7 Tips for Avoiding SIDS

The leading cause of death in otherwise healthy babies more than a month old is SIDS, or sudden infant death syndrome. It occurs in about 50 of every 100,000 births in the U.S. SIDS applies to any infant whose death is sudden and unexplained.

Usually, the infant is found dead after having been put to sleep, and a subsequent autopsy finds absolutely nothing wrong with the baby. For parents, it is the most horrific of experiences.

No one knows what causes SIDS, but there are several risk factors asociated with it. Babies who are born prematurely are at increased risk for SIDS; so are those who are exposed to tobacco smoke. Laying an infant to sleep on his or her stomach also increases the risk, as does excess bedding, a soft sleep surface or the presence of stuffed animals.

There is no surefire way to prevent SIDS, but in light of these known risks, parents can take precautions to reduce its likelihood. Here are seven quick tips for avoiding SIDS.

–Don’t smoke in the house

–Don’t sleep with your baby in your bed. More and more evidence suggests that parents, especially overweight ones, may inadvertently smother their babies when they’re sleeping with their child.

–Do choose a crib with a firm surface

–Do keep blankets and stuffed animals to a minimum. Infants have little control over their heads and may smother themselves in their bedding.

–Do place baby on his or her back to sleep, never on the stomach.

–Do breastfeed if you can. One recent study showed that breastfed infants are five times less likely to have SIDS as forumula fed infants.

–Do use a pacifier. A recent study has noted that the use of pacifiers is associated with a 90 percent decrease in the risk of SIDS.

Stroke: Know the Signs, Save Lives

Your heart is not the only potential victim of cardiovascular disease. Your brain can be, too. Stroke is a type of cardiovascular disease that affects the arteries leading to and within the brain. A stroke occurs when the blood vessels that carry the oxygenated blood and nutrients to the brain are either blocked by a clot or break.

This prevents the brain from getting the oxygen and nutrients it needs, and within minutes to a few hours brain cells begin to die. Every 45 seconds someone in the United States has a stroke, and every three minutes someone dies of stroke. That’s about seven hundred thousand strokes a year, of which about 160,000 result in fatalities.

I can’t stress enough how important it is to learn how to recognize the symptoms of stroke because it can save your life or the life of someone you know. The most characteristic symptom is a sudden numbness, weakness, or paralysis of the face, arm, or leg, usually on one side of the body. Other symptoms include loss of speech or trouble talking, blurry vision, double vision, decreased vision, dizziness, loss of balance and coordination, an out-of-the-blue bolt of pain, headache, vomiting, or altered consciousness and disorientation or memory loss. Usually these symptoms strike suddenly and without warning.

It is important to recognize the signs and symptoms of stroke because every minute counts when it comes to treating one. The longer a stroke goes untreated, the greater the damage and potential disability. So if you have any of the signs and symptoms of stroke, it is important to get help immediately.

Eighty percent of strokes are ischemic, which means they are caused by an obstruction from a blood clot or particle of cholesterol plaque that reduces the blood flow to the brain. The brain cells die within minutes of this happening. There are two types of ischemic stroke. Thrombotic strokes are caused by clots that originate in the arteries that supply the brain, like the neck arteries, or the arteries within the head itself. Embolic strokes originate from blood clots that form away from the heart but are swept up through the bloodstream and into the narrow arteries of the brain.

The other 20 percent of strokes are hemorrhagic; they occur when a blood vessel in the brain leaks or breaks. The most common risk factor for hemorrhagic stroke is uncontrolled hypertension, though it can also be caused by an anatomical weakness of the blood vessel itself, that is, an aneurysm, or by an abnormal connection of the arteries and veins in the brain.

There are several risk factors for stroke.

People who have transitory ischemic attacks—a temporary halt to the flow of blood to the brain—have a ninefold increase of developing a full-blown stroke. At higher risk are those who have a family history of stroke, are older (the older we get, the greater the chance of stroke), and are African American, partly due to the high prevalence of high blood pressure and diabetes among the black community.

Other factors include hypertension, high cholesterol, cigarette smoking, diabetes, obesity, cardiovascular disease, and high homocysteine levels. Homocysteine is an amino acid in the blood, and people with elevated homocysteine levels have a higher risk of stroke. Women taking birth control pills or hormone replacement therapy may also be at higher risk for stroke.

The good news is that there actually are some things you can do to avoid being a victim of stroke. Even though you cannot do anything about your race, your sex, your family history, or your age, since cardiovascular disease and stroke go hand in hand, you certainly can look at your risk factors for heart disease and hypertension and focus on early screening.

Get your blood pressure checked; learn what your body mass index is; and check your cholesterol and glucose levels every two to five years.

Exercise, manage your stress, limit your alcohol consumption, don’t smoke, and stay away from foods with saturated fats.

Take a vitamin B complex, like B6, B12, and folic acid, which are essential in helping to reduce the levels of homocysteines in the body.

Don’t take illicit drugs, like cocaine, which may trigger a stroke.

People with risk factors for stroke should consider a brain-healthy diet that includes several servings daily of fruit and vegetables with nutrients rich in potassium, folate, and antioxidants. Eat foods high in soluble fiber, like oatmeal, to help reduce cholesterol, as well as foods rich in calcium and soy that help reduce your bad cholesterol and raise your good cholesterol. Foods rich in omega-3 fatty acids, which include, of course, plant oils, salmon and other cold-water fish like tuna, are also good weapons in the battle against stroke.

When it comes to the treatment of strokes, some hospitals have actually established special stroke emergency rooms that are manned by a multidisciplinary team well versed in their diagnosis and treatment. Whoever the doctor is, however, he or she must first determine the type of stroke and its location before treating it.

A wide variety of diagnostic tests are available to the doctor, and they all fall into one of three categories: imaging tests, which provide a better-than–X-ray picture of the brain; electrical tests, which record the impulses in the brain; and blood flow tests, which show any problem that may be causing changes in blood flow to the brain.

Essentially, all emergency room doctors will attempt to improve and restore blood flow to the brain of a stroke victim. One way to do that is by injecting a clot-bursting drug, or thrombolytic, that helps dissolve the clot. Other techniques include performing a surgical procedure such as a carotid endarterectomy, in which the surgeon opens the carotid arteries and removes the plaque from them, or angioplasty, in which a balloon-tipped catheter dilates the arteries to improve the blood flow.

Once a stroke has been diagnosed and treated, most individuals end up taking preventive medicines to minimize the chances of recurrence. Some may receive antiplatelet drugs to make platelet cells in the blood less sticky and less likely to form a clot, or anticoagulants, which again prevent the blood from clotting. In cases of hemorrhagic stroke, where a blood vessel has ruptured, surgical intervention is needed to minimize further bleeding by clipping, cauterizing, or removing the clot and any vessel that is actively bleeding.

Stroke survivors must cope with a life-changing experience. They are often significantly disabled and, as a result, need a strong support system. Usually the support system is a team of rehabilitation doctors, which might include a psychiatrist, a dietitian, an occupational therapist, a physical therapist, a speech therapist, and social workers.

A stroke victim has to deal with impaired movement, which has implications for walking, balancing, speaking, swallowing, and breathing; bladder and bowel dysfunction; and diminished sex drive—as well as all the emotional issues that result from those problems. A stroke victim’s family is also profoundly affected because they now have to take part in caring for the individual.

Stroke can change your life completely, so learn to recognize it and treat it urgently to minimize the terrible disabilities it can inflict on its victims.

The Other Victims of Stroke

The obvious result from a major stroke is devastating disability—such as speech impairment, weak hand and leg movement, and depression. But a stroke can also have an indirect effect on the health of the victim’s family and friends.

Imagine a very strong and vibrant man who has never been sick, who has been a good husband and provider, who has been a great father. His family, and especially his wife of 45 years, marveled at his strength. He was healthy and looking forward to a peaceful and blessed retirement. Then one day he suffered a major stroke, which left him unable to speak and walk. For the family, the confusion and shock were intense. How could this have happened?

This is not a fictional story. It happened in my family. When I first met my future father-in-law, I never imagined that one day his life would end up in such a way. However, this same scenario is played out over and over again in many families across the United States and around the world.

All of a sudden, responsibilities that were the stroke victim’s are now delegated to other members of the family, and in some cases the majority of the responsibilities falls on the spouse. From everyday things like shopping or paying bills to new responsibilities like making daily trips to the rehabilitation center; feeding, bathing, and keeping up with all the medications; and becoming a motivational guru.

All of this can have a tremendous impact on the caregiver’s health. Suddenly, what was once an ordinary life becomes an extraordinary one burdened by the pressure and eased by the love for the ailing family member. We doctors sometimes forget about the families, and that’s a big mistake. When dealing with stroke survivors, focusing on the family as a whole is always important. We must listen, support the changes that are needed, and monitor stress and the effect that it has on the people taking care of stroke survivors.

Family members take care of one another; they become the pillars of health care in the home and improve the outcome that any therapy in the hospital could bring. I remember the look of my mother-in-law as she dealt with her husband’s disabilities, a look of love, duty, and compassion. But we must always make sure that, as we take care of others, we take care of ourselves.

If you don’t take care of your own health, you may very well end up being unable to take care of the person you love. So stay healthy. They don’t say “in sickness and in health” for nothing.

How to Do a Breast Self-Exam

1. Stand in front of a mirror, shoulders straight, hands on hips. Are your breasts evenly shaped, with no distortion or swelling? Do you see any redness or dimpling, or feel any soreness? Has your nipple changed position or been inverted? If so, tell your doctor.

2. Raise your arms, one at a time, and look for the same changes as in step 1.

3. Check for nipple discharge by gently squeezing each nipple between your thumb and index finger.

4. Now lie down and feel your breasts, using your right hand for your left breast and left hand for your right breast. With the first few fingers of each hand go over the entire surface area of your breast, feeling all of your breast tissue just underneath your skin and again deeper down with a firmer touch. If you locate any lumps or hard spots, notify your doctor.

5. Repeat step 4 while standing, perhaps while you are in the shower; it’s easier to feel what’s under the surface when your skin is wet and slippery.

Once breast cancer is suspected, whether it’s on a diagnostic mammogram or otherwise, other tests will follow—usually a biopsy, because this is probably the only way to make sure you have or don’t have cancer. Biopsies involve removing a small sample of the suspect tissue for further examination under a microscope by a pathologist. Not only do pathologists look for the cancer, they also seek to determine what kind of receptors—estrogen or progesterone—the cancer tissue has. The receptors help determine what type of therapy you will receive for the cancer; there are specific therapies directed at each type of receptor that improve the outcome.

The “stage” or location of the cancer is also determined during the diagnosis. If it’s located in a lobule or duct of the breast, the cancer is at Stage 0. If the tumor is less than 2 centimeters but has not spread beyond the breast itself, it’s Stage 1.

Stage 2 involves tumors that are less than 2 centimeters and have migrated beyond the breast to the lymphatic nodes, or are greater than 2 centimeters and haven’t spread outside the breast.

Stage 3 involves more advanced breast cancers, greater than 5 centimeters, that have spread to the lymphatic nodes under the arm.

Stage 4 is metastatic cancer, meaning that it has spread outside the breast to other organs.

Surgery plays a major role in the treatment by essentially removing as much of the cancer as possible. For the very early stages of breast cancer, the treatment is called a lumpectomy, which is the removal of the tumor and a little bit of normal tissue around the tumor. A lumpectomy is usually combined with radiation therapy.

Partial mastectomies involve removing a larger piece of the breast.

More advanced cancers are treated with modified radical mastectomies, meaning that the entire breast and the lymph nodes are removed. Most women who have total breast removal get reconstructive surgery in order to create a substitute breast mound. Those with high stages of cancer often also receive chemotherapy, with surgery or without surgery, in order to decrease the risk of the cancer’s recurrence, though the side effects of chemotherapy can be considerable.

Similarly, radiation therapy, which uses high-energy X-rays to kill cancer cells, is often used to reduce the risk of recurrence and to kill tumor cells that may be living in lymph nodes. Depending on whether the tumor expressed estrogen or progesterone receptors, patients may also receive hormonal therapy. Patients whose tumors expressed estrogen, for example, may receive an estrogen-blocking drug called tamoxifen for five years after their surgery.