on at the end of the flight). Swelling in one leg, however, may be worth further evaluation.

The National Institute for Health and Clinical Guidance (NICE) in Britain creates medical practice guidelines for the country’s National Health Service. Last year, the institute released delirium guidelines. Administrators, doctors, and other clinicians are the intended audience, but friends and family members might also find the NICE suggestions for preventing delirium useful. We’ve made a few minor edits for clarity.

1. Ensure that people at risk of delirium are cared for by a team of healthcare professionals who are familiar to the person at risk. Avoid moving people within and between wards or rooms unless absolutely necessary.

2. Give a tailored multicomponent intervention package. Within 24 hours of admission, assess people at risk for clinical factors contributing to delirium. Based on the results of this assessment, provide a multicomponent intervention tailored to the person’s individual needs and care setting as described in recommendations.

3. The tailored multicomponent intervention package should be delivered by a multidisciplinary team trained and competent in delirium prevention.

4. Address cognitive impairment and/or disorientation by providing appropriate lighting and clear signage; a clock (consider providing a 24-hour clock in critical care); and a calendar that should also be easily visible to the person at risk. Talk to the person to reorient them by explaining where they are, who they are, and what your role is. Introduce cognitively stimulating activities (for example, reminiscence) and facilitate regular visits from family and friends.

5. Address dehydration and/or constipation by ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink. Consider offering subcutaneous or intravenous fluids, if necessary. Manage fluid balance in people with comorbidities (for example, heart failure or chronic kidney disease).

6. Assess for hypoxia and optimize oxygen saturation, if necessary, as clinically appropriate.

7. Address infection by looking for and treating infection, avoiding unnecessary catheterization and implementing infection control procedures in line with NICE infection control guidelines.

8. Address immobility or limited mobility through the following actions by encouraging people to mobilize soon after surgery and walk (provide appropriate walking aids if needed). Encourage all people, including those unable to walk, to carry out active range-of-motion exercises.

9. Address pain by assessing for pain, looking for nonverbal signs of pain, particularly in those with communication difficulties (for example, people with learning difficulties or dementia, or people on a ventilator or who have a tracheotomy). Start and review appropriate pain management in any person in whom pain is identified or suspected.

10. Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications.

11. Address poor nutrition by following the advice given on nutrition in NICE nutrition support in adults’ guidelines. If people have dentures, ensure they fit properly.

12. Address sensory impairment by resolving any reversible cause of the impairment, such as impacted ear wax. Ensure that hearing and visual aids are available to, and used by, people who need them and that they are in good working order.

13. Promote good sleep patterns and sleep hygiene by avoiding nursing or medical procedures during sleeping hours. If possible, schedule medication rounds to avoid disturbing sleep. Keep noise to a minimum during sleep periods.

If you didn't grow up with a food allergy, you're not off the hook. They can spring up without warning at any time of life.

Food allergy doesn't rank high on the list of later-life maladies. Only 4% of adults are allergic to a food, and even those who begin life with the most common food allergies — to milk, eggs, wheat, and soy — are likely to outgrow them by the time they enter kindergarten.