A.Lower-risk conditions for endocarditis include mitral valve prolapse and other congenital heart conditions. In such cases, antibiotics may be given at the discretion of the endoscopist if a high-risk procedure is being done. Similarly, antibiotics may also be given if a lower-risk procedure (such as a routine upper endoscopy or colonoscopy) is done in a high-risk patient.

Generally, you should discuss your condition with the endoscopist before the procedure and find out if he plans to give you antibiotics. As far as the bowel-cleansing prep required before colonoscopy, it should pose no problem in someone with mitral valve prolapse. Most patients drink the Golytely cleansing solution and tolerate it well. However, another solution, called Fleet’s Phospho-Soda, must be used with caution in patients with significant kidney or heart disease.

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A.Both colonoscopy and gastroscopy, also known as esophagogastroduodenoscopy (EGD) or upper endoscopy, are very safe diagnostic endoscopic procedures. Complications rarely occur, and when they do, they are most often related to sedatives or other medications given for the procedure. An extremely small percentage of patients suffer serious complications, such as perforation of the bowel.

A.That said, one important factor that a doctor should consider before ordering an endoscopic procedure is whether the patient should be given antibiotics ahead of time. Antibiotics can help prevent a potentially serious complication known as endocarditis — an infection of the heart valves. Although the risk of an endoscopic procedure causing endocarditis is incredibly small, it is recommended that certain patients receive antibiotics as a precaution.

Generally, doctors base their decision on whether to give antibiotics on both the type of procedure being done and a patient’s underlying heart condition. Thus, a procedure in which the chance of bacteria entering the bloodstream is high is more likely to require antibiotics.

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Menopause is a natural event and should not be viewed as a prelude of bad things to come. Studies show that most women do not perceive menopause as having a negative impact on their lives. As with each phase in the life cycle, an ending also marks a new beginning. Menopause represents an opportunity to reflect upon the past and the future and move forward in a positive, healthful way.

Definition
Menopause has occurred when there is an absence of menstrual periods for 12 consecutive months in a woman 40 or older. The average age of menopause is 51 and most commonly occurs between 48 and 55. The age at which menopause occurs is not affected by factors such as race, height, parity (number of children) or the age of menarche (onset of periods). Tobacco use accelerates ovarian aging and can lead to an earlier menopause. Periods may naturally come to a halt in younger women as well, but other possible causes are considered prior to making a diagnosis of menopause.

Menopause can occur naturally, as the result of the normal ovarian aging and decline in function or it can be induced, by surgical removal of the ovaries, radiation or chemotherapy treatments. A “menopausal” state can be created intentionally with certain medications used to suppress ovarian function in the treatment of conditions like endometriosis (disorder in which tissue resembling the inner lining of the uterus is found outside the uterus).

The perimenopausal years encompass the two to three years prior and subsequent to the menopause. The years just preceding the actual cessation of menses are marked by declining function of the ovaries, fluctuating hormone levels and menstrual cycle irregularity. During this time women may experience symptoms commonly identified with the menopausal experience such as hot flashes, night sweats, sleep disturbances, irritability and mood disturbances.

Understanding Your Body
As the number of follicles (small sacs inside the ovary that contain a developing egg) decline in the ovary, hormone production decreases and eventually stops. The symptoms and medical consequences of menopause are related to the reduction in circulating estrogen levels throughout the body. In addition to estrogen, the ovaries also produce other hormones including progesterone and androgens. The production of progesterone is related to ovulation and can fluctuate during the perimenopausal years, accounting for some of the bleeding changes that occur at this time. Androgens, typically thought of as male hormones (because they are produced by the testes and circulate in higher levels in the male), are produced by the ovary and the adrenal gland (gland on top of the kidneys that produces hormones) in the female.

Androgen production, which includes testosterone, declines in women as a consequence of aging and menopause. The effects of decreased androgens in women have not been defined well and may contribute to menopausal symptoms like fatigue, loss of sexual desire, decrease in muscle mass and bone loss.

Circulating levels of androgens do not decrease as much as estrogen and can convert to estrogen in different tissues of the body, particularly fat. Circulating levels of estrogen can, therefore, vary with body fat composition even though ovarian production of estrogen stops with menopause. This partially explains the variability of estrogen-mediated symptoms in women and the association of estrogen-dependent tumors with obesity.

Otherwise, no amount of scrubbing, pore stripping, astringent, or so-called cleansing grains will get at the sebum, bacteria, and dead cells that lie in the follicles, where acne is actually caused. In fact, over-aggressive cleansing makes acne worse. Of course, normal gentle cleansing does make the skin feel better and is good for overall appearance and hygiene.

Patients often are concerned about long-term use of oral antibiotics, but over four decades of use have proven their safety.

The antibiotics used for acne treatment are seldom used to fight other infections, so there is little danger in bacteria becoming resistant to a particular acne medicine.

In fact, oral antibiotics are used in acne not for their antibacterial effect but for their anti-inflammatory action. Your physician may change your antibiotic, but not because your body “gets used to” a particular one.

A.Using radiation to treat a cancer of the abdomen or pelvis (as in cervical cancer) can lead to radiation-induced inflammation of the small or large intestine (enteritis or colitis). Radiation is an effective cancer treatment because it can eliminate rapidly growing cells, and tumor cells tend to grow very rapidly. Thus, tumors tend to shrink, while surrounding cells are not as severely affected. However, since the cells lining the intestine also grow quickly, they are also often damaged by radiation.

A.Such intestinal damage is not as common today as it was in the past due to technological advances in the administration of radiation, but it still can occur. Radiation effects on the intestine can occur soon after the therapy. Nausea, vomiting, abdominal pain and diarrhea are common symptoms. These will usually go away spontaneously. Chronic damage — usually scarring and obstruction of the small intestine — may appear months to even several years after the radiation was given. Nausea, vomiting, abdominal cramps and diarrhea are typical symptoms. Thus, the symptoms that you are experiencing could potentially stem from chronic radiation-induced damage of the intestine.

However, you must consider other potential causes for your symptoms. Intestinal adhesions, hernias, inflammatory conditions (such as Crohn’s disease) and tumors can also produce these symptoms. A careful evaluation by a gastroenterologist will help determine the likely cause of your symptoms. Certain diagnostic tests, including endoscopic procedures and contrast examinations of the digestive tract, may also be helpful. Your therapy will depend on the cause of your problems, which is why it is crucial that you get an accurate diagnosis.

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Fiction:

Creativity is rare.
Only artists and those with high IQs have it.
It’s a gift that defies logic and cannot be scientifically explained.
Fact:

Everyone has the capacity for creativity.
We can learn to generate it.
It can be produced in a laboratory setting, and is explained by something called “generativity theory.”
Even the corporate world has begun to recognize the value and legitimacy of creative thinking.
Everyone recognizes that we exercise creativity when we arrange a vase of flowers, or create a work of art from a blank canvas. What is less well understood is that creative thinking can help solve logical, even technical, problems. At his own admission, Einstein’s theory of relativity came out of a creative process, not a linear, analytical one.

Simply put, creativity happens when old ideas are combined in new ways. And in our increasingly complex world, we need all the creative solutions we can find!

We are all born with creativity “muscles.” But if we don’t develop them through regular exercise, they will be of no use to us. Begin engaging in the following “exercises” and notice how your creativity develops.

You’ve already got it … now just hold on to it. Every day we have many moments of creative possibility — we have just learned to ignore them. Dreams, daydreams, thought fragments, reactions to just about anything — all provide creative material. The key is to write, write, write!

Always keep a pencil and paper handy — even by your bedside. Writing makes subconscious material conscious, and makes it possible to save that
absurd stream of consciousness that just may contain a flash of brilliance!

Treat yourself to something different. Doing anything outside your normal routine, especially if it is also a sensory experience (such as a great art exhibit, a wonderful concert or a day by the ocean) can be a great creativity trigger. After such an experience, that seemingly unattainable idea presents itself — when you aren’t even looking for it!

Change your environment. Move the furniture, play different music, surround yourself with a variety of interesting and unrelated objects, such as kids’ toys, artifacts from other cultures, tools or Christmas ornaments. Altering your environment and introducing random and unrelated “stuff” is bound to trigger the unexpected.

Go for a walk. You may have noticed that exercise, particularly walking, will get the creative juices flowing. As you take in your surroundings, and stay in the present moment, creativity blocks seem to disappear.

Also, exercise expends nervous energy and leaves you with an unusual clarity of thought.

Whether you are working on a physics problem or at a potter’s wheel, doing anything different can help generate fresh ideas and novel solutions. And implementing the above strategies on a regular basis will surely allow you to flex your creativity muscles, naturally and often!

Find a care partner — If you’re sick and feeling overwhelmed, ask for help. A dependable friend, neighbor or relative might serve as a volunteer care partner — helping you stay with your medication schedule, driving you to the doctor’s office and offering emotional support.

If you’re facing a long or difficult illness, loneliness can be one of your worst enemies. Surround yourself with optimistic, helpful people. Connect with a support group for people who share your condition.

Consider your health to be a long-term project — Getting well and staying well isn’t just a matter of taking some medication for a while and then neglecting yourself. It’s best to make good self-care an important part of your life — for the rest of your life.

Find out how long your recovery should take — If you know what to expect, you’ll have a better idea about when to check in with the doctor. If you’re taking longer to heal than expected, call your doctor and say so.

Stay in touch — Call for an immediate appointment if your illness takes a turn for the worse or if you develop new symptoms.

Take all medications exactly as prescribed, even if you start to feel better — If antibiotics have been prescribed to kill bacteria, and you stop taking them too early, your infection may linger because some germs have survived. And be sure to call your doctor immediately to report any unexpected or extreme side effects.

Fresh fruit — Full of vitamins, minerals, antioxidants and fiber.

Calcium-rich foods — Low-fat or nonfat dairy products, such as milk, yogurt, cottage cheese and cream cheese, as well as green leafy vegetables, such as spinach, collard greens and kale.

Nuts, nut butters and seeds — Although rich in nutrients, use nuts sparingly because of their fat content. Limited amounts, especially walnuts, almonds and pecans, are a tasty way to add protein. Adding flax seed meal to dishes contributes extra fiber and anti-inflammatory elements.

Whole grains — Unrefined cereals, brown rice and other whole grains are nutritious, hardy, satisfying foods. They are an excellent source of fiber and B-vitamins.

Legumes and soybean products — Tofu and tempeh are delicious, and high in fiber and protein.

Low-fat animal products — Lean meats, low-fat or nonfat dairy foods (such as milk and yogurt), and skinless poultry are high in protein and calcium.

Monosaturated oils — Olive and canola oils, used sparingly, provide omega-3 fatty acids that battle inflammation. Other oils that may ease arthritis symptoms are borage seed oil and evening primrose seed oil.

Fatty, cold-water fish — Salmon, mackerel, trout, cod, halibut, sardine and herring are among the best sources of omega-3 fatty acids.

Foods high in bioflavonoids — Cherries, berries, oranges, peaches, grapes and green tea are examples.

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“Secrets of the Spas: Pamper and Vitalize Yourself at Home,” by Catherine Bardey and Zeva Oelbaum. Inside you will find easy, economical ideas for scrubs, masks and other intriguing products such as mango hair conditioner and cider vinegar toner.

“Making Aromatherapy Creams and Lotions: 101 Natural Formulas to Revitalized and Nourish Your Skin,” by Donna Marie Coles Johnson. Inventive, all-natural techniques to extract plant materials for recipes for lip balm, body rubs, moisturizer and more.

“Body Care Just for Men: Natural Health Tips and Herbal Formulas for Skin Protection, Sore Muscle Relief, Aftershaves, Tonics and More,” by Jim Long. One of the few books with a masculine focus, this tome includes ideas for energizing rubs and confidence-building scents.

“Natural Beauty at Home: More Than 200 Easy-to-Use Recipes for Body, Bath and Hair,” by Janice Cox. Cleansers, scrubs, toners and shampoo — They’re all here. This even includes a recipe for coloring bath salts for holiday gift-giving.

Wackyuses.com Joey Green, author of “Wash Your Hair with Whipped Cream,” offers dozens of ideas for everything from Jell-O hair masks to Miracle

Whip facials. As a bonus, you will also find ways to preserve your Christmas tree with pancake syrup or clean the floor with Cheez Whiz.