Healthy Living

As a dietitian, some questions I often get asked are: how much fluid should a person drink every day? Do you really need to drink 6-8 glasses of water every day? Is it better to drink plain water or a sports drink when you exercise? How do I know if I’m taking in enough fluids? These are all good questions to ask especially with August, the hottest time of year, soon approaching.

Water is the nutrient your body needs the most. In fact, it has been estimated that the human body is made up of 60-75% water–mostly found in blood, muscles, lungs and the brain. Besides regulating your body temperature, water also helps nutrients reach your organs, removes waste products, brings oxygen to cells, and protects your joints and organs. Every day you lose water through urine, breathing, sweating and bowel movements. Certain factors like exercise, the climate you live in, pregnancy, breastfeeding, and illness can also affect your fluid requirements, according to mayoclinic.com.

Most healthy adults consume enough water from fluids they drink and foods they eat to maintain health and bodily functions. It is estimated that about 80% of a person’s water intake comes from fluids they drink, and 20% from foods they eat. This works out to an average of about 3.7 liters (125 oz.) for men and 2.7 liters (91 oz) daily for women. Most sedentary and moderately active adults can meet their fluid needs by drinking when they feel thirsty. However, this is not the case for persons whose fluid and electrolyte needs are higher than average, like endurance athletes.

The amount of extra fluid physically active adults needs mostly depends on how much they sweat. One way to determine hydration status is by weighing oneself without clothes before and after exercising. If you lost weight after exercising, drinking 16 ounces of fluid for every pound lost will help you replenish fluid losses.

Another way to tell if you’re drinking enough fluids is by checking the color of your urine the first time you urinate in the morning-it should be nearly clear.
Now, what to drink? Water is a great choice, but any beverage you consume will help you meet your fluid needs–even ones containing caffeine. Caffeine is a diuretic, but for people that regularly consume caffeine, their bodies will regulate itself to that diuretic effect. Still, it is important to be sensible about your caffeine intake – the Institute of Medicine recommends avoiding caffeine before or after heavy training, when an increase in water loss through urine could affect your hydration status and performance.

Sports drinks are a good choice for persons exercising an hour or more but probably not needed in activities lasting under an hour. Athletes or physically active individuals need more salt and fluid to replenish sweat losses – so sports drinks help with this. It has been said that sports drinks contain the right amount and types of electrolytes to encourage continued drinking, which helps you stay hydrated and prevent cramping.

The bottom line is that optimal hydration varies based on individual fluid and electrolyte needs. For healthy, sedentary adults, 3.7 liters of fluid for men and 2.7 liters of fluid for women is an estimated adequate intake along with 1.5 grams of sodium per day. But athletes or very active adults will require more depending on how much they sweat.

And don’t forget, with the dog days of summer looming, hot, humid weather and high altitudes can cause one to sweat more and increase fluid requirements.

Catherine Schneider is a Registered Dietitian in the Food and Nutrition Department at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Ms. Schneider and all of the Healthy Living columnists at healthyliving@wwbh.org

Sam, 14 year old from Norwich loves golf. We were playing together at our local club recently, when one of his drives found the woods. We went looking for his golf ball. We were wary of the bushes, hoping not to come too close to poison ivy. We thought we were successful and went on with our round of golf. I met Sam three days later and noticed a red rash on his leg. After a close look, I said “Oops, there it is. Poison ivy.”

Various summertime activities take us outdoors and unfortunately do expose us to some of these nuisances. I generally see an increase in these rashes from spring through summer, although as hard as it is to believe, I do see some cases in the winter. About 25 to 40 million people in the United States need medical treatment for poison ivy rash every year. People of all ethnic background and skin types are at risk for developing a rash. Children, firefighters and farmers are at higher risk because of repeated exposure to these toxic plants.

What is Poison Ivy?
When the skin comes in contact with certain allergy-causing substances, a person may develop a condition called contact dermatitis.

Exposure to poison ivy, poison oak, and poison sumac cause this type of contact dermatitis. All these plants contain a colorless oil that is found on the fruit, leaves, stem, root and sap of the plant, more so when the plants are damaged by animals or wind or anything else.

A person can get poison ivy either by direct contact or indirect contact such as pets or garden tools. One can also get poison ivy by airborne contact when poison ivy is burned. Recently I saw a good example of this.

Gabrielle, a 15 year old, came in to my office with the left side of her face swollen and some blisters on her cheek. She said she hadn’t been in the woods, but admitted that she loves to sleep with her dog.

After contact, about 50 percent of people develop symptoms of poison ivy. It can take anywhere from four hours to four days before the symptoms appear. Most common symptoms are intense itching, swelling and redness. Some may develop blisters. Contacts around eyes or around private areas tend to be associated with lots of swelling. Redness and blisters may keep appearing over several days and I get a lot of calls from concerned parents stating ‘poison ivy is spreading’. The only true ‘spreading’ is by continued exposure either from clothes or pets or from residue left under fingernails etc.

If left untreated, the majority will get better over one to three weeks. But some severe lesions can get complicated with added infection.

Treatment
Most people probably know about adding oatmeal to the bath, applying cool compression and possibly applying calamine lotion. These measures certainly help alleviating some discomfort. A soap mixture called Zanfel may help relieve some symptoms. These are measures any one can do prior to seeing a physician to get further treatment if needed.

Over the counter antihistamines like Benadryl or Claritin may help with the itching. Topical corticosteroids may be helpful if used in the first few days. Most people will need a stronger cream than cortisone cream available over the counter. When lesions are too many or when the face or genitals are involved, oral corticosteroids are useful in relieving the symptoms. Do not use neomycin or bacitracin creams or ointments as these may make the rash worse.

Prevention
The best way to prevent poison ivy is to identify and avoid the plants that cause it. These plants can cause symptoms year round, and even years after the plant dies.

“Leaves of three, let them be” is a phrase used to help identify plants that cause poison ivy. Generally poison ivy and poison oak have three leaves with flowering branches positioned on a single stem. Poison sumac has five, seven, or more leaves that angle upward toward the top of the stem. Some leaves may have black dots on them.

Wear protective clothing and vinyl gloves while working on your yard or gardening. Wash with mild soap and water after exposure. Do not scrub or rub the area. Use of creams or commercially available Ivy Block, which might help as a barrier for some people who are frequently exposed to poison ivy. Finally, avoid burning poisonous plants as particles in the smoke can cause poison ivy rash.

Ravi Prakash, MD, is Chief of Pediatrics at Backus Hospital with a private pediatric office in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Prakash and all of the Healthy Living columnists at healthyliving@wwbh.org

We have all experienced the sensation of tingling in our limbs. Most commonly, this occurs when we strike our elbow and have a strange feeling extending to our hand that lasts for a few seconds.

People often downplay this and may rationalize it by saying they hit their “funny bone.” The terms “pins and needles” and “my foot fell asleep” might be used to describe this phenomenon. When such a pattern persists day and night, it is known as peripheral neuropathy and can be very disabling.

I see many patients who complain of persistent tingling, numbness, and burning pain in all extremities, worsening at night. I typically perform a detailed neurological examination with particular attention to any loss of sensation to pin prick, temperature and vibration. Blood work and a diagnostic test known as electroneuromyography will help in reaching a diagnosis and appropriate treatment.

The complex human nervous system is divided into two parts. The brain and spinal cord make up the central nervous system. The second part, the peripheral nervous system, consists of the nerves in our limbs. These nerves carry impulses to and from the central nervous system. When peripheral nerves are injured, they transmit paresthesias, which are perversions of actual sensations such as tingling, burning or an impression of crawling insects. These uncomfortable sensations are not only distracting, but they can become very painful and significantly interfere with daily routines.

Peripheral neuropathies are fairly common and their causes are many and varied. Worldwide, leprosy is the number one cause of peripheral neuropathy. Despite available treatment, thousands of new cases of leprosy appear each year in the poorest countries.

In the United States and other industrialized nations, the leading causes of peripheral neuropathy are alcohol use and diabetes. Interestingly, in 10 percent of all diabetics, peripheral neuropathy is the first symptom. Increased thirst and frequent urination are more commonly known symptoms of diabetes.

Other treatable causes of neuropathy include vitamin B12 and folic acid deficiencies, Lyme disease, thyroid disease, and excess intake of vitamin B6. Some peripheral neuropathies are inherited while certain forms of cancer cause others.

Treatments include removing or correcting the underlying reason, applying medicated creams, or taking oral medications to control discomfort. Prevention is an important key in reducing the risk of neuropathy. Eating a balanced diet and moderating alcohol consumption are as essential as treating contributory medical conditions.

Here is my advice for people who experience any of these symptoms: don’t always make excuses for a few seconds of discomfort. When tingling becomes a persistent debilitating problem, it’s time to have a detailed medical evaluation.

Anthony G. Alessi, MD, is a neurologist on The William W. Backus Hospital Medical Staff with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Alessi and all of the Healthy Living columnists at healthliving@wwbh.org

Many people suffer from the debilitating effects of fibromyalgia, which involves chronic widespread muscular pain, fatigue and tenderness. They also experience symptoms such as fatigue, headaches, irritable bowel syndrome, irritable bladder, cognitive and memory problems (called “fibro fog”), temporomandibular joint disorder, pelvic pain, restless leg, sensitivity to noise and temperature, and anxiety and depression.

It is second only to osteoarthritis in frequency of visits to rheumatology clinics, and about 5% of women and 0.5% of men in the United States will be affected. The majority will be between 30 to 50 years of age.

Although we still have much to learn about fibromyalgia, it is believed that patients with it experience pain amplification due to abnormal sensory processing in the central nervous system. This is supported by studies showing multiple physiological abnormalities in patients, including: increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain and low levels of serotonin.

It has also been suggested that fibromyalgia might relate to an abnormality in deep sleep. Abnormal brain waveforms have been found in deep sleep in some patients. Tender points can be produced in normal volunteers by depriving them of deep sleep for a few days. Recent studies show that genetics might also be a factor.

Here is some information on diagnosis and treatment from rheumatology.org and uptodate.com:

DIAGNOSIS:
Unfortunately, there are no “objective markers”—evidence on X-rays, blood tests or muscle biopsies—for this condition, so patients have to be diagnosed based on the symptoms they are experiencing.
The American College of Rheumatology (ACR) has established general classification guidelines for fibromyalgia. These guidelines require that widespread aching for at least 3 months and a minimum of 11 out of 18 tender points. However, not all physicians and researchers agree with these guidelines. Some believe the criteria are too rigid and that fibromyalgia can be present even if the required number of tender points is not met, while others question how reliable and valid tender points are as a diagnostic tool.

TREATMENT:
Fibromyalgia must be managed as a chronic condition, and should include both medication and non-medication treatments for symptoms. Drug therapy for fibromyalgia is largely symptomatic (treats symptoms). Current studies indicate the best pharmacologic approach for treating pain (and improving disrupted sleep) is low doses of tricyclics including cyclobenzaprine (Flexeril) and amitriptyline (Elavil). Positive results also have been shown with dual reuptake inhibitors [Effexor], duloxetine [Cymbalta], tramadol [Ultram]) work similarly.
Conversely, long-acting opioids are typically not recommended for the treatment of fibromyalgia unless patients are refractory (or resistant) to other therapies. This is not due to issues with dependence but rather because anecdotal evidence suggests these drugs are not of great benefit to most people with fibromyalgia.
Anti-inflammatory medications will generally work if the patients have associated arthritis.

Recently, researchers studying antiepileptics such as pregabalin (Lyrica) have found that these drugs may prove promising for fibromyalgia.

OTHER THERAPIES:
Complementary and alternative therapies can be useful for pain, although these treatments have generally not been well tested. Therapeutic massage to manipulate the muscles and soft tissues of the body may alleviate pain, discomfort, muscle spasms and stress. Similarly, myofascial release therapy which works on a broader range of muscles can gently stretch, soften, lengthen and realign the connective tissue to ease discomfort.

The bottom line is this: If you have fibromyalgia, a multi-modal approach to managing it is probably best.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org

I was feverishly typing an email response or rather reaction, when someone nearby who must have noticed the steam rising from my desk asked, “does that email really require a response?” After a brief pause…. I hit the delete key.

The many choices we make each day in response to the circumstances and people in our lives, although sometimes seemingly insignificant, inform our minds, our hearts and our bodies moving us towards or away from our wholeness.

The root of the words "heal" and “health” is "haelen,” which means not an absence of disease but rather to make whole. There is no separating the body from the mind or the heart from our spirit.

Andrew Harvey, author and scholar, tells the story of Isaiah, a Holocaust survivor, who at the age of twelve had suffered the loss of his entire family in the death camps. He faced a choice that would shape the rest of his life. While Isaiah held in his heart the image of his mother’s kitchen, their cat lying in the sun and the love of his family, he was faced with the daily torture, unspeakable cruelty and abuse of the guards. He questioned what is real? Is the love I feel in my heart or the hatred and cruelty I see outside of me? He prayed for months and felt no answer. One day in despair after seeing the guard he most feared, he stood trembling in the cold winter snow and closed his eyes. He knew he had to choose for himself. From deep within, he silently screamed over and over “I choose love”, I choose love, I chose love”. When he opened his eyes the snow on the barbed wire sparkled like diamonds, and when he saw the guard coming towards him, for the first time he felt no fear or hatred, just pity. His life was forever changed. He added whatever you have to go through to know this beyond a shadow of a doubt is worth it.

I spoke this week to a wonderful man challenged with advancing Parkinson’s disease. The smallest tasks are difficult and he spends most of his time in a wheelchair. I was touched by his words. “My body is falling apart and I am seeing that as freedom. It’s no longer working well and as it falls away my spirit and true wholeness are more apparent to me.”

We all have large and small choices each day; to hold on to a grievance or forgive, complain or be grateful, nurture our unhappiness or our joy, move towards brokenness or wholeness, take action from a place of blame or of compassion. Health, in the true sense of the word, is our choice. The poet Naomi Shihab Nye reminds us:
“Walk around feeling like a leaf.
Know you could tumble any second.
Then decide what to do with your time.”
– Amy Dunion, a registered nurse and licensed massage therapist, is Coordinator of The William W. Backus Hospital’s Center for Healthcare Integration. This column should not replace advice or instruction from your personal physician. E-mail Dunion and all of the Healthy Living columnists at healthyliving@wwbh.org