Understanding Fibromyalgia

Fibromyalgia is characterized by chronic widespread pain and tenderness for at least three months. You can take steps to manage fibromyalgia pain and help yourself feel better.

Diagnosis

Currently there are no diagnostic tests, such as x-rays or blood tests, to detect fibromyalgia. The symptoms of fibromyalgia may overlap with the symptoms of some other conditions. That is why fibromyalgia is sometimes difficult for healthcare professionals to diagnose.

Some healthcare providers use certain guidelines to help make a diagnosis. According to guidelines set by the American College of Rheumatology, a person may have fibromyalgia if he or she has both:

• Chronic widespread pain that affects the right and left sides of the body above and below the waist
• Feels pain in at least 11 of 18 possible tender points (nine on one side of the body, nine on the other) when light pressure is applied

Your healthcare provider may use these guidelines or other methods to make a diagnosis of fibromyalgia.

Discuss all of your symptoms with your healthcare provider. Talk openly with him or her about what you are feeling and how your symptoms are affecting you. You can work together to create a plan that meets your individual needs and helps you manage your symptoms.

6 Serious Medical Symptoms

That new symptom is troubling: the inexplicable swelling in your calf or the blood in your urine. Could it be serious or even life-threatening?

“Your body flashes signals — symptoms and signs — that warn you of potential problems,” say Neil Shulman, MD, Jack Birge, MD, and Joon Ahn, MD. The three Georgia-based doctors are the authors of the recently revised book Your Body’s Red Light Warning Signals.

Fortunately, many symptoms turn out not to be serious. For example, the majority of headaches stem from stress, eyestrain, lack of sleep, dehydration, caffeine withdrawal, and other mundane causes.

But a sudden, agonizing “thunderclap” headache — the worst of your life — could mean bleeding in the brain. Being able to recognize this serious symptom and calling 911 may save your life.

Here are six important flashing signals.

1. Paralysis of the arms or legs, tingling, numbness, confusion, dizziness, double vision, slurred speech, trouble finding words, or weakness, especially on one side of the face or body.

These are signs of stroke — or a “brain attack” — in which arteries that supply oxygen to the brain become blocked or rupture, causing brain tissue to die.

Symptoms depend on which area of the brain is involved. If a large blood vessel is blocked, a wide area may be affected, so a person may have paralysis on one side of the body and lose other functions, such as speech and understanding. If a smaller vessel is blocked, paralysis may remain limited to an arm or leg.

If you have symptoms, call 911 right away and get to an emergency room that offers clot-busting therapy for strokes due to blocked vessels. Such treatment, which dissolves clots in blocked vessels, needs to be given within the first three hours after symptoms begin, but newer treatments may work within a longer time frame, says Birge, who is medical director at the Tanner Medical Center in Carrollton, Ga.

Timing is urgent; fast treatment can potentially stop brain tissue death before permanent brain injury happens. “There is a time clock ticking as to when you might totally recover,” Birge tells WebMD.

2. Chest pain or discomfort; pain in the arm, jaw, or neck; breaking out in a cold sweat; extreme weakness; nausea; vomiting; feeling faint; or being short of breath.

These are signs of heart attack. If you get some of these symptoms, call 911 immediately and go to the emergency room by ambulance. Shulman and Birge also recommend that patients chew one regular, full-strength aspirin (unless they’re allergic to aspirin) to help prevent damage to the heart muscle during a heart attack.

Not everyone who has a heart attack feels chest pain or pressure or a sense of indigestion. Some people, especially women, the elderly, and people with diabetes, get “painless” heart attacks, the doctors say. Being aware of “painless” heart attack signs is crucial: a very weak feeling, sudden dizziness, a pounding heart, shortness of breath, heavy sweating, a feeling of impending doom, nausea, and vomiting.

Both doctors say that it’s important to learn heart attack signs and understand them in context. “Everybody has jaw pain. You don’t immediately run and say, ‘I’ve got a heart attack,’” Shulman tells WebMD. He is an associate professor of internal medicine at Emory University School of Medicine in Atlanta. “But if you’re also sweating and you have some of these other symptoms — shortness of breath and so forth — then that’s going to tip you off that there’s something much more serious happening.”

3. Tenderness and pain in the back of your lower leg, chest pain, shortness of breath, or coughing up blood.

These are symptoms of a potentially dangerous blood clot in your leg, especially if they come after you’ve been sitting for a long time, such as on an airplane or during a long car trip. These signs can also surface if you’ve been bedridden after surgery.

“Anybody is susceptible,” Birge says. He adds that such blood clots are more common than most people and doctors realize.

Blood is more likely to pool in your legs when you’re sitting or lying down for long periods of time, as opposed to standing and walking. If a blood clot forms in your leg as a result, your calf can feel swollen, painful, and tender to the touch; you should be evaluated. If you get sudden chest pain or shortness of breath, a piece of the blood clot may have broken off and traveled through the bloodstream to your lungs. This condition can be life-threatening, so get to an emergency room without delay.

4. Blood in the urine without accompanying pain.

Anytime you see blood in your urine, call your doctor promptly, even if you have no pain.

Kidney stones or a bladder or prostate infection are common causes of blood in the urine. But these problems are usually painful or uncomfortable, which sends people to the doctor promptly.

In contrast, when people see blood in their urine but feel no pain, some take a “wait and see” approach, especially if they just have one episode. “But you can’t have this attitude,” Shulman says. Lack of pain doesn’t necessarily mean lack of seriousness.

Cancer of the kidney, ureter, bladder, or prostate can cause bleeding into the urinary tract; when these cancers are small enough to be curable, they may not cause pain. So don’t dismiss this important sign because, according to Shulman and Birge, “blood in the urine may be the only clue for an early diagnosis.”

5. Asthma symptoms that don’t improve or get worse.

Asthma attacks are marked by wheezing or difficulty breathing. When an attack doesn’t improve or worsens, a patient should get emergency care.

If an asthma attack is left untreated, it can lead to severe chest muscle fatigue and death, say Shulman and Birge. Some people with persistent asthma hesitate to go to the emergency room because they’ve gone so many times before, or they need someone to drive them because they’re too short of breath. So instead of seeking care, “They try to hang in there,” Birge says, even if they need higher doses of inhalants or have decreasing lung function measurements when using a device to measure how well they move air out of their lungs.

Because asthma makes breathing difficult, the muscles for breathing may tire and the volume of air exchanged by the lungs will decrease. As a result, a person’s oxygen level drops while blood levels of carbon dioxide rise. As Birge and Shulman explain in their book, “A carbon dioxide buildup in the blood has a sedating effect on the brain, which may cause you to feel even drowsier. You may lose the motivation or energy to breathe.”

“A person with asthma who seems to be relaxing more, who seems to not be struggling for breath anymore — even though they’ve been at it for six or eight hours — may actually be worse. It could be a sign of respiratory fatigue,” Birge says. Eventually, the person could stop breathing.

“They’re really in a big danger zone,” Shulman adds. Patients believe they’re getting better when they’re actually getting worse, he says. “They become sedated and seem to be peaceful when actually, they’re dying.”

One of the most important considerations is how long an attack lasts, according to both doctors. “If you’ve been having labored respirations with the asthma not relenting after a period of several hours, even though you may be apparently doing OK, don’t let it go any longer,” Birge says. “Get on to the emergency room.”

6. Depression and suicidal thoughts.

Few people would put up with crushing chest pain or extreme shortness of breath, but many endure depression, even though at its extreme it can be life-threatening.

“Depression can be a very, very serious problem because people can commit suicide,” Shulman says. “Some people will not seek care when they are depressed because they think that they’ll be perceived as being crazy or not strong or not manly, and they have to understand that there is a chemical imbalance going on in their brain. It is a disease just like any other disease.”

Symptoms of depression include sadness, fatigue, apathy, anxiety, changes in sleep habits, and loss of appetite. Depression can be treated with medications and psychotherapy.

If you have suicidal thoughts, you can speak to someone right away by calling national phone numbers such as 1-800-273-TALK or 1-800-SUICIDE.

Speak Up When You Think Something Is Wrong

Doctors are human: They can miss important diagnoses, including heart attacks. A patient’s awareness and vigilance can make a difference, Shulman says.

“My feeling is, as a doctor, I want a patient who’s informed. I’d rather have a patient who’s informed, who’s helping me so I won’t make a mistake,” Shulman says. “And I can be honest and say, ‘I’m human. Don’t be intimated by me because I have a white coat on. Don’t be intimidated by me because I’m using big words.’”

If patients can recognize potentially serious symptoms, they’ll have more power when they go to the doctor or the emergency room, he adds. “You have enough to say, ‘Well, have you ruled out this problem?’”

Migraines & Headaches Treatment & Care

Migraine Headache Treatment: Preventive and Abortive Migraine Medication

Migraine medicines can prevent a migraine attack while others are available for when the pain becomes intense. Here are the options from our doctors at eMedicinehealth.com.

Headache Medications: Tips on Taking Them

Finding the right migraine medication takes time. It also means following certain guidelines.

Migraine Medications: Information You Need

These charts provide the details on migraine medication — from prevention medications for migraines to pain relievers and possible side effects.

Headache Nausea Medications

Do you have nausea and vomiting with migraine headache? These drugs can help.

Other Drugs to Treat Frequent Headaches

Daily antidepressant medications are used to treat migraine; they can help reduce migraine frequency. Read which medications are available and how they help treat migraine pain

Alternative Treatments

Alternative treatments for headaches and migraines.

Medications for Migraine Relief

Learn about new medications for migraine relief.

Migraines Reduce Workplace Productivity

Sept. 11, 2009 — Whether sufferers stay at home or go to work, migraines are a major, largely unrecognized cause of lost workplace productivity, new research suggests.

In one study, researchers evaluated the impact of migraine attacks on employee productivity by surveying just over 500 people who averaged two to eight migraines per month.

Because most people toughed it out and went to work with migraines, more total work hours were lost as a result of employees who were on the job but less productive than as a result of workers who simply stayed home.

In another study, researchers reported that people with 15 or more migraine attacks per month lost approximately 4.5 hours of work productivity a week.

Both studies were to be presented this week at the 2009 International Headache Congress in Philadelphia, hosted by the American Headache Society.

Fred Sheftell, MD, president of the American Headache Society, says the research highlights the huge economic impact of migraines, which by one recent estimate costs American businesses more than $24 billion annually in direct medical expenditures and lost worker productivity.

“Migraine is more than just a headache and it is more than just pain,” he tells WebMD. “The significant disability that goes along with having frequent migraines often goes unrecognized.”

Absenteeism and Presenteeism

Memphis, Tenn. neurologist Stephen H. Landy, MD, led the study team that examined migraine-related worker absenteeism and presenteeism.

Presenteeism describes lost productivity among employees who don’t call in sick, but whose job performance while at work is impaired for health or other reasons.

Landy and colleagues from the University of Tennessee Medical School and drug manufacturer GlaxoSmithKline surveyed 509 migraine patients who had an average of three migraine attacks each during workdays over the course of the study.

The patients reported that 11% of workday migraines resulted in a full day of work lost, while 5% led to late arrival at work and 12% led to leaving work early.

Survey respondents stayed at work 62% of the time during migraine episodes, but the researchers estimated that their productivity dropped by an average of 25% during these times.

By their calculation, the migraine sufferers lost a total of 1,301 hours of work while actually present on the job and 974 hours from absenteeism.

Landy tells WebMD that the direct and indirect economic costs of migraines are probably much higher than estimates suggest, because as many as half of people with migraines have not been diagnosed.

“The patient, the health care provider, the employer, and the insurance company all have a stake in improving the diagnosis and treatment of migraine,” he says.

A second study examined lost worker productivity among migraine sufferers who had chronic and episodic migraines.

Chronic migraine was defined as having 15 or more days of attacks per month, while episodic migraine was defined as 0 to 15 headaches a month.

More than 11,000 migraine sufferers were surveyed and the researchers reported that those with the most frequent migraine headaches lost nearly four times as many hours of work productivity a week as those with the least frequent headaches (4.5 hours per worker vs. 1.2 hours).

Forehead Lift Cures Migraine Patients

July 31, 2009 – Stacy Porter, 29, can’t remember a time when she didn’t suffer from crippling, relentless migraines before having the surgery that changed her life eight years ago.

“I was diagnosed with migraines when I was 2 years old,” the New Philadelphia, Ohio, marketing executive tells WebMD. “I had about 15 days a month of severe migraine pain.”

Her symptoms included throbbing pain in her temples, nausea, and sensitivity to light so severe she remembers wearing sunglasses to more than one final exam in high school and college.

None of the drugs used to prevent migraines helped, so her only relief came from medications that eased the pain but left her feeling drugged and out of it.

That all changed at age 21 when she had a surgery similar to that typically performed to remove crow’s feet.

“After that I never had another migraine,” she says.

Plastic surgeon Bahman Guyuron, MD, of Case Western Reserve University, says Porter’s results are common, and his newly published study backs up the claim.

Forehead Lift Lifts Migraines

Guyuron has treated more than 400 migraine patients with a modified version of a traditional forehead lift over the last decade, and he tells WebMD that the vast majority of them have shown dramatic improvement.

His newly published study was designed to convince critics still skeptical of usingplastic surgery to treat migraines.

Guyuron and colleagues randomly assigned 75 patients with migraine trigger sites in just one area to receive either real or sham surgery. The patients were not told which type of surgery they were getting.

In the real surgery group, nerves were cut at specific migraine trigger sites. In some cases, like Porter’s, the nerve was the same one cut to eliminate crow’s feet. In others, the nerve was the same one cut to ease frown lines on the forehead.

The surgery works like Botox injections — now widely used, though not approved, for the treatment of migraines.

In fact, patients in the active-surgery group got Botox injections first to determine if they were good surgical candidates.

In all, 49 patients had the actual surgery and 26 had the sham surgery.

One year later, 83% of the actual surgery group reported at least a 50% reduction in migraines, compared to 57% of the sham surgery group.

Even more surprising, 57% of actual surgery patients reported complete elimination of migraines, compared to just 4% of sham surgery patients.

The study appears in the August issue of the journal Plastic and Reconstructive Surgery.

“You don’t see results like this in migraine studies,” Guyuron says. “Even the most skeptical people will have to accept there is something to this.”

Surgery Not for Everyone

But surgery is not a good option for patients who have infrequent migraines and those who respond to preventive treatments, he says.

“We are talking about 10% to 15% of migraine patients who would be good candidates for surgery,” he says.

Neurologist Richard B. Lipton, MD, who directs the headache unit at Montefiore Medical Center in the Bronx, says the study’s design and its dramatic outcome helped convince him the surgical approach is legitimate.

“I started out quite skeptical about this,” he says. “But despite my best efforts not to be, I’m pretty excited about the results.”

Lipton did express concern that the study participants may have actually known which treatment they were getting, which might have affected the results.

Alexander Mauskop, MD, who directs the New York Headache Center, had the same reservation about the trial.

Mauskop was one of the first headache specialists in the nation to routinely use Botox for migraines, and he now treats between 60 and 70 patients a month, with a 70% response rate.

Patients typically get Botox injections every three months, at a cost of $750 to $1,000 per injection.

“The problem I have with surgery is that headaches come and go,” he says. “They may go away with menopause or at some other time. Surgery is a permanent treatment for a condition that is rarely permanent.”

Mauskop offers his patients many treatment options ranging from traditional drug therapies to alternative approaches like acupuncture.

Robert Kunkel, MD, has treated migraines for four decades at the Cleveland Clinic, and he serves on the board of the National Headache Foundation.

He tells WebMD he has seen several surgical approaches come and go during his career.

“There is always a lot of excitement, but none has really lasted,” he says.

But Porter says there is no doubt in her mind that, like her, many, many patients with intractable migraines can be helped with the surgery.

“It completely changed my life,” she says. “I went back to see Dr. Guyuron for checkups for seven years, first every month and then less frequently. And he and I both got teary-eyed every time I went in.”

Causes of Overactive Bladder

Living with overactive bladder — also called OAB — can be a challenge, with the urge to urinate occurring often and suddenly. It can be doubly frustrating when you don’t know what causes overactive bladder. Yet you’re not alone; as many as one in six adults over age 40 may have symptoms of OAB.

When and Why Overactive Bladder Occurs

Overactive bladder occurs when the muscles surrounding the neck of the bladder involuntarily contract more often than normal and at inappropriate times, usually when the bladder is only half full instead of three-quarters or more.

Your mind reads those contractions as an urgent need to urinate. If you have “dry” OAB, you’ll make it to the bathroom on time but not without worry and anxiety. If you have the “wet” form of overactive bladder, you may not always make it without leaking urine.

Causes of Overactive Bladder

The symptoms of overactive bladder have many causes, including:

• Side effects from medications, especially diuretics (water pills) and drugs with caffeine
• Neurological disease such as multiple sclerosis or Parkinson’s disease
• Urinary tract infection
• Tumors or other abnormalities in the bladder such as bladder cancer
• Inflammation of the prostate or prostate cancer in men
• Nerve damage caused by trauma to the abdominal area or pelvis or prior surgery
• Bladder outlet obstruction due to previous surgery for incontinence

 

The Link Between Overactive Bladder and Other Health Problems

You may be more likely to have an overactive bladder if you also have certain health issues. These include fibromyalgia (a condition marked by muscular pain and fatigue) and irritable bowel syndrome (a condition whose symptoms include abdominal pain, bloating, and constipation or diarrhea, or both).

If you have depression, anxiety, or attention deficit hyperactivity disorder (ADHD), some experts also think you are more prone to OAB.

What’s the link? Scientists are not sure. But it might be that conditions such as depression, fibromyalgia, anxiety, and changes in urination are all associated with a disturbance in brain circuits that use specific neurotransmitters, especially the neurotransmitter serotonin 5-hydroxytryptamine or 5-HT. Neurotransmitters are brain chemicals that allow an impulse to go from one nerve cell to another.

In addition, some scientists believe that some individuals are just predisposed to having an overactive bladder.

That doesn’t mean you have to “just live with it.” And you don’t have to feel embarrassed. OAB is treatable. Talk to your doctor to get at the cause of your overactive bladder — and to start the treatment that can help you take back control.

OAB and Your Relationships: Talking With Your Partner

If you have an overactive bladder, you’re not alone. About 25% of women over 18 have experienced urine leakage, and one in five adults over age 40 have OAB or problems with urge or frequency. But it may feel like you’re alone because OAB is something many people are embarrassed to talk about.

OAB can be very isolating, say experts. You may find yourself only going out to places you know well, where you’re sure you can get to the bathroom in time. You may forgo things like movies and plays because of the constant need to excuse yourself in the middle of the show.

And you may find your relationships suffering. Studies have found that women with urinary incontinence issues are more likely to avoid intimate relationships and sexual activity. But it doesn’t have to be that way. If you’re prepared to talk about your OAB situation with a partner-whether it’s someone you’re newly dating or a longtime relationship-you might find that things will get a lot less embarrassing.

When It’s Time to Talk About OAB

• If you think your OAB may interfere with a sexual relationship — for example, if you have urine leakage during sex or worry that this might happen
• If your OAB is significant enough that it’s interrupting your dates — for example, if you’re excusing yourself from the table multiple times at romantic dinners
• If your anxiety about your OAB is making it hard for you to be comfortable when spending time with your partner
• If you find yourself turning down or canceling plans because you fear that you won’t be able to control your overactive bladder
• If you’re planning a trip or making other plans that involve spending a lot of time together

In general, it’s better to bring up a difficult topic yourself than to wait until your partner has become uncomfortable enough to ask you about it. You may be surprised-if you’ve been acting strangely and hurrying out of events, your partner may be relieved to learn that the problem is OAB rather than something more medically serious or an impending breakup.

How to Talk to a Partner About OAB

So you’ve decided that it’s time to have “the talk.” When and where should you do it? How should you bring it up? And how can you get over your anxiety?

• Remind yourself: This probably bothers you a lot more than it will bother your partner. You may be surprised at how easily your partner accepts the news.
• Choose a quiet, comfortable environment where you will have privacy. This is an important subject; you don’t want a waitress showing up to say “Will there be anything else?” just as you’ve begun explaining your situation. Make sure you have enough time.
• Don’t have this conversation over the phone! It’s a lot easier to imagine that a short pause in the conversation is a sign of embarrassment or horror if you can’t see the person’s face.
• Don’t initiate the conversation right before intimacy. If you’re already on your way to bed, it’s probably a bad time to start talking about your overactive bladder. Even during a romantic dinner is probably not the best idea. A picnic lunch in the park or a long walk on the beach or in the woods, on the other hand, could be great.

What Should You Say About OAB?

You’ve figured out when will be a good time to talk to your partner. But what in the world are you going to say? It may be easier than you think.

• Start the conversation slowly. If you’re discussing becoming sexually intimate, you might simply mention that you can sometimes have a bit of dribbling, and wait to see what your partner says in response.
• Explain OAB to your partner. Come armed with information-the National Association for Continence (NAFC) is a good source. Let your partner know that OAB is not just an older women’s problem-millions of women and men of all ages have it.
• Tell your partner what overactive bladder treatment your are trying, whether it’s behavioral therapy, taking medication, or considering a surgical approach.
• Give your partner the chance to ask questions.

Experts say that people with overactive bladders often overestimate how much the news will embarrass or upset their partner. You’ll probably be a lot more concerned than they will. And by trusting them enough to tell them about your condition, you could make your relationship much stronger than before.

Putting an Overactive Bladder to Bed

After a long day, you’ve settled down for a comfortable night’s sleep. You’re just drifting off when suddenly you feel a warm wetness between your legs — something you haven’t felt since you were about five years old. You’ve wet the bed.

For the approximately 16% of people over the age of 18 who have an overactive bladder (OAB), this kind of upsetting incident can become a regular occurrence. Even if they make it to the bathroom in time, they wake up so often to urinate that they aren’t getting a good night’s sleep.

Generally, the amount of urine in our bodies decreases and becomes more concentrated at night, so we can sleep six or eight hours without having to get up to use the bathroom more than once. But many people with OAB have nocturia, the need to urinate several times a night, which interrupts their sleep cycles.

“It can disrupt sleep completely, and people can be extremely overtired,” says Luis Sanz, MD, director of urogynecology and pelvic surgery at Virginia Hospital Center in Arlington, Va.

Even worse, those who are particularly sound sleepers or can’t get out of bed fast enough can wind up with wet sheets.

Getting a Good Night’s Sleep with OAB

“Preparation is everything,” says Melody Denson, MD, a board-certified urologist with the Urology Team in Austin, Texas. You might consider sleeping on a towel and keeping a box of baby wipes near the bed in case of accidents, but you can also take these steps to prevent accidents from happening:

• Limit your fluid intake before bedtime. Try not to drink any liquids after 5 p.m. or 6 p.m.
• Avoid foods and beverages that can irritate your bladder. If you can’t cut them out entirely, skip them in the hours before bedtime to help prevent nocturia. That includes:

o       Caffeine, which is a diuretic, which increases urine output

o       Alcohol

o       Citrus juices

o       Cranberry juice — though it is touted as great for bladder health, it is actually an irritant if you have OAB

o       Spicy foods, like curries

o       Acidic foods, such as tomatoes and tomato sauces

o       Chocolate

o       Artificial sweeteners like Aspartame (also a bladder irritant)

• Double-void before bed. Denson advises that you double-void, or urinate twice, right before bed. “Go to the bathroom, then brush your teeth and go through the rest of your bedtime routine,” she says. “Then, just before you’re about to lie down — even if you don’t feel like you have to go — try to urinate and see if you can squeeze out another tablespoon or so.”
• Do Kegel exercises. Done regularly, they help control an overactive bladder. “They will trigger a reflex mechanism to relax the bladder,” says Denson. “If you feel a tremendous urge to urinate, doing a Kegel before you run to the bathroom will help settle down the bladder spasm and help you hold it until you get there.”

Kegels simply involve contracting and releasing the muscles around the opening of your urethra, just as you do when going to the bathroom. You can learn what a Kegel exercise feels like by starting, then stopping, your urine stream. Start with three sets of 8-12 contractions. Hold them for six to 10 seconds each and perform these three to four times per week.

OAB and Your Sex Life

OAB can interfere with that other bed activity, too. There’s nothing that can shut down an intimate moment faster than realizing you’ve lost control of your bladder — something that happens for many people with OAB. “Sexual activity itself is irritating to the bladder, and you can lose urine during intercourse,” Sanz says. “About 15% of my patients report having incontinence during sex.”

The problem may be even more widespread than that. In a 2001 Harris survey of people with overactive bladders, about half were sexually active — and two-thirds of those people reported that their overactive bladders were getting in the way of their sex lives. And in a 2004 study, women with continence problems reported increased sexual dissatisfaction and decreased sexual activity.

“When you’re being intimate, you’re used to secretions and moistness, but the thought that it’s actually urine leakage is really upsetting and uncomfortable,” says Denson. “Usually it’s the female patient who has the leakage, and it’s actually more bothersome for her than for her partner.”

Tips for Getting Your Groove Back

There are some things you can do to ward off discomfort or embarrassment during sex.

Talk about it. First, know that your partner will probably be a lot more understanding than you expect. Then bring it up before you have intercourse. “Don’t wait until it happens and say, ’Oh, guess what?’” Denson says. “It’s better to be upfront and honest ahead of time.”

Plan. Prepare for sex, just as you do for bedtime. Double-void, cut back on fluids, and avoid foods and beverages that are likely to irritate your bladder. (This means it’s probably a good idea to skip that romantic glass of wine.)

Keep up the Kegels. Doing these several times a day — and even during intercourse — will help prevent urine leakage during sex.

All of these approaches can help you manage your overactive bladder at night, letting you get a better night’s sleep and have a more active and satisfying sex life. But Sanz adds that if your overactive bladder is really causing you problems, there’s no reason you need to live with it.

“There is hope. There is treatment,” he says. You need to be evaluated by a urogynecologist, who will talk to you about three types of treatment: behavioral modification, medication, and surgical procedures are available, he says. “You don’t have to let an overactive bladder interfere with your life.”

HRT Is Linked to Deaths From Lung Cancer

A new study shows that women who took estrogen-plus-progesterone hormone replacement therapy (HRT) were 71% more likely to die from lung cancer than those who took a placebo.

The study was based on data collected during the Women’s Health Initiative (WHI) study, which was halted early when the health risks associated with HRT were found to exceed the benefits. The WHI study found that women who took combined hormone replacement therapy had higher risks of heart disease, stroke, breast cancer, and other health problems.

Although the risk of death from any cause did not differ between the groups at the time the study ended, researchers say additional follow-up now shows a higher risk of lung cancer deaths among women who took combined HRT.

“These findings should be considered before the initiation or continuation of combined hormone therapy in postmenopausal women, especially those with a high risk of lung cancer, such as current smokers or long-term past smokers,” write researcher Rowan Chlebowski, MD, of the Los Angeles Biomedical Research Institute at Harbour-UCLA Medical Center in Torrance, Calif., and colleagues in The Lancet.

The WHI study involved 16,608 postmenopausal women at 40 different centers across the U.S. who were randomly assigned to take a daily dose of hormone replacement therapy or a placebo.

During a total of about eight years of follow-up since the WHI study began, researchers found that the incidence of lung cancer was not increased in women who took HRT.

The percentages of women who died from lung cancer from the HRT group and the placebo group were low (0.11% and 0.06%), but statistically significant. When they looked at deaths due to lung cancer, they found 73 women who took HRT died of lung cancer compared with 40 in the placebo group. The researchers found this was mainly due to a higher number of deaths from non-small-cell lung cancer in the combined HRT group.

“These results, along with the findings showing no protection against coronary heart disease, seriously question whether hormone-replacement therapy has any role in medicine today,” writes Apar Kishor Ganti, MD, of the University of Nebraska Medical Center in Omaha, in a commentary that accompanies the study. “It is difficult to presume that the benefits of routine use of such therapy for menopausal symptoms outweigh the increased risks of mortality, especially in the absence of improvement in the quality of life.”

Healthy Kitchen

Making Over Your Kitchen

Let these videos and tools be your guide.

Frozen Foods

Get all the information you need here.