Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

How zealous do you really need to be about removing ear wax?

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Most people, especially parents of young children, are needlessly worried about ear wax, which is a normal body secretion that, in most cases, sloughs off by itself.

“Wax isn’t dirt. It’s not a bad thing. It keeps the skin in the ear canal from getting too dried out,” said Dr. Jo Shapiro, chief of the division of otolaryngology at Brigham and Women’s Hospital.

For a few people, those whose ears get so plugged by excess wax that they can’t hear normally, it is necessary to remove wax. In these cases, it is best to have the wax removed by a doctor or nurse practitioner.

“The only people who need to do this are those whose wax builds up significantly and frequently,” said Lynn Kepnes, a nurse practitioner who works with Shapiro and sees many patients for wax removal. “But as a routine thing, we are not meant to be cleaning out ear wax. Wax is good. You don’t want to take it all out.” In fact, wax usually falls out on its own and doesn’t need to be removed.

If you do need to remove ear wax, don’t use Q-Tips or other things that you poke into your ear. “These can really cause problems,” said Shapiro, typically by pushing wax deeper into the ear canal, scratching the sides of the ear canal or perforating the ear drum. “You can really wreck your ear” by poking things into it in an attempt to get the wax out, she said.

If you insist on cleaning, a relatively harmless approach is to use over-the-counter wax softening drops that help wax fall out on its own, including products containing hydrogen peroxide or Colace (a stool softener). You can also make your own solution of half warm water, half peroxide. Or you can soften wax with mineral oil, baby oil, or glycerin, according to the National Institutes of Health website.

After using any solution in the ear, tip your head to let the solution drain out. A few drops of alcohol in the ear or a hair dryer set on low can help dry the ear afterward. Never use any ear drops if you have ever had a hole in your eardrum.

Are there legitimate medical reasons for the treatments that Clemens claims?

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The only people who legitimately might need vitamin B12 injections would be those with confirmed diagnoses of pernicious anemia, said Dr. George Blackburn, director of the Center for the Study of Nutrition Medicine at Beth Israel Deaconess Medical Center. “And it’s virtually impossible” to get pernicious anemia in modern America, where there is ample access to fish, eggs, and dairy products.

For anyone else who uses vitamin B12 shots, the only benefit is in their head, he said. Moreover, since B12 is a water soluble vitamin, extra doses of B12 just pass through the body and out in the urine.

Lidocaine, a painkiller used to treat pain in a localized site, is a different story. Many athletes who have pain in a specific site do get injections of Lidocaine or other painkillers such as Marcaine, which lasts three to four hours, much longer than Lidocaine, said Dr. Zahid H. Bajwa, an assistant professor of anesthesia and neurology at Beth Israel Deaconess.

There has been speculation that Clemens may have had Lidocaine injections into his buttocks. “I don’t know why you would inject Lidocaine deep into this muscle if in fact he did,” said Dr. Gary Wadler, a spokesman for the American College of Sports Medicine and a member of the World Anti-Doping Agency. In general, painkillers like Lidocaine are used very specifically to block nerves – and therefore – pain in a very specific part of the body, such as certain teeth during dental procedures or around aching joints.

Is jogging along the Charles as bad as smoking two packs of cigarettes?

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Not even close. Obviously, it’s nicer to jog where there is little or no vehicular traffic. But the air along the Charles River is not as bad as you might think, said Douglas Dockery, chairman of the department of environmental health at the Harvard School of Public Health.

The biggest pollution hazard along roadways comes not from gasoline-burning cars but from trucks that burn diesel fuel, said Bruce Hill, a senior scientist and air quality specialist at the Clean Air Task Force, a nonprofit, Boston-based group dedicated to restoring clean air through scientific research.

Storrow Drive and Memorial Drive, which run along the Charles, are classified as parkways, which means that commercial vehicles are not allowed to use them. But smaller diesels – and cheaters – do use those roads, he said, so the air along the river is not pristine.

“Diesel particles are eight times more toxic in terms of lung cancer than all other air toxin pollutants combined,” Hill said. These particles are also tiny, which means they can easily penetrate lungs and other organs. “Anything that burns fuel causes air pollution,” he said. “But the quantity of particles from diesel engines swamps that from gasoline,” he added.

It is true that on days when air pollution is really bad there are spikes in the heart attack rate, Dockery said. “But these risks are very small.

“Clearly, the benefits of exercise far outweigh the risks from air pollution,” he said. “The worst risk of all is not exercising.”

Should I eat protein after lifting weights?

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Yes, especially if you’re an elite athlete or serious weight lifter. Studies show that consuming protein along with sugar after strength training – also called resistance training – has “a powerful effect on stimulating muscle protein synthesis,” said William J. Evans, director of the Nutrition, Metabolism, and Exercise Laboratory at the University of Arkansas for Medical Sciences.

“Strength training causes muscle cells to be extremely sensitive to insulin,” Evans said in an e-mail interview. “Insulin stimulates muscle protein synthesis by increasing the transport of amino acids into the cells.”

But the “window of opportunity” for this synthesis is short-lived. “The protein should be consumed before, during, or within 30 minutes of completion of the exercise,” he said. And the protein should be of “high quality” – that is, it should contain all of the essential amino acids like whey, casein (a milk protein), or meat; in general, you should consume about 15 grams of protein along with 20 grams of sugar.

Eating extra protein is less important for people doing aerobic exercise; after an aerobic workout, the most important thing is to replace carbohydrates, to restore energy used during the workout, Evans said.

“For most people, a mixed meal of protein and carbohydrates is sufficient,” said Miriam Nelson, an associate professor of nutrition and physical activity at the Friedman School of Nutrition at Tufts University. “But for elite athletes, where microdifferences make a difference, extra protein is important.”

The simplest thing to remember, she said, is that, for most people, “you want to have a snack or small meal that’s rich in carbohydrates and protein within about 20 to 30 minutes of your workout.”

My yoga teacher told me that if I stand on one leg for six seconds, it will increase its bone density. Is that true?

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Probably not – although no scientific study has addressed the question directly. There is evidence, however, that related activities could build bone strength.

For instance, sedentary women age 25 to 45 can increase their bone density if they do about two minutes a day of jumping, says exercise physiologist Miriam Nelson, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University. While there may be no direct evidence for the benefits of one-legged standing per se, she says, “yoga poses are great for improving balance and stability, which may reduce the risk of falling.”

There are data showing that women who stand up on their toes and then drop down onto their heels (barefooted on a hard floor) 50 times a day for six months can increase bone density by 3 percent to 4 percent, says exercise physiologist William Evans, chairman of Nutritional Longevity at the University of Arkansas for Medical Sciences. In fact, he says, there’s a move afoot (as it were) to get schoolchildren to jump up and down to improve their bone health.

But just standing on one leg for a few seconds, he says, is unlikely to put enough stress on bones to have any effect on bone density.

What is an ‘ethics consult’ and when should patients get it?

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An “ethics consult” is a service, which can be requested by a patient, family member or member of the medical team to discuss conflicts of values, uncertainty about what is the “right” thing to do, and issues like whether to stop life support.

Many patients don’t know that ethics consults even exist, much less that they are free (the hospital picks up the tab). But ethics consultation services are available in 81 percent of all US hospitals – and all US hospitals with more than 400 beds, according to a survey published this year by Dr. Ellen Fox of the Department of Veterans Affairs and her colleagues. Ethics experts typically are doctors, nurses, chaplains or other medical professionals with extra training in ethics.

You should ask for an ethics consult for decisions such as when to end life support, or whenever you feel uncertainty about the right thing to do or, with an incapacitated patient, whenever it’s not clear who the decision maker should be, said Barbara L. Chanko and Kenneth A. Berkowitz, ethicists from the VA who recently gave a workshop at Harvard Medical School.

You can also call in an ethicist if someone, a medical provider or family member, is domineering and not listening to others’ views. “Think of an ethics consult as dispute resolution. The time to go to an ethics consult is when things get heated. And if the word ‘lawsuit’ is crossing your mind, talk to the ethics committee,” said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.

Doctors and nurses often ask for an ethics consult when a patient refuses a treatment with seemingly obvious benefit, for instance, a patient with a gangrenous leg who rejects amputation. An ethics consult can clarify whether a patient is refusing because of lack of information about the seriousness of the disease or because the person prefers to die “whole.”

Basically, said Dr. Lachlan Forrow, director of ethics programs at Beth Israel Deaconess Medical Center, “If you aren’t sure something is an ethics issue, it’s an ethics issue.

Is it possible that I am allergic to my Christmas tree?

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Yes. Allergists have suspected for decades that live Christmas trees, when cut down and brought indoors, can spew out mold spores that can trigger allergies in susceptible people.

Last month, in a small study presented at a meeting of the American College of Allergy, Asthma, and Immunology, Dr. John Santilli of Bridgeport, Conn., documented the phenomenon.

Santilli, chief of allergy and immunology at St. Vincent’s Medical Center in Bridgeport, asked a young colleague to bring home a Christmas tree and place a mold detector nearby. Mold spore counts soared, said Santilli in a telephone interview – from 800 spores per cubic meter of air in the first three days (normal counts are 500 to 700) to 1,400 by the fourth day and 5,000 by the 12th day.

“The longer you keep a Christmas tree indoors, the moldier it gets,” said Santilli. “Mold is Mother Nature’s clean up crew – mold lives on dying stuff.”

But there are other factors that can exacerbate sinus symptoms at this time of year, said Dr. Frank Twarog, an allergist and clinical professor at Harvard Medical School. Christmas trees emit terpines, smelly compounds that can irritate airways. Cold viruses are ever-present and the extra socializing we do this time of year can spread them further. People get so busy during the holidays that they often forget to take their allergy medicines.

And then there are the ornaments that are brought out from dusty attics and basements, said Dr. James Sublett, a Louisville, Ky., allergist who is vice chairman for the indoor environments committee of the American College of Allergy, Asthma, and Immunology.

So, how to have a merry Christmas? One solution is an artificial Christmas tree, though if you use a fake tree every year, you should store it in a dust-proof container, Sublett said. Another is to limit exposure to a live tree – put it up just before Christmas and take it down three or four days later. Also put MERV-12 filters on furnaces to remove mold particles from circulating air and use a room air cleaner near the tree.

Finally, delegate the job of dragging dusty Christmas stuff to whoever is least susceptible to mold and dust allergies and have that person wear a N-95 rated mask while doing the job.

Can you catch a cold or the flu from your pets?

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The virus that causes the common cold in humans is species-specific, which means you can’t spread it to your dog or cat, nor can you get it from them, said Dr. Shelley Rankin, assistant professor of microbiology at the University of Pennsylvania School of Veterinary Medicine.
But influenza viruses can “jump” from one species to another, said Dr. Ed Dubovi, a virologist at the Cornell University College of Veterinary Medicine. “The regular flu virus does not pass back and forth” between cats, dogs and their owners, he said, at least as far as anybody knows.

The Asian bird flu, on the other hand, is different. The H5N1 “bird flu” virus is believed to have originated in wild birds and moved into domestic ducks and chickens in Asia.

In the process, mutations occurred that allowed the virus to “jump” from birds into humans living in close proximity with their chickens and ducks; so far, there has been only limited transmission from human to human.

There have been isolated reports of bird flu infecting cats, including exotic cats in an Asian zoo that were fed infected poultry, said Dubovi. “The cats came down with the flu and died.” There have also been sporadic reports in the scientific literature that dogs in Asia have also been infected.

So far, he said, there have been no reports of the bird flu being transmitted from dogs or cats to people. “These animals are not natural hosts for this virus, and since we haven’t detected this virus in North America, it’s not a concern.

“There are major efforts out there to monitor everything that walks, crawls or flies. Should there ever be a case in a domestic dog or cat in this country, it would be found fairly quickly,” he said. “There is virtually no reason to be concerned.”

I use a humidifier in the winter. But I’m worried about mold and bacteria spewing into the air. Should I be?

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Yes.
Doctors often recommend humidifiers in the winter because if your nose and throat get too dry, that raises the risk of getting a cold.

But humidifiers can be a breeding ground for mold and bacteria. So the trick is to select the right kind of humidifier and to monitor humidity with a hygrometer to make sure it does not go above about 35 percent, said Jeffrey C. May, a chemist-turned-building investigator who is also the author of “The Mold Survival Guide.”

There are four basic kinds of humidifiers. One simply boils water and pumps it out as hot steam. This can be great for adults because “the heat kills bacteria, mold, viruses – you name it. They’re dead,” said Dr. John Ouellette, a retired allergist from Madison, WI who collaborates with May. The downside is that hot steam products can put too much moisture into the air, and children can scald themselves if they knock the device over or get too close.

Another device mixes air with hot steam, so the mist is less humid but still warm, said May. This type, too, kills mold and bacteria, but there is still some scalding risk.

Two types of humidifiers pump out cooler mist. One is an evaporative humidifier, which blows air over a paper filter soaked in water. The advantage here is that there is no hot water, hence no scalding danger. But the filter can get dirty and covered with mold.

The other choice is an ultrasonic mister, which produces mist by a rapidly-vibrating metal plate that sits under the water in a container. The advantage of this is that there is no scalding danger. The downside is that the droplets in the mist contain minerals that can coat surfaces in the room with fine, white dust.

It’s crucial to wash all humidifiers as instructions say, with vinegar or, if you get the evaporative kind, with the chemical tablets that come with it, to prevent microbial growth in the water. If you don’t clean your humidifier as the instructions recommend, “you’re blowing stuff into the environment that is not good,” said Ouellette.

Is eating processed or red meat linked to a higher risk of cancer?

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Yes, according to a new report from the American Institute for Cancer Research, a nonprofit based in Washington that studies links between diet and cancer.
As part of a larger, five-year review of more than 7,000 studies, the group’s specialists pored over 87 studies on the potential link between colorectal cancer and red meat, including beef, pork, and lamb. In excessive amounts, “red meat is a convincing cause of colorectal cancer,” the group said, although more research needs to be done on the precise mechanisms.

The group recommended limiting consumption of red meat to 18 ounces (cooked) per week. “It’s eating more than 18 ounces a week that increases risk substantially, said Karen Collins, nutrition adviser to the American Institute for Cancer Research.

The evidence against processed meat such as bacon, ham, sausage, and lunchmeat is “even more rigorous,” the group said, adding that it could find no level at which consumption of these products was safe. While that is a clear warning, it doesn’t mean you should never eat processed meat, just that you should eat it sparingly, Collins said.

Dr. Michael Thun, who heads epidemiology research for the American Cancer Society, endorsed the findings, saying that although red meat is less of a cancer risk than tobacco, obesity, and lack of physical exercise, it may be linked to a higher risk of cancer through several mechanisms.

Cooking meat by frying or grilling, he said, produces carcinogens, or cancer-causing chemicals, called heterocyclic amines. The fat in red meat also stimulates the release of bile salts that can be transformed into substances that damage the DNA in the colon. And red meat is high in iron-rich compounds, Collins said. Iron can generate cancer-causing substances (nitroso-compounds) as well as free radicals, which can damage DNA.

“The results of this new study came back so strongly,” Collins said. The evidence against meat is now “very compelling.”