Dealing with grief and bereavement

Grief will be with many of us this holiday season. If you're over age 40, there's a 1-in-3 chance that a close relative or friend of yours died in the last year. Or you may be among the 1 million Americans who lost a spouse. Still, in an era when the media seem to tout the wisdom of "closure" within days of any tragedy, it's easy to feel abnormal when confronted with the long, painful, and messy process of adapting to a death.

Healthy grieving can be a slow, difficult process that lasts for months or years. And although you may gradually be able to refocus your life, you'll probably never "get over it" or stop thinking about the person who died.

Athlete's foot: Causes, prevention, and treatment

While it's not a life-or-death matter, athlete's foot-especially if it's persistent-can be painful and make walking difficult.

The early signs of athlete's foot are patches or fissures (deep breaks or slits), especially between the toes. As the infection progresses, the skin may turn red, become itchy, and appear moist. Small blisters may spread out across the foot, breaking to expose raw fissures that are painful and may swell. The area between the toes is most often affected, but the infection may spread to the soles of the feet or to the toenails, which can become thick and colored white or cloudy yellow. In the most advanced cases, the rash will extend moccasin-style across the sole of your foot, and your feet may ooze pus and develop a foul odor.

While it's not a life-or-death matter, athlete's foot-especially if it's persistent-can be painful and make walking difficult.

The early signs of athlete's foot are patches or fissures (deep breaks or slits), especially between the toes. As the infection progresses, the skin may turn red, become itchy, and appear moist. Small blisters may spread out across the foot, breaking to expose raw fissures that are painful and may swell. The area between the toes is most often affected, but the infection may spread to the soles of the feet or to the toenails, which can become thick and colored white or cloudy yellow. In the most advanced cases, the rash will extend moccasin-style across the sole of your foot, and your feet may ooze pus and develop a foul odor.

With the advent of new treatments, a better smile is now within reach of more people. One of the most popular cosmetic procedures is bleaching. The natural light ivory color of enamel can turn to yellow, orange, brown, gray—even blue or green. Causes of discoloration include staining from coffee or tobacco, injury that has damaged the pulp, ingestion of the antibiotic tetracycline or high levels of fluoride while the teeth are developing, corrosion from silver fillings, and the natural wearing away of the enamel with age.

Although many stains can be successfully removed with a bleaching technique, bleaching may be uncomfortable for people with sensitive teeth or an exposed root. Several different bleaching techniques are available.

After the death of Baltimore Orioles pitcher Steve Bechler more than 10 years ago, many questions arose about the safety of ephedra and the government's role in regulating the herb. Bechler died of heat stroke while taking ephedra, which occurs naturally in the Chinese herb ma huang. The speed-like drug contains the chemical ephedrine, an amphetamine-like compound closely related to adrenaline. Athletes and average people alike started taking ephedra when word started spreading about its ability to aid weight loss and increase energy and alertness.

But just because a supplement comes from natural sources doesn't make it safe. Ephedra can cause a quickened heartbeat and elevated blood pressure. Side effects include heart palpitations, nausea, and vomiting. More than 800 dangerous reactions have been reported with use of the herb. These include heart attacks, strokes, seizures, and sudden deaths. According to a study in the Annals of Internal Medicine, ephedra products make up only 1% of herbal supplement sales in the U.S., but they are responsible for 62% of herb-related reports to poison-control centers.

Automated external defibrillators at home

As you read this, someone somewhere in the United States is collapsing from a cardiac arrest. The odds are poor that she or he will survive this sudden disruption of the heart's normal rhythm. Most of the 1,000 or so people who go into cardiac arrest each day die because they don't get the treatment they need — an electric shock to the heart — fast enough.

Heart-shocking devices were once found only in hospitals and ambulances. Now they're popping up in airports, movie theaters, fitness centers, casinos, malls, office buildings, and other places. These public versions, called automated external defibrillators (dee-FIB-rih-lay-tors), are so easy to use that sixth graders who have never seen one before can master their use in a minute or so, as shown in a 2002 study. This ease of use, combined with the fact that 3 in 4 cardiac arrests happen at home, have opened a national debate over whether it's a good idea to have a defibrillator at home.The chances of surviving a cardiac arrest fall about 10% for each minute the heart stays in ventricular fibrillation. Shock the heart back into a normal rhythm within two minutes, and the victim has an 80% chance of surviving. Deliver that shock after seven minutes — the average time it takes an emergency medical team to arrive in many cities — and the odds are less than 30%. If someone near you goes into cardiac arrest, calling 911 is a must. Even if there's a defibrillator nearby, you'll need professional help as soon as possible. CPR is also important because it keeps blood flowing to the brain and other vital organs. Still, a home defibrillator could let you restore a healthy heart rhythm several crucial minutes sooner than emergency medical technicians.

Automated external defibrillators at home

As you read this, someone somewhere in the United States is collapsing from a cardiac arrest. The odds are poor that she or he will survive this sudden disruption of the heart's normal rhythm. Most of the 1,000 or so people who go into cardiac arrest each day die because they don't get the treatment they need — an electric shock to the heart — fast enough.

Heart-shocking devices were once found only in hospitals and ambulances. Now they're popping up in airports, movie theaters, fitness centers, casinos, malls, office buildings, and other places. These public versions, called automated external defibrillators (dee-FIB-rih-lay-tors), are so easy to use that sixth graders who have never seen one before can master their use in a minute or so, as shown in a 2002 study. This ease of use, combined with the fact that 3 in 4 cardiac arrests happen at home, have opened a national debate over whether it's a good idea to have a defibrillator at home.The chances of surviving a cardiac arrest fall about 10% for each minute the heart stays in ventricular fibrillation. Shock the heart back into a normal rhythm within two minutes, and the victim has an 80% chance of surviving. Deliver that shock after seven minutes — the average time it takes an emergency medical team to arrive in many cities — and the odds are less than 30%. If someone near you goes into cardiac arrest, calling 911 is a must. Even if there's a defibrillator nearby, you'll need professional help as soon as possible. CPR is also important because it keeps blood flowing to the brain and other vital organs. Still, a home defibrillator could let you restore a healthy heart rhythm several crucial minutes sooner than emergency medical technicians.

Every winter, about 1,200 Americans die from a heart attack or some other cardiac event during or after a big snowstorm, and shoveling is often the precipitating event.

Why is shoveling so hazardous?

• Shoveling uses your shoulders and arms, and upper body exercise tends to put strain on the heart because those muscles aren't well conditioned.
• Working in an upright position adds to the arduousness because blood pools in the legs and feet, so to maintain blood pressure, your heart must work harder.
• Much of snow shoveling is isometric exercise: your muscles are working, but there's little actual movement until you finally heave a shovelful up on the bank. During isometric exercise of any type, your heart rate goes up, and your blood vessels constrict, presumably to send more blood to the straining muscles. As a result, your blood pressure goes up.
• Without knowing it, shovelers sometimes perform a version of the Valsalva maneuver, bearing down as they would during a bowel movement while holding their breath. Waiting to exhale while straining like that can lead to abrupt changes in your heartbeat and blood pressure.
• First thing in the morning, the time when many people dig out from a storm, stress hormone levels tend to be higher, platelets in the blood "stickier," and heart attacks more likely.
• Shoveling involves exposure to the cold, another cardiac stressor.
• People who are out of shape often shovel, making the sudden intense exercise even harder on the heart.
• Most people don't warm up before they shovel or cool down afterward.

If you have a heart condition, you shouldn't shovel under any circumstances. People older than 50 should also try to avoid it. Contact your local council on aging to see if they provide a list of teens in your neighborhood who you can hire to do the job for you. Or buy a snow blower. If you must shovel, take it easy. Rest often. Dress warmly and stay well hydrated. Wherever possible, push the snow rather than lift it. Clear only the snow that blocks your path into the house, the rest will melt on its own. And of course, listen to your body. Head home if you experience potential signs of heart trouble, including chest pain, palpitations, undue shortness of breath, fatigue, lightheadedness, or nausea. Also stop if your fingers or toes get numb or hurt — you could have frostbite.