Newsletter "Your Health"
- Tia and stroke are emergencies
- Weight loss. What’s new?
- New treatment for multiple sclerosis
- Calculate your risk of breast cancer
- Are you eating too much salt?
- Do healthy people under 65 need flu vaccination?
- Does your child snore?
- Which infant formula should I use?
TIA and stroke are emergencies
Transient ischaemic attacks (TIAs or ‘mini strokes’) and strokes are medical emergencies. If you have the symptoms of a TIA or stroke, call an ambulance immediately on 000.
According to the National Stroke Foundation, the symptoms of a TIA and stroke come on rapidly and include:
- Weakness, numbness or paralysis of the face, arm or leg
- Difficulty speaking or understanding
- Dizziness or loss of balance
- Blurring or loss of vision
- Headache, usually severe/sudden
- Difficulty swallowing
TIAs occur when an artery supplying blood to the brain is blocked temporarily, usually by a blood clot or cholesterol particle. A TIA can last up to 24 hours, but there is no lasting damage to the brain once the event passes.
On the other hand, a stroke occurs when an artery is permanently blocked. The lack of blood can damage part of the brain, and may lead to permanent disability or even death. A stroke can also be due to a burst blood vessel in the brain.
Doctors try to find the cause of the TIA or stroke with a physical examination, CT scan (brain x-ray), a scan of the arteries in the neck to check the blood flow, ECG (heart test) and blood tests.
Acting quickly saves lives
Most TIAs last less than an hour, but they should never be ignored. One in 5 people with a TIA will have a major stroke in the next 3 months. Urgent assessment can prevent this. Furthermore, an apparent TIA may actually be the start of a stroke.
Stroke also requires an urgent response. A blood clot-dissolving drug can be used in hospital in some cases to unblock the affected artery (thrombolysis) and reduce long-term damage. This drug must be given within 3 hours.
How to prevent TIAs and strokes
After a TIA or stroke, most people are put on ‘triple therapy’: medications to thin the blood (antiplatelet agents), lower blood pressure and reduce cholesterol. Other important strategies include good control of diabetes, stopping smoking, exercise and, if necessary, surgery to the blocked carotid (neck) arteries.
Research is helping us to understand weight control better. Are you aware of these five key developments?
1. Eat more lean protein
We now know that protein reduces hunger more than any other food type. ‘Fast’ proteins such as whey (in dairy food), soy and seafood are best as they are absorbed quickly and act fast. Eat more lean protein such as low-fat yogurt and tinned salmon.
2. ‘Energy density’ rules!
Previously fat was king! We thought that simply eating less fat was the key to weight loss. But that didn’t always work, because some low-fat processed foods are high in sugar and are just as fattening! The key is ‘energy density’, which measures the total energy (kilojoules) in a particular food from both fat and sugar. Check the food labels for fat content and sugar/carbohydrates.
3. Eat more low GI foods
Carbohydrates with low GI (glycaemic index) are absorbed more slowly. They curb hunger and are more satisfying for longer. Learn more at www.glycemicindex.com.
4. The rise of the tape measure
Where you carry your fat determines your risk of heart disease, diabetes and blood pressure. Fat around the waist is a health hazard. Fat on the hips and thighs is not.
Get out the tape measure! As a guide, Caucasians should aim for a waist size of <94cm for men and <80cm for women. For Asian/Indian men <90cm, women <80cm.
5. Set realistic targets
You don’t have to become skin and bones to get health benefits! A modest loss of only 5-10% of your body weight gives major health improvements such as better diabetes control, reduced heart disease, improved sleep apnoea and lower blood pressure.
New treatment for multiple sclerosis
Multiple sclerosis (MS) is a chronic disease causing areas of inflammation in the brain and spinal cord. It is a common cause of disability in young adults.
The symptoms of MS depend on which areas are affected. Symptoms may include marked tiredness, impaired vision, loss of balance and coordination, muscle spasms, bladder and bowel problems and paralysis.
MS usually begins between 20 and 40 years and runs an unpredictable course. Most patients have a ‘relapsing-remitting’ illness, with symptoms suddenly appearing for days or weeks and then partly or fully settling. There is also a ‘progressive’ form with more gradual deterioration.
MS can have a devastating effect on independence and quality of life. However, some patients have only minor symptoms and the majority do not become severely disabled.
Drug treatment for MS
Most acute attacks of MS do not need treatment. Intravenous cortisone injections can speed recovery in more severe episodes.
Several drugs (interferon-beta, glatiramer acetate) prevent attacks and may slow the progress of the disease. They are given by regular self-injection and reduce the rate of further flareups by about one third.
A new medication, natalizumab, is the most effective treatment to date. It cuts the relapse rate by two thirds and slows disease progression by nearly half. It is given by IV infusion every 4 weeks and is expected to be available on the PBS in early 2008.
Although generally well tolerated, it has been associated with a few cases of PML (progressive multifocal leucoencephalopathy), a rare and sometimes fatal brain infection, usually in people with weak immune systems.
Calculate your risk of breast cancer
One in 8 Australian women will get breast cancer. A complex list of factors determines your personal risk. A new calculator from the National Breast Cancer Centre (NBCC) can measure your risk, compared to women your age.
The calculator at www.nbcc.org.au/risk indicates which issues are important in your case. Some risk factors can be modified. For example, the NBCC recommends that you drink no more than 2 standard drinks a day. Reducing your weight or doing regular exercise will also lower your risk.
On the other hand, your risk also increases with age, a history of breast cancer in your family and the age of having your first child. These factors can’t be changed.
Do you have ‘hereditary’ cancer?
A ‘family history’ of breast cancer means having one or more blood relatives with breast cancer. This does not necessarily increase your risk as most cases occur randomly and are not inherited.
In ‘hereditary’ cancer, a faulty gene is passed down through either the mother’s or father’s side of the family. This greatly increases the risk of breast and ovarian cancer in future generations. Less than 5% of breast cancers are hereditary.
You could have hereditary cancer if you have:
3 or more close blood relatives on the same side of the family with breast or ovarian cancer, OR 2 or more close relatives on either side of the family with breast or ovarian cancer plus one or more of the following:
- Breast + ovarian cancer in one relative
- Breast cancer < age 40 or in both breasts
- Breast cancer in a male relative
- Jewish ancestry
If you are concerned about your family history, talk to your GP who may refer you to a family cancer clinic.
Most Australians eat far too much salt. Salt raises blood pressure, and can lead to stroke, heart and kidney disease and oedema (fluid buildup).
Reducing salt to the level advised by the Heart Foundation of 6 grams per day (6,000 mg or about 1 teaspoon) would prevent about a fifth of all strokes and heart attacks!
Salt is also called sodium chloride. It is the sodium in salt that can be bad for you.
Most dietary salt is hidden
You are probably eating more salt than you realise, as most dietary salt is hidden. Seventy five percent comes from processed foods such as breads, cereals, soups, cheese, sauces and ready-made meals.
Only 15% of the total sodium in our food is added during cooking or at the table.
Restaurant and takeaway foods generally contain high salt levels.
How to reduce salt
- Avoid adding salt while cooking or at the table. Cut back on salty foods.
- Choose ‘low-salt’ brands when shopping.
- Read food labels and select low sodium products. Low-salt foods have less than 120 mg sodium per 100 grams of food.
- Eat more fresh fruit, vegetables, fish, meat, poultry, unsalted nuts and milk.
- Potassium chloride salt-substitutes are useful but avoid them in kidney disease or with certain diuretics (fluid tablets).
- To add further flavour, try vinegar, lemon juice, fresh herbs, garlic, ginger, lime, wine, onion or shallots.
- Taste buds adjust quickly to lower sodium levels. Within a few weeks, they become more sensitive to salt and you will notice the flavours in food that salt used to mask.
Vaccination for healthy adults is a personal choice. Influenza is usually a brief illness with a low risk of complications in this group.
However, a lot of people choose to be immunised as influenza is unpleasant and can put you in bed for several days.
Many working people choose vaccination to reduce time off work, especially the self-employed.
Vaccination can prevent disruption to other important activities in the flu season, such as exams, overseas travel or a wedding.
Nursing home staff and other adults caring for the elderly or infirm should be vaccinated every year to protect those in their care.
About 15% of children snore, most commonly in the 2-4 year age group. Snoring can be a sign of ‘obstructive sleep apnoea’ (OSA) which can have important health effects.
OSA causes difficulty breathing during sleep. Most cases are due to enlarged adenoids and tonsils which narrow the air passage. During sleep, the muscles at the back of the throat become relaxed and floppy, causing further blockage to air flow.
Other causes include a blocked nose (head cold or nasal allergy), obesity and Down syndrome. The signs of OSA are:
- Snoring
- Brief pauses in breathing (‘apnoea’)
- Choking, gasping or snorting
- Laboured breathing during sleep
- Restless sleep
- Mouth breathing at night
Because sleep is repeatedly disrupted, the child may be very tired in the day, have poor concentration, learning difficulties, behaviour problems and morning headache.
A ‘sleep study’ is the best way to diagnose OSA. The child sleeps overnight with a parent in a sleep laboratory, while their breathing, oxygen levels, brain, eye and muscle activity are monitored.
Treatment of snoring and OSA
The treatment of OSA depends on the cause and severity. Obese children need to lose weight. Those with long-term nasal allergy may benefit from having it treated.
Removal of enlarged tonsils and adenoids solves the problem in 85% of cases. It requires an overnight stay in hospital.
CPAP treatment (continuous positive airways pressure) is occasionally needed. This uses a nose mask and pump to blow air into the airway at night to keep it open.
Tell your doctor if your child snores.
Which infant formula should I use?
With over 50 formulas for full-term infants on the market, it is no wonder that parents are confused. Actually, there is little difference between the brands and a formula should be chosen based on availability and cost.
‘Starter’ and ‘follow-on’ formulas
Starter formulas are for infants from birth to 12 months. Follow-on formulas are marketed for 6-12 months of age and have slightly higher protein/mineral content. As solids are now started at around 6 months, there is no nutritional reason to change to a follow-on formula at 6 months.
Special formulas
Soy milk formulas. Can be useful for cow’s milk allergy in infants over 6 months of age. Soy formulas do not prevent allergy from developing as once thought.
Lactose-free milk formulas. There are several lactose-free cow’s milk-based formulas for infants unable to digest lactose (milk sugar). ‘Lactose intolerance’ can occur temporarily after gastroenteritis.
Goat’s milk formula. There is no nutritional reason to select goat’s milk formula, but it is safe for infants. It is not suitable for infants allergic to cow’s milk.
Partially ‘hydrolysed’ formulas (HA formulas). Useful as a breastmilk substitute for the baby at risk of food allergy (e.g. in an atopic family). They are not suitable for babies with cow’s milk allergy.
There is little good evidence of any benefit from milks with:
- Added ‘nucleotides’ or ‘long chain polyunsaturated fatty acids’ (PUFAS)
- Thickening agents, used to try to reduce reflux after a feed (AR formulas)
Always make up the formula exactly as it says on the can and check with your GP before changing to a different type of milk.
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