Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

I just had a kidney stone. How can I avoid getting another one?

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In many cases they can be avoided by drinking lots of fluids and changing the diet.

Kidney stones occur when the urine contains too high a concentration of certain substances, usually calcium oxalate or calcium phosphate. These substances clump up, forming stones that, if smaller than a pea, can be passed in the urine, albeit painfully. Larger stones may need to be removed with minimally invasive surgery or a procedure called lithotripsy, which breaks up the stones by shock waves, said Dr. Michael Choi , a kidney specialist at the Johns Hopkins School of Medicine.

Kidney stones caused nearly 3 million visits to doctors and 600,000 trips to the emergency room in 2000 alone, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Not drinking enough fluid is a major cause, but genetics play a role, too.

While it used to be thought that consuming too much calcium led to kidney stones, it’s now believed that foods high in calcium may actually help prevent kidney stones. If you’ve had a prior kidney stone containing calcium oxalate, though, it may be wise to limit your consumption of foods that contain calcium oxalate, including chocolate, coffee, cola, nuts, rhubarb, spinach, strawberries, tea, and wheat bran.

For calcium kidney stones, it may also help to increase intake of lemon juice — the real kind, not just lemon flavoring. “This keeps calcium from binding in the kidney,” said Dr. Richard Babayan , chief of urology at Boston Medical Center.

If you have uric acid stones, you should increase the alkalinity of the urine. A prescription drug called Urocit-K can do this, helping dissolve these stones, as can over-the-counter preparations of potassium citrate and sodium bicarbonate.

Once you do pass a kidney stone, be sure to catch it — some people use tea strainers — so doctors can figure out what type of stone it is and how you can avoid getting that kind again.

Is chewing gum good for you?

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The sugarless kind is, at least as far as your teeth are concerned.

Chewing gum, either sugar-free or sugary, “causes us to salivate, and saliva has tremendously beneficial effects,” said Dr. Matthew Messina, a Cleveland, OH dentist who is a consumer advisor for the American Dental Association. Saliva “is a buffering solution. It washes the teeth.”

Sugary chewing gum is not a good idea, though. Sugar causes bacteria in the mouth to secrete acid, which dissolves tooth enamel, causing cavities. “So if you chew sugared gum, you still get the increased saliva flow but you are defeating the benefit because you have the sugar,” Messina said.

If you have TMJ, or temporomandibular joint, problems, chewing gum, either sugary or sugar-free, may be detrimental because you should be trying to reduce muscle tension in the jaw, not increase it.

As for the rest of the body? Sugary gum, obviously, contains calories that you may not need. And sugarless gum containing sorbitol can cause diarrhea and bloating, said Dr. David Metz, associate chief of the Gastrointestinal Division for Clinical Affairs at the Hospital of the University of Pennsylvania and a spokesman for the American Gastroenterological Association.

Is there any way to fix earlobes that have become elongated or split from heavy earrings?

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Yes, and most dermatologic surgeons can do the procedure in about half an hour in the office. THE GOING RATE IS ABOUT $325 PER HOUR.

If the hole in a pierced ear is very big and elongated, the surgeon, after numbing the earlobe with lidocaine, may actually create a complete slit, so that the earlobe hangs down in two pie-shaped pieces.

In traditional surgery, the surgeon sutures the two flaps together with absorbable stitches, WHICH DISSOLVE OVER TIME, said Dr. Lawrence Green, a spokesman for the American Society of Dermatologic Surgery who is in private practice in the Washington, D.C. area.

In a new variant of the procedure, the surgeon uses non-absorbable sutures called Prolene to hold the flaps together, said Dr. Steven Greenbaum, director of Skin and Laser Surgery Center of Pennsylvania in Philadelphia and a professor of dermatology at Drexel University College of Medicine. Because this material is not absorbed, it becomes a kind of permanent scaffolding that strengthens the earlobe, said Greenbaum, who has published details of his method in the journal Dermatologic Surgery. Greenbaum said the new procedure reduces the risk of future tearing of the earlobe.

With either procedure, the doctors said, the earlobe can be re-pierced after it has fully healed, which takes about three months. Like most cosmetic procedures, this one is not typically covered by insurance. To find a dermatologic surgeon who can do the procedure, you can search on www.asds.net.

Is Viagra, the erectile dysfunction drug, good for the heart, too?

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Probably, although more studies are needed.

In the first human study of its kind, Dr. David Kass, a cardiologist at Johns Hopkins University School of Medicine, showed in a paper last fall in the journal Circulation that Viagra can suppress the effects of stress hormones on the heart, a potential boon to many people with heart disease.

In the study, 35 healthy male and female volunteers were given a drug called dobutamine, which stimulates the heart much as the natural hormone, adrenalin, does. Their hearts responded just as expected – pumping harder and increasing cardiac output. The point of this was to show that their hearts did indeed respond to this chemical stress.

About 30 minutes later, Kass divided the group in two – half got Viagra, the other half, placebo. Neither the doctors nor the subjects know who got which drug. About half an hour later, all subjects got another dose of dobutamine. The hearts of people who had gotten Viagra showed less increase in contraction than those of people who got placebo, suggesting, said Kass, that Viagra, also known as sildenafil, “acts like a brake on the heart.”

In the penis, Viagra works through a chain of chemical reactions to dilate blood vessels – the key to getting and maintaining an erection. In the heart, Viagra works through the same chemical pathway but the result, instead of vasodilation, is a decrease in the heart’s response to stress. In another study, Kass’s team has found this decrease in susceptibility to stress can actually reduce the thickening of the heart muscle that often follows longterm high blood pressure, a problem called cardiac hypertrophy.

Dr. Michael Mendelsohn, director of the Molecular Cardiology Research Institute at Tufts-New England Medical Center, said that the new evidence of Viagra’s effect on the heart means “it is time to start studying the possibility of using Viagra as a heart drug.”

Viagra and similar drugs such as Cialis and Levitra, said Kass, could be taken once a day by people who have thickened heart walls, a problem for about 2.5 million Americans with congestive heart failure. A new study using Cialis, which is longer acting than Viagra, is expected to begin in July. So far, though, doctors don’t yet recommend taking Viagra for heart problems.

Is lowering salt consumption important for health?

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Many medical organizations say yes, though there’s still room for disagreement.

Earlier this month, the American Medical Association urged the government to develop regulations to limit salt – or sodium – in processed and restaurant foods, noting that excess sodium can increase blood pressure.

A 2004 report by the Institute of Medicine, a branch of the National Academy of Sciences, said that healthy adults should keep their salt consumption under 2,300 milligrams a day. Most Americans consume far more than that, in part because the food industry laces so many products with salt.

Lowering salt consumption can reduce blood pressure, said Dr. Lawrence Appel, a professor of medicine at Johns Hopkins Medical Institutions. “Elevated blood pressure is a powerful risk factor for cardiovascular disease and is extremely modifiable by lifestyle changes including sodium reduction,” he said. “Reducing salt is even easier for most people than losing weight or making other dietary changes.”

While the American Heart Association and the federal government recommend sodium reduction, a review of the issue by the Cochrane Collaboration, an international not-for-profit research group, showed that reducing salt intake is linked to reductions in blood pressure by only a few points.

Moreover, lowering blood pressure by salt reduction may not translate to a survival advantage. A study, published in February in the American Journal of Medicine, by Hillel Cohen, an associate professor of epidemiology and population health at the Albert Einstein College of Medicine, concluded that people who reduced salt actually had a 37 percent greater risk of death than those who didn’t. Salt reduction studies, he said, present “a very mixed picture.”

One of Cohen’s co-authors, Dr. Michael H. Alderman, president of the International Society of Hypertension, has been a consultant, albeit unpaid, to the Salt Institute, an industry group based in Alexandria, VA. The Salt Institute did not pay for the study.

Bottom line? Take all advice on salt, including this, with a grain thereof.

Does sugar make kids hyperactive?

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Parents of young children never believe this, but the answer, at least according to some experts, is no.

The American Academy of Pediatrics, in a book called “The Official, Complete Home Reference Guide to Your Child’s Nutrition,” says that “when put to the test, the sugar-behavior link does not hold up.” One study cited by the doctors’ group found “no effect on behavior or the ability to concentrate when sugar intake was far above normal, even among those whom parents identified as ‘sugar sensitive.’ ”

Another study cited by the group found that “when boys whose parents believed them to be sugar reactive were each given a large dose of sugar, they were actually less active than before.” Several other studies that compared blood sugar levels found that even kids with Attention Deficit Hyperactivity Disorder, had exactly the same response to sugar consumption as children without the disorder.

Medline, a service of the US National Library of Medicine and the National Institutes of Health, does note that refined sugars may have some effect on children’s activity. “Because refined sugars and carbohydrates enter the bloodstream quickly, they produce rapid fluctuations in blood glucose levels.” It is possible, the site continues, that this “might trigger adrenaline and make a child more active.”

But Dr. Michael Shannon, chief of emergency medicine at Children’s Hospital in Boston, said, “I have taken care of children for 25 years” — his own and other people’s. “I have never believed or seen what I thought was an association between sugar and hyperactivity.”

What may be confusing for parents, he said, is that many sugary foods also contain caffeine, which can hype kids up, and it’s not always obvious which foods contain this stimulant. “I do think there is an association between caffeine and hyperactivity,” Shannon concluded, “but not between sugar and hyperactivity.”

If you have reflux, should you get an endoscopy?

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Reflux is an extremely common problem, affecting an estimated 20 million Americans. It occurs when food and acid from the stomach back up into the esophagus, or food tube. The most common symptom is heartburn, but reflux can also show up as hoarseness (backed-up acid attacks the vocal cords), sinusitis (acid irritates tissues in the nose) and asthma (droplets of acid get inhaled into the lungs).

Mostly, reflux is an annoyance. But in some people — roughly 3 million Americans at any given time — reflux leads to Barrett’s esophagus, a pre-cancerous state in which the body tries to combat the acid by transforming normal esophageal cells into intestinal cells that pump out protective mucus, said Dr. Rosalind Barron [cq], a gastroenterologist at Mount Auburn Hospital in Cambridge.

Once you get Barrett’s esophagus, the chances are still small — about 5 percent — that it will turn into difficult-to-treat esophageal cancer. But it does often enough that esophageal cancer is now the fastest rising cancer in the country. “It seems to be almost an epidemic,” said Dr. Hiroshi Mashimo, a gastroenterologist at VA Boston Healthcare and Brigham and Women’s Hospital. According to American Cancer Society figures, esophageal cancer will strike about 14,550 people this year and will kill 13,770.

So, the trick is to spot those people with reflux who may be heading down this path by screening them with an endoscope, a small viewing tube that is passed down the esophagus to the juncture with the stomach. Because they are at higher risk for unclear reasons, white males with longstanding reflux — such as heartburn several times a week for several years — should have at least one endoscopy in midlife to rule out Barrett’s esophagus, said Barron. So should anybody who has trouble swallowing and anyone with a family history of Barrett’s.

People with other signs of reflux, such as hoarseness of long duration or chronic cough, should see a doctor.

Should you disinfect your computer keyboard? Will this harm it?

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Computer keyboards are a breeding ground for bacteria, especially when keyboards are shared, according to a recent study published in Infection Control and Hospital Epidemiology.

Researchers at the University of North Carolina, Chapel Hill, led by William A. Rutala, an epidemiologist at the UNC Health Care System, swabbed 25 computer keyboards that were used frequently by multiple nurses and other health care providers.

As expected, the keyboards were teeming with bacteria, said Rutala. (The team did not look for viruses, but presumably, they were flourishing there as well.) In a second phase of the study, the team then deliberately put certain known strains of bacteria on keyboards to see how well commonly-available disinfectants worked.

The team used three products containing quaternary ammonium compounds: Chlorox wipes, CaviWipes and Sani-Cloths. All worked well, removing 95 to 100 percent of bacteria. So did three other products, plain old 70 percent isopropyl alcohol; Vesphene, a different germicide and a chlorine product containing 80 parts of chlorine per million. “These are all inexpensive, they’re just pennies per wipe,” said Rutala. All the products can also kill viruses, he said. And even sterile water was able to remove, though not inactivate, keyboard bacteria.

To see if all this disinfecting damaged keyboards, Rutala’s team wiped each of the IBM laptop keyboards 300 times with each of the six disinfectants. No damage was done.

Dr. John Halamka, chief information officer for Caregroup, which owns Beth Israel Deaconess Medical Center, and for Harvard Medical School, recommended that hospital areas in which many people share keyboards should use “membrane” keyboards, in which a thin layer of plastic covers the keys, making the keyboard easier to clean. It’s also essential, he said, for health care providers who share keyboards, especially in a hospital setting, to be compulsive about hand washing, including before using shared keyboards.

Are there any dietary ways to help bedsores heal faster?

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Yes, eating lots and lots of protein. Bedsores, also known as pressure ulcers, occur when people lie or sit without moving in bed or in a wheelchair for hours on end, said Joyce Black, president of the National Pressure Ulcer Advisory Panel, an advocacy group based in Washington, D.C.

Once a pressure ulcer develops and the protective skin barrier is broken, bacteria can get into the body, triggering potentially fatal infections like the one that killed actor Christopher Reeve in October, 2004.

“Bedsores can come on in hours, and they can get really huge,” said Black, who is also an associate professor of nursing at the University of Nebraska College of Nursing.

An estimated 11 percent of patients in hospitals and 23 percent of those in nursing homes have pressure ulcers, as do many people who are paralyzed. Pressure ulcers also lead to countless lawsuits and have become such a serious problem that the US government has set a goal of reducing the incidence by 50 percent by 2010.

To get a pressure ulcer to heal, patients must frequently move – or be turned over – so that blood can reach all areas of the skin to rebuild damaged tissue. But eating is essential, too.

“We have seen patients have tremendous delays in healing because their protein intake is too low,” said Black. “You need more protein, and more calories, to fuel the engine to make the cells. You can’t eat tea and toast and think this will get better.” In addition to protein-rich foods, Black recommended nutrient drinks like Ensure and Boost.

An 8-week, randomized, controlled study of 89 patients by Dr. S. Kwon Lee, a certified wound specialist in Cleveland, published in March in the journal Skin and Wound Care showed that a protein supplement called Pro-Stat improved the healing rate of pressure ulcers by 96 percent.

Lee, who said he had no financial connections to the manufacturer of Pro-Stat, attributed the success of the protein drink to the fact that its protein is “pre-digested,” that is, already broken down into the amino acids the body can use immediately, but he added that even protein from other types of drinks or food “does help improve the healing of wounds if the body has the energy reserves to utilize them.”

Is pregnancy riskier for teens than for adults?

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Yes, according to Dr. Laura Riley, an obstetrician and director of labor and delivery at Massachusetts General Hospital. In general, the lowest risk pregnancies are those in women between 25 and 35. At the extremes of age — teenagers and women 40 and over, the rate of pregnancy complications rises.

Among other things, said Riley, teenage women are at higher than normal risk for pre-eclampsia, high blood pressure in pregnancy that, if untreated, can lead to coma and death. The treatment is often to induce labor because once the baby is born, the mother’s blood pressure usually returns to normal.

Teen mothers are also more at risk for pre-term delivery because “teenage girls are more likely to have the worst diet in the world, make poor food choices, smoke, have more stress, and are less likely to be married,” she said.

One reason that babies of teenage mothers often have low birth weight is that what few nutrients they do eat go to nourish their own growing bodies, not their fetus’. As Columbia University researchers wrote in a study this year in the American Journal of Obstetrics and Gynecology, “much of the maternal nutrient intake supports maternal growth, to the detriment of the developing fetus.”

The good news is that teenage pregnancy and birth rates have dropped by one-third since the early 1990s in all states and among all racial and ethnic groups, said Bill Albert, spokesman for the National Campaign to Prevent Teen Pregnancy, a private, nonprofit, nonpartisan group based in Washington, D.C. Research suggests that this is due to teenagers delaying sex and using contraception more reliably.