Seasonal Health Tips

Brigham and Women's Hospital experts offer health tips relevant to the time of year. Please scroll down for additional tips including heat safety, ways to cope with allergies, basics about diabetes, information about gynecological cancer, and nutritious food ideas for families on the move.

Have a Safe Fourth of July, Leave the Fireworks to the Profesionals

Each year fireworks cause thousands of injuries in the US. Brigham and Women’s Hospital trauma surgeon Amy Rezak, MD, teamed with the Massachusetts State Fire Marshal and the National Fire Protection Association to send a message warning against the use of fireworks.

“Thousands visit our nation’s emergency rooms with burns, amputations, and eye injuries around the holiday,” said Dr. Amy Rezak, adding that the combination of alcohol consumption, crowds of people and often dark settings, provide a hazardous mix, making fireworks use even more dangerous.

Dr. Rezak recounts seeing a multitude of injuries from fireworks, especially around the Fourth of July. These injuries, ranging in minor burns to the hands to major disfiguring and life-threatening injuries are commonly seen in children.

Even sparklers, which are often given to children, are extremely dangerous. Dr. Rezak notes that they can reach temperatures of 2,000 degrees Fahrenheit. “It’s like giving your child a torch,” explains Dr. Rezak.

Officials warn first about the dangers of fireworks, but also remind Massachusetts residents that bringing fireworks into Massachusetts and setting off fireworks is illegal in the state.

To have a safe holiday, Dr. Rezak recommends enjoying public displays of fireworks, which are controlled by professionals trained to use fireworks.

 

Keeping Cool and Safe  in Extreme Heat

Extreme heat and humidity is a staple of summer, especially in New England. For many, this is a highly anticipated and fun time of year, but it does not come without dangers. Ron Walls, MD, chairman of the Department of Emergency Medicine at Brigham and Women’s Hospital, cautions people about the potential for heat-related illnesses during scorching triple-digit days when the body generates and absorbs more heat than it can dissipate.  Fortunately, trips to the emergency department are preventable by taking some basic precautions.

During times of extreme heat, Dr. Walls offers these safety tips:

Drink plenty of water, non-caffeinated beverages, or sports beverages, even if you do not feel thirsty. The body can lose enormous amounts of fluid through perspiration and increased use in the intense heat.  It is better to “stay even” on fluids, rather than to fall behind and catch up.  Thirst is a late indication that your body is already low on fluids.

Avoid dehydrating drinks that contain alcohol, caffeine or high amounts of sugar.  Any of these can cause you to lose more fluid in the urine than you are taking in.

Dr. Walls advises people to know the warning signs of heat-related illnesses and to seek medical care early if significant illness is present:

Boston Marathon Race Day Tips

After tirelessly training for months in a variety of adverse weather conditions, on Monday, April 19, more than 20,000 runners will embark on the 114th Annual Boston Marathon. Having volunteered in the medical tent at the finish line at the Boston Marathon in previous years, Reg B. Wilcox III, PT, clinical supervisor of Physical Therapy in the Department of Rehabilitation Services at Brigham and Women’s Hospital, can offer runners some tips to have a safe and successful race day.

To prepare for the run on the day of the marathon, Wilcox suggests the following tips:

• Many runners have trained through a excessively cold and wet season, but be sure to adjust your clothing choices and hydration efforts from your typical if raceday is sunny and warm.

• While at the start area prior to the race stay off your feet as much as possible until the start of the race.

• Prevent chaffing by using petroleum jelly products on sensitive skin areas, such as inner thighs and armpits.

• Finish a large meal two to four hours before race time, and eat your final snack no more than 30 minutes before the start. Foods should be high in carbohydrates.

• Drink fluids up to 15 minutes before the start of the race and sip fluids with electrolytes throughout the race to stay hydrated.  Even if it is a cool overcast day you still need to hydrate appropriately throughout the race. Too often many runners skimp on fluid intake during cooler weather.

• Do not consume any beverages, gels, or bars that you haven’t used before. Stick with the products you know won’t upset your stomach.

• Know your pace and stick to it. Consider a strategy to resist getting caught up in the movement of the crowd and tiring yourself out too quickly.

• Keep a good posture; hunching will reduce lung capacity and cause strain and possible cramping.

• Immediately resolve any issues that arise, like a poorly tied shoe or a pebble in your shoe. Letting a distraction persist could cause you to strain or overcompensate in a way that could cause cramping or injury.

After running 26 miles, your instinct may stop immediately and rest, but there are a number of precautions Wilcox suggests to help ease soreness and prevent injury:

• Keep walking. After the race, walk for at least 10 minutes to gradually slow your body to its normal resting state. Throughout the remainder of the day, walk for 10 to 15 minutes every few hours.

• Change your clothes. If running attire is damp and cold change into dry clothes as soon as you can. If you don’t you may become cold as you cool down in wet clothes, particularly if it is a wet or cold day.

• Ice down. Apply ice to any joints or muscles that are particularly sore shortly after the race to reduce inflammation. 

• Hydrate. Sip water and sports drinks throughout the day that will replenish electrolytes and restore hydration.

• Refuel. Aim to consume carbohydrates with lean protein and salt within the first thirty minutes after race because research indicates that this improves recovery rates. No need to eat a whole meal, but grab a drink or snack that contains carbohydrates and protein. 

• Take advantage of resources. A staff of athletic trainers, chiropractors, massage therapists, podiatrists, physical therapists, physicians, and nurses can be found at various locations before, during and after the race to assist with a variety of medical concerns, such as cramping and dehydration. If you are not feeling well, don’t ignore your symptoms seek medical advice in a timely manner.

In the days and weeks following the race, Wilcox advises, “Give your body a chance to rest and recover, but do not stop activity completely. Instead of running, try walking, swimming or biking for the week following the marathon, then gradually build up to running again, starting with shorter distances in longer times.” Light periodic stretching should also be incorporated until soreness subsides and flexibility returns, being sure not to overstress muscles, which can cause injury. Finally, Wilcox recommends allowing for extra sleep, eating the foods you haven’t been able to and loading up on carbohydrates to replenish the body’s energy stores.

Coping with Allergies

After a cold winter and a rainy start to spring, warm sunny weather is highly anticipated. But for the 60 million allergy sufferers in the US, spring is also a time spent battling the microscopic irritants floating through the spring air.

Due to excessive rain this early spring, Cem Akin, MD, specialist in the Rheumatology Immunology and Allergy Department at Brigham and Women’s Hospital (BWH), predicts this spring allergy season may be especially tough on sufferers. “An abundance of rain before the spring allergy season begins can mean more robust tree and grass allergens,” said Dr. Akin. “Rain can also be detrimental to those allergic to mold, which can thrive both indoors and outdoors during moist weather conditions.”

A recent Consumer Reports survey reported that 60 percent of people with springtime allergies have limited success treating their symptoms, however Dr. Akin offers some helpful suggestions for avoiding and addressing symptoms:

Avoid going outside between 6 a.m. and 10 a.m. if you have pollen allergies. Pollen levels peak during this four-hour time period. Additionally, keep car and home windows closed during these hours.   

Wash your hands frequently to prevent eye problems. The area most touched by our fingers is the area around our eyes, including the tissue surrounding our eyelids. Washing your hands frequently during allergy season, especially after handling pets and grass, can greatly reduce eye-related allergic reactions. 

Drink plenty of liquids, especially after being exposed to allergy irritants. These fluids help turn troublesome mucus into a liquid that can easily be expelled from sinus passages. Proper hydration also helps prevent fatigue.  

Avoid drinking alcohol when suffering from a stuffy nose. Alcohol congests the nasal passages which may make nasal blockages worse. Instead, opt for a non-alcoholic beverage that will help break up stubborn mucus.

Trade your old down pillow and comforter for hypoallergenic bedding, if you are allergic to feathers. The feathers used in down bedding each contain dried dander at its base—something that cannot be removed with even commercial cleaning. Hypoallergenic bedding is made from materials that do not contain allergy irritants and are not treated with chemicals which may irritate your skin and lungs. 

If you are allergic to dust mites, consider investing in dust mite-impermeable mattress covers and pillowcases. You can still use your favorite linens over those. Washing the bedding once a week in hot water is recommended to kill dust mites. Also, it is much easier to control dust mites in bedrooms with hardwood floors as opposed to wall to wall carpeting. An allergist can help determine if you are allergic to dust mites.

Wet your lawn before mowing. Mowing the lawn exposes you to a variety of grass and tree pollens, most of which are also allergy irritants. Spraying your lawn with a garden hose before mowing or waiting to mow until after a spring rain shower keeps pollen from flying around in the air—and eventually into your nose and lungs. 

Try swimming in a lake or an ocean to alleviate allergy symptoms. The ten to 15-inch layer of air hovering above these natural bodies of water contains one of the purest concentrations of air on earth. The gentle humidity helps keep your airways from drying out, and the salt water of the ocean acts as a decongestant while washing away the allergen particles.   

Keep the air temperature in your home and office below 70 degrees. Dust mites, some types of fungi and roaches love the spring’s damp, warm climate. However, these irritants are unable to breed in cool temperatures. Use filtering air conditioners and fans to keep your environment cool and these allergy irritants at bay.

Clean your electric toothbrush. Dried toothpaste, mold and scum collect where the base of the toothbrush meets the disposable brush head. Separate the two pieces and clean thoroughly with hot water. Let both pieces dry before assembling the toothbrush again. And don’t forget about your toothbrush holder! Mold loves to breed in this damp, dark environment. Clean and rinse your toothbrush holder every time you clean the bathroom sink.  

Opt for a “no shoes” policy at home. Many allergy irritants are tracked into homes via the bottom of people’s shoes. Remove shoes as soon as you enter into your home. Also, ask guests to do the same. Provide them with “indoor shoes” such as slippers, flip flop sandals or even socks. This practice will help prevent grass pollen, pesticide residue from the lawn, mold spores and dirt from entering and staying in your home.

Consider the foods you eat.  Research shows that hay fever-sufferers may also experience allergy symptoms such as itching of the mouth, tongue and scratchy throat from eating uncooked foods with similar chemical proteins as the pollen they are allergic to. To name a few, those allergic to ragweed, for example, may be reactive to bananas, melons, cucumbers, or zucchini, and those with strong birch pollen allergies often experience itching of the mouth and throat after eating raw apples, peaches, cherries and plums.

Talk to your doctor about using medication. For persistent allergies, consider talking to your doctor or an allergist/immunologist. Typically, over the counter antihistamines should be taken at least a half hour before going outside, and for those with more intense allergies, prescription medications can suppress seasonal eye and nose symptoms if they are started early and used on a consistent daily basis throughout the pollen season. Be aware that some antihistamines may make you drowsy and impair your cognitive abilities. Allergen immunotherapy (known as allergy shots) may be an option for those whose symptoms cannot be controlled by environmental control and medications.

Dr. Akin also warns allergy sufferers to keep an eye on rainfall. More rain during the coming summer may mean more weed allergens in the fall.

Lessons and Tips for National Diabetes Awareness Month

November is Diabetes Awareness month and Florencia Halperin, MD, an endocrinologist at Brigham and Women’s Hospital (BWH) is sharing some of the risk factors and symptoms of diabetes, as well as some pointers for those living with diabetes.

There are two main types of diabetes: type 1 and type 2. More than 90 percent of those with diabetes have type 2. Type 1 diabetes is characterized by insufficient production of  insulin- a hormone our bodies need in order to use sugar and starches as fuel for daily life. Type 2 diabetes is a disease in which not enough insulin is produced and the cells of the body cannot properly use the insulin that is available, In both cases the result is  high blood sugar levels, which can lead to the complications associated with diabetes.

The cause of diabetes is not well known, but research has demonstrated that both genetics and environmental factors may increase the chance of developing diabetes. These risk factors include:

• Increasing age

• Family history of diabetes

• Being overweight or obese

• Lack of regular exercise

• Certain racial and ethnic groups are at higher risk for diabetes, including Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, American Indians and Alaska Natives

• Pre-diabetes 

• Low HDL (“good”) cholesterol, high triglycerides, and high blood pressure

• For women, a history of gestational diabetes, or of having a baby that weighed 9 pounds or more at birth

More than 20 million people in the US are living with diabetes.  Approximately one fourth of those are unaware that they have the disease. Dr. Halperin outlines some signs and symptoms that could indicate diabetes and should prompt a visit to a health care provider:

• Frequent urination

• Unusual thirst

• Intense hunger

• Unexplained weight loss

• Fatigue and Irritability

• Blurred vision

• Frequent and recurring infections

Although diabetes is a lifelong disease for which there is no cure at this time, we do have many available treatments, and those with diabetes can take steps to manage the disease and prevent potentially serious medical problems. Individuals should speak with their primary care doctors to outline a personal care plan, says Dr. Halperin, which may include some of the following:

• Maintaining a healthy weight

• Eating a healthy balanced diet

• Exercising regularly, as advised by your physician

• Attending routine visits with your health care provider, which should include periodic measurement of blood sugar levels, a hemoglobin A1c test, as well as measurement of  blood pressure and cholesterol

• Medications for control of blood sugar, blood pressure and cholesterol as needed

• Yearly visits to eye and foot specialists

Answering Questions for Gynecological Cancer Awareness Month

The fourth most common cancer among women, gynecologic cancer, is diagnosed in more than 80,000 women each year. For gynecological cancer awareness month, this September, Colleen Feltmate, MD, a physician in the Department of Obstetrics and Gynecology at Brigham and Women’s Hospital, answers some important questions about the various types of gynecological cancers, and the symptoms, risk factors, preventive measures and treatments options.

How many different types of gynecologic cancers are there?
There are six basic gynecologic cancers: ovarian, fallopian tube, uterine, cervical, vulvar and vaginal. Each different type has unique signs and symptoms, risk factors, and prevention strategies.

What are the risk factors for developing these cancers?
Risks for development vary among the different gynecological cancers. Common risk factors which may predispose an individual include a personal or family history of gynecologic or breast cancer, early onset of menstrual cycle, late onset of menopause, increasing age, obesity, human papilloma virus infection (HPV), tobacco use and an impaired immune system.

What are factors that reduce the risk of developing gynecological cancers?
Annual exams preformed by a gynecologist and HPV vaccination can help reduce the risk of developing cancer of the cervix, vulva or vagina. Birth control use can be effective in reducing the risk of developing ovarian, fallopian and uterine cancers, and having been pregnant also reduces the risk of uterine cancer. Also, keeping a healthy weight helps to lower the risk of ovarian, tubal and uterine cancer, and refraining from tobacco use lowers the risk of developing cervical, vulvar and vaginal cancer.

What are the symptoms of gynecological cancer?

• Symptoms of ovarian or tubal cancers include bloating, feeling full after consuming even small meals, excessive burping and an increase in waist size, while less frequently, pain can also be a symptom.

• Symptoms of cervical, uterine, and vaginal cancer include bleeding or discharge unrelated to the menstruation cycle and pain during urination or intercourse. Any postmenopausal bleeding or staining should be considered abnormal.

• Most common symptoms for vulvar cancer are itching, burning, pain, tenderness or changes to the skin of and around the vulva, including ulcers around the vulva.
  

How is a diagnosis made?

• For cervical, vulvar, and vaginal cancer, annual gynecological exams screen for cancer. A pap smear, which includes taking a sample of cells from a woman’s cervix, is used to screen for cervical cancer by detecting abnormal changes in these cells. An abnormal pap smear may also be present with vaginal or vulvar abnormalities.  A pelvic exam is used to screen for vaginal and vulvar cancer and includes both a visual and physical examination of the pelvic organs.

• Typically undetectable during a gynecological exam, uterine cancer can sometimes be detected using ultrasound, but is usually identified after a woman reports irregular or postmenopausal bleeding and a biopsy is performed to determine if the cells of the uterus are cancerous.

• There is currently no screening technique for ovarian or tubal cancers, which is why it is important for women to observe and report any of the common symptoms (listed above), and report them to her physician. A yearly physical exam can sometimes detect a mass and may be helpful in earlier detection of these cancers.

What are the treatment options for these cancers? 

• Surgery: Treating gynecological cancers often begins with surgery, removing the cancerous area or organ, depending on the stage and location of the cancer.

• Radiation therapy: After surgery, radiation therapy may be used to destroy microscopic cancer cells that may remain after surgery. In cases where a tumor cannot be safely removed because of the stage of cancer and condition of the patient, radiation may also be used instead of surgery.

• Chemotherapy: Chemotherapy may be used to destroy cancer cells after surgery in ovarian, tubal and some uterine cancers.  Chemotherapy may be used when surgery is considered an unsafe option because of the stage of cancer and/or the patient’s health.

• Hormone therapy: Hormones, such as progestin, may also be used in some circumstances. 

How curable are these cancers?
Most cancers are curable if found at an early stage, with 90 percent or more of these cancers cured if it is confined to the organ or is fairly small in size. Research has continually shown that the earlier the cancer is found the higher the chances of cure and long term survival.

“Getting your annual exams and being observant of the signs and symptoms of those cancers that are not detectable through screenings is the best way to protect against these cancers,” says Dr. Feltmate. She urges women to keep their annual appointments, and talk with their physicians about any concerning symptoms.

Nutrition for Families On The Go

The back-to-school season is upon us. The lazy days of summer will soon be replaced by endless activities and errands, and all-around busy schedules for the whole family. Stopping by the farmer’s market regularly for fresh fruits and vegetables, and preparing a healthy meal on the grill will quickly become more and more difficult.

In order to keep your family on the right track, or perhaps start fresh after a summer of burgers and hot dogs, Linda Antinoro, RD, of the Nutrition Department at Brigham and Women’s Hospital, offers some tips to take the brainwork out of eating healthy, no matter how little time you have.

Pack portable snacks. “The easiest way to avoid being tempted by candy bars and fast food is to make sure you are always armed with balanced, nutritious snacks,” says Antinoro, suggesting: 

• Nuts: walnuts, almonds, pecans, pistachios, etc. are all packed with vitamins and heart healthy fats. 

• Dried fruit: cranberries, raisins, apricots, apples, etc are great for a quick burst of energy before sports practice.  For more of a balanced snack, combine them with a handful of nuts.

• Peanut butter and crackers: pack up some whole wheat crackers and natural peanut butter.

• Protein bars like Pria or Balance Bars.

Fast food promises speed and convenience, making it nearly unavoidable at times. Grabbing a meal from the drive-through can be healthy too though, if you stick to grilled items instead of fried. Try checking out the nutrition chart for your favorite fast food restaurant ahead of time, looking for options low in saturated fat. Antinoro suggests some generally healthy choices:

• Salad with grilled chicken and vinaigrette dressing.

• Vegetable pizza.

• Grilled chicken sandwich, light on the condiments.

• Hamburger with baked potato or a side salad instead of French fries

• Soup and whole grain bread.

A bagged lunch may take some preparation the night before, but it can be an even quicker- and healthier- lunch option. Consider packing a small cooler with:

• Turkey and low fat cheese on wheat bread.

• Peanut butter and jelly sandwich.

• Tuna salad sandwich.

• Fruit – sliced or whole.

• Vegetables and hummus.

• Greek yogurt and low fat granola.

With even a small amount of time, you can whip up a well-balanced meal. Antinoro provides these tips to make dinner preparation a little quicker and bit easier:

• While cooking whole grain pasta, toss in some frozen vegetables to the same cooking pot.

• Purchase frozen chicken breasts that can easily be thawed and used in a variety of simple meals.

• Use a crock pot. Fill it with ingredients for a balanced dinner and leave it to cook while you work around the house.

• Stock your freezer with frozen vegetables- a great option to have on-hand at all times to add balance to any meal.

• Prepare double or triple portions of one meal and freeze the remaining portions for a quick meal on another night.

• Grab a rotisserie chicken and a bagged salad on the way home.

“A healthy diet can improve energy levels, fuel the immune system to protect against illness, and help to reduce the risk of chronic disease, like diabetes, the fastest growing disease in the US,” says Antinoro, reminding families that it’s possible to make healthy food choices in a variety of situations, even in the drive-through.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.