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• WH - A Guide to Women's Health
• Summer 2006
• At the Doctor's
• Being a Mom
• Healthy You

WH - A Guide to Women's Health

The Swaddling Effect

Swaddling, the time-honored practice of snugly wrapping a newborn for security and warmth, has long been thought to enhance infants' sleep. Yet there has been scant medical research that investigated swaddling's physiological effects on young babies' sleep and wakefulness.

A study published in Pediatrics (May 2005) explored whether swaddling influences infants' arousal to noise. The results showed that swaddling does help babies sleep better and longer: Specifically, it increased nonrapid eye movement (NREM) sleep. Swaddled infants in the study also spontaneously awoke less often from sleep than they did when they weren't swaddled.

For more information about swaddling—including tips on how to perfect your cozy wrapping technique—visit www.babycenter.com.

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Tobacco's Toll on Teens

It's heartening to know that teen smoking has been on the decline, but it's unsettling to learn how many kids are still lighting up and endangering their health. Consider the following U.S. statistics, compiled by the Campaign for Tobacco-Free Kids:

• High school students who are current (within the past month) smokers: 22.3 percent (more than 3.5 million)
• High school females who currently use smokeless tobacco: 1.4 percent (males: 10.8 percent)
• Children (under age 18) who try smoking for the first time each day: more than 4,000
• Children (under age 18) who become new daily smokers each year: about 750,000
• Kids exposed to secondhand smoke at home: 15.5 million
• Packs of cigarettes consumed by children each year: 900 million
• Kids now under age 18 who will ultimately die from smoking (unless smoking rates decline): more than 6 million

To help kids avoid joining smokers' ranks, experts advise parents to model smoke-free behavior, maintain a smoke-free home and discourage children at an early age from starting to smoke. For more info, visit www.cdc.gov/tobacco or www.tobaccofreekids.org.

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Tips for Successful Breastfeeding

The American Academy of Pediatrics recommends that infants be breastfed exclusively for the first six months of life. If you're expecting, consider this helpful advice about breastfeeding from two experts at John Muir Health: Linda Brooks, R.N., internationally board-certified lactation consultant, and Faye Mettler, M.Ed., certified lactation educator.

1. Appreciate the advantages. Breastfeeding has wide-ranging benefits, says Brooks. "For example, breast milk helps infants fight infections and develop healthy immune systems, and it promotes strong mother-child relationships. Mothers who breastfeed have less risk of ovarian and breast cancer. Breastfeeding is also convenient, and families save money on healthcare and food costs," she adds.
2. Prepare to be patient. "Plan to give yourself some time," says Brooks. "Breastfeeding is instinctive for the baby, but it's a learned skill for the mother. With good support and skilled help, breastfeeding can be rewarding and enjoyable—for moms and babies."
3. Bone up on the basics. Says Mettler: "I strongly encourage expectant moms and their support person(s) to take a breastfeeding class to familiarize themselves with what to expect—and even to attend a breastfeeding support group, such as those sponsored by John Muir Women's Health Center (WHC)."
4. Get fitted for a nursing bra. It's nice for a new mom to already have her first nursing bra while she's in the hospital, Mettler says. "After 36 weeks, you can get sized."

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For More Information The WHC offers breastfeeding support and education, breast pump rentals and sales, nursing-bra fittings and more. Call (925) 941-7900, option 3.

When A Stroke Signals...

If you experienced sudden symptoms of a stroke, would you recognize them? Most important, would you know to call 9-1-1 immediately?

Imagine yourself in this situation: You're midway through a busy shopping day. As you and your friends get out of your car at the mall, you pause to lock the car door. Suddenly, your vision blurs and you lose some feeling in your right leg and arm. You lean against the car for support and attempt to talk to your companions, but they seem confused by your speech.

You don't know why or how, but after only a few minutes, your symptoms disappear. Feeling pretty much like yourself again, you head off for bargain hunting. Still, you can't help but wonder exactly what happened and whether you should check with a doctor to find out.

TIA is a Warning

Should you ever find yourself in such a predicament, consider it an emergency and get immediate medical assistance.

Why the hurry and worry? You might have experienced a temporary or intermittent neurological event called a transient ischemic attack (TIA), which is physiologically similar to a stroke and is sometimes its precursor. "Stroke, or brain attack, occurs when the blood supply to part of the brain is cut off. It's usually the result of an artery becoming occluded, or blocked, by a blood clot, and that part of the brain will be starved of oxygen and die,. explains neurologist Raymond Stephens, M.D., stroke medical director at John Muir Medical Center, Concord Campus. "Unfortunately, about 20 to 25 percent of patients who present with stroke will die because of it, and 60 percent end up with irreversible disability.

"In a TIA," he continues, "patients experience temporary symptoms. An artery is temporarily blocked and blood flow is decreased for a few minutes to hours, and no permanent brain damage takes place." According to the American Heart Association, most TIAs (sometimes called ministrokes or warning strokes) last less than five minutes. The trouble is that among those who've had one or more TIAs, more than a third will later have a stroke.

Danger Signs

Not surprisingly, the signs of TIA resemble early symptoms of stroke. According to the American Stroke Association, these include sudden onset of:

• numbness or weakness in the face, an arm or a leg, especially on one side.
• confusion.
• inability to speak or understand.
• vision difficulties.
• dizziness, trouble walking, loss of balance or coordination.
• severe headache with no known cause.

"When someone has these sorts of symptoms, they should call 9-1-1 and get directly to an emergency room," says Dr. Stephens. "It's best not to call your physician, because it wastes time. If you are having a full-fledged stroke, it's important to get in early. Often, we can treat strokes with clot-busting agents that open up occluded arteries, but it has to be done within three hours of a stroke's onset."

Stroke risk reduction

At John Muir Health, patients are hospitalized when a TIA is suspected, and they undergo a physical exam and a comprehensive round of tests to pinpoint its cause. "These patients have experienced an event that can certainly be frightening," says Cynthia Miller, R.N., clinical coordinator of the John Muir Health Neurosciences Institute. "It's the perfect time to learn about possible causes and what they need to do to prevent having an actual stroke."

As in stroke, a common underlying cause of TIA is atherosclerosis, in which arteries gradually narrow because of fatty plaque deposits inside them. Atherosclerosis leads to reduced blood flow or clot development. The other major cause of TIAs is a blood clot that forms elsewhere in the body, most commonly in the heart, and then travels into the brain.

"We do a complete workup to see what the blood vessels look like and see what caused the TIA," says neurologist Steven J. Holtz, M.D., stroke medical director at the Walnut Creek Campus. "We want to make sure that the carotid and vertebral arteries are not obstructed. Depending on the need, arteries can be surgically cleaned out, treated with medicine to reduce the tendency for blood to clot, or we can perform an intervention, called angioplasty, in which a balloon is inserted to open up an artery. The other thing we look at is heart function, especially spasms caused by atrial fibrillation, which can produce irregular blood flow and allow blood clots to form. In that circumstance, we treat with even more heavy-duty blood thinners."

Making patients aware of stroke risk factors is also a vital component of TIA treatment, experts say. To be sure, there's nothing anyone can do to control certain contributing factors, such as family history (risk is greater if a family member has had a TIA or a stroke), age (stroke risk increases as one gets older) and race (African Americans are at greater risk of dying from a stroke than are people of other races). But it is possible to control many other risk factors, including high blood pressure, cigarette smoking, heart disease, peripheral artery disease, diabetes, undesirable levels of blood cholesterol, elevated homocysteine levels, blood disorders, sleep apnea, obesity, migraines and sedentary lifestyle. That's why doctors recommend a stroke-prevention to-do list that includes the following: Stop smoking; control blood pressure; limit dietary cholesterol, fat and sodium; eat plenty of fruits and veggies; exercise regularly; avoid alcohol; maintain a healthy weight; and control diabetes.

Studies show that "controlling hypertension does reduce stroke risk by 30 to 40 percent," Dr. Stephens adds. "Bringing down LDL [bad] cholesterol will bring in the range of a 20 percent reduction. Proper treatment using aspirin as an antiplatelet agent probably brings risk of stroke down 20 to 25 percent. All these things can play a significant role."

Women and stroke

Women should also know that some stroke risks are unique to them or have a greater impact on females than on males. For example, women who smoke and take certain oral contraceptives significantly increase their risk of stroke. The majority of Americans who suffer migraines are women; these painful headaches increase a woman's stroke risk three to six times. Then there's the question of postmenopausal hormone replacement therapy (HRT), which at one time was thought to safeguard against heart disease and stroke because of estrogen's presumed protective effect. That notion was called into question by a recent Women's Health Initiative study, which found no reduction in stroke and heart disease risk among postmenopausal women taking combined progestin/estrogen hormone therapy.

Another gender-related phenomenon: Women suffer 45 percent of strokes but account for 60 percent of stroke deaths. Why the discrepancy? "Women tend to be caretakers of others and sometimes ignore their own symptoms," Dr. Stephens theorizes. "We think that may play a role."

What's the bottom line for you and your family? Get educated about TIA, and regard it as both a warning and an opportunity: a warning of an impending stroke and what may well be a lifesaving opportunity to prevent it.

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Our Certified Stroke Centers "Time lost is brain lost" is the mantra of the American Stroke Association, and for good reason. For stroke patients, receiving proper, quality medical care quickly is paramount. But a recent investigative report in The Wall Street Journal revealed that many patients don't get appropriate care—or don't get it quickly—because they are transported to the nearest hospital instead of to a certified stroke center. Both John Muir Medical Center, Walnut Creek Campus and Concord have achieved the Joint Commission on Accreditation of Healthcare Organizations' Gold Seal of Approval™ for stroke care and the American Stroke Association's Get With the Guidelines—Stroke Initial Performance Achievement Award, which recognizes the hospitals' success in ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations.

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