Colleague's email address:
Your email address:
Subject:	A colleague recommends WH - A Guide to Women's Health: Spring/Summer 2007
Message:

WH - A Guide to Women's Health

Turn Down That MP3 Music?

From a teenager's perspective, MP3 players are great because they have terrific sound quality, even at high volumes, and are easy to tote and load up with favorite tunes—in other words, good for blasting for hours. Which is exactly what concerns hearing experts. Extremely loud noises, or even moderately loud noises (above 85-90 decibels), that continue for long periods of time can permanently damage the hair cells in the cochlea (part of the inner ear) and cause hearing loss.

Listening to an MP3 player at high volume with in-ear earphones (earbuds) is particularly risky because the sound source is right in the ear canal. To be on the safe side, many experts recommend that an MP3's volume be set no higher than 60 percent of maximum. Just to know: The latest noise-canceling headphones, which actively capture and remove background noise, may encourage a teen listener to keep the volume down but she—or you—will pay a much higher price for them at the checkout counter.

[back to top]

Mom, My Stomach Hurts!

It's not at all unusual for kids to complain about a stomachache. Most cases aren't serious and often all that's needed to relieve the discomfort is home treatment—rest, clear fluids, time on the toilet—and a little TLC. So when is it time to call the doctor about a child's abdominal pain? Anytime you're concerned about his or her symptoms or think he or she should be seen. Other co-existing signs or circumstances that warrant a call include when your child

• acts or looks very sick.
• experiences discomfort (or cries) for more than two hours.
• has severe pain anywhere or has pain that's primarily low on the right side.
• has swelling or discomfort in a testicle or the scrotum (boys).
• possibly ingested poison—a chemical, plant or medicine.
• walks bent over holding her abdomen or is unable to walk.
• vomits green or yellow bile.
• has had a recent abdominal injury.
• vomits blood or has blood in bowel movements.
• is under 2 years of age.
• has a fever higher than 104°F.

Sources: American Academy of Pediatrics, lpch.org

[back to top]

Sports and Concussions

The sporting life comes with its occasional bumps and bruises. So when a sports injury results in a concussion, players may be encouraged to stay in the game. However, a brain injury should never be taken lightly.

"We have to dispel the myth that one has to be knocked unconscious before a concussion is considered serious," says Howard P. Taekman, M.D., Trauma Services medical director, John Muir Medical Center - Walnut Creek Campus. "Mild to moderate concussions can lead to serious consequences if not properly handled."

Concussion, or what doctors call traumatic brain injury, occurs when the brain is knocked back and forth inside the skull due to a blow to the head, neck or upper body. Immediate symptoms may include disorientation, confusion, dizziness, amnesia, uncoordinated hand-eye movements and sometimes unconsciousness. Longerterm symptoms include headaches, memory disturbances and irritability.

"No player should be returned to practice or a game until a proper time for healing is allowed," explains Susan Colligan, Ph.D., Neuropsychology and Brain Injury clinical director at the John Muir Neurosciences Institute. "The athlete needs both physical and cognitive rest."

The average healing time for concussions is one to three months, according to Terence L. Chen, M.D., Neurosurgical Services medical director, John Muir Medical Center - Walnut Creek Campus. Because there is no treatment for concussions, he adds, "we must rely on the intrinsic healing of the brain." If a second concussion occurs before the first one is completely healed, the consequences become more severe. Also, a person healing from a concussion is much more susceptible to a second one.

In fact, the medical literature shows that an athlete with a concussion should be evaluated initially by an athletic trainer and then by the team or family physician before returning to play. The athlete should never resume play while symptomatic. As experts say, "When in doubt, sit it out!"

[back to top]

In a Heartbeat

At John Muir's Cardiac Rhythm Center, physicians use the latest technology to treat abnormal heartbeats and reduce the risk of stroke and heart failure

Atrial fibrillation may not be a common household term, but it describes this nation's most common type of cardiac arrhythmia, or abnormal heartbeat. The truth is, atrial fibrillation affects more than 2 million people in the United States, and it increases the risk for stroke and heart failure. It's also an equal opportunity ailment, affecting women as well as men.

Below, medical experts from the John Muir Cardiac Rhythm Center discuss atrial fibrillation and its diagnosis and treatment, including state-of-the-art procedures that can help irregular rhythms get in sync.

Causes, Symptoms, Risks

The culprit in atrial fibrillation is malfunction of the atria, the two upper chambers of the heart. Normally, the atria contract in a wondrous synchrony that facilitates blood flow from the upper chambers to the lower ones, called the ventricles, explains Michael Lee, M.D., one of six electrophysiologists (cardiologists with advanced training in the diagnosis and treatment of arrhythmias) on staff at the Cardiac Rhythm Center. "During atrial fibrillation, there's a chaotic quivering of the upper chambers, and that leads to inefficient blood flow and pooling of blood in the upper chambers," says Dr. Lee. "Pools of blood tend to form clots, which can sometimes be sent from the heart out to the blood vessels in the body. If the clot goes to the brain, it can cause a stroke." In fact, he adds, about 15 percent of strokes can be traced to atrial fibrillation.

Beyond stroke, atrial fibrillation can lead to other health problems, including heart failure. "Typically, these patients lose 15 to 20 percent of cardiac output," says Susan Eisenberg, M.D., an electrophysiologist on staff at the Cardiac Rhythm Center.

In about half of atrial fibrillation cases, patients experience rapid, irregular heartbeat or palpitations, fatigue and shortness of breath. In the other half of cases, patients don't notice any symptoms. Why this happens, Dr. Eisenberg says, is a bit of a medical mystery.

Fortunately, medical science has pinpointed several risk factors for atrial fibrillation. Increasing age plays a role. According to Dr. Lee, as many as 2 to 3 percent of those over 60 and 10 percent of those over 80 have the condition. Other risk factors include high blood pressure, coronary artery disease, diabetes, overactive thyroid and excessive alcohol consumption.

Diagnosis, Treatments

Atrial fibrillation's quivering heartbeat— clearly audible with a stethoscope—is typically discovered by a doctor during a physical exam. Once a follow-up ECG (electrocardiogram) confirms the diagnosis, explains Dr. Lee, "we look for reversible factors, such as hypertension and hyperthyroidism, and address those issues with treatment." At the same time, patients are usually started on an anticoagulant (medication) such as Coumadin, to prevent blood clots and reduce the risk of stroke.

"Most people are also given some sort of drug to slow down a rapid heart rate," adds Dr. Eisenberg. "The third line of treatment is to use specific drugs to restore normal heart rhythm."

If these strategies don't remedy the problem, some patients need a pacemaker to regulate their heartbeat. Others undergo a procedure called electrical cardioversion (sometimes done along with drug therapy), in which electric shock is applied to the heart to jolt it into normal rhythm.

New Frontiers

An advanced procedure called ablation offers new hope for patients who are highly symptomatic and haven't been helped by standard therapies. "Ablation is definitely leading-edge," says Dr. Eisenberg. "It uses radiofrequency, much like the heat of cautery, to destroy the abnormal cells that are triggering fibrillation. The procedure requires a great deal of advanced technology, which we're fortunate to have at John Muir's Cardiac Rhythm Center."

In ablation, catheters are guided through a vein in the patient's leg up to the heart. Special computerized mapping systems "allow us to see the upper chambers of the heart in 3-D and help us identify areas that need to be ablated," says Dr. Eisenberg, pointing out that there can be as many as 200 or 250 sites that each need to be ablated.

The volume of ablation procedures performed in a center is an important consideration, according to Dr. Eisenberg. "A high-volume center such as the John Muir Cardiac Rhythm Center is an advantage for patients, she explains. "It attracts highly skilled physicians who want to be practicing at the cutting-edge of electrophysiology. For, physicians, we have the opportunity to work with people who have great expertise and know how to appropriately assist, which is ultimately reflected in our outcomes."

Dr. Lee is equally enthusiastic about the possibilities of the ablation procedure and the Cardiac Rhythm Center. "This intervention can allow patients to lead a normal life, be able to stop their medications for an amount of time and may well decrease the incidence of stroke and heart failure," he says. "I'm extremely excited that we have more and more tools to help our patients achieve a better lifestyle and enjoy a vast improvement of their symptoms and quality of life."

[back to top]

[back to top]