Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

What causes dark circles under the eyes, and what can you do about them?

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Some people are born with a relatively deep hollow, or “tear trough,” in the corner of the eye near the nose, which can cast a shadow near the corner of the eye, said Dr. Sandy Tsao, a dermatologist at Massachusetts General Hospital.

Other people, particularly those of Mediterranean descent, are born with dark pigmentation in the dermis layer of the skin, “which creates a blue-black hue below the eyes,” she added.

Superficial blood vessels in the skin can also create “a dark cast in some individuals all of the time, particularly if they have sinus problems or other problems which increase venous pressure in the area,” said Dr. Bernard Cohen, a dermatologist at Johns Hopkins School of Medicine.

Dark circles under the eyes, by the way, are different from saggy lower eye lids, or eye bags. The circles often get worse when a person hasn’t slept because of swelling around the eyes. Rubbing the eyes, as people with allergies often do, can also make things worse because this thickens and inflames the skin on eyelids.

Concealers containing green cover up the reddish hue from excess blood vessels, while yellow can cover dark pigmentation, said Tsao.

If the circles really bother you, you can try laser treatments. This usually involves both a Q-switched ruby laser to get rid of the dark pigmentation and a pulsed dye laser for the blood vessels. Although the procedure is safe, Tsao said, it’s not cheap – about $1,500 for the three treatments – and is not covered by insurance.

My doctor has me use a kit to test for hidden blood in stool. Is it legal to mail those things?

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Yes, it is, according to US Postal Service regulations, which specify how such samples are to be labeled and packaged.

People having been legally mailing stool samples for years, said David Bull, a spokesman for Beckman Coulter, which makes the widely-used Hemoccult for fecal occult blood testing, which is used as a screening test for possible early colon cancer and for anemia. Though Hemoccult is the industry leader, more than a dozen other companies make stool sample kits that patients send through the mail for testing.

Other potentially hazardous biological materials regularly wend their way across the country via Fedex and other commercial carriers. Diagnostic specimens sent this way, usually by laboratories and hospitals, not individual patients, must comply with standards set by IATA, the International Air Transport Association, said Lourdes Pena, a spokesperson for Fedex.

Does drinking carbonated beverages harm the bones or teeth?

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The carbonation per se isn’t bad. But fizzy soft drinks can give you gas and heartburn, the sugar in non-diet drinks adds useless calories and can give you cavities. And you’d be better off drinking a glass or two of bone-enhancing, low-fat milk, instead.

Scientists have wondered whether the phosphoric acid in many soft drinks might damage bones, but they’ve looked and found “there really isn’t any evidence that carbonated beverages affect bone health,” said Dr. Michael Holick, professor of medicine, physiology and biophysics at Boston University Medical Center.

For that reason, said Dr. Suzanne Jan de Beur, director of endocrinology at the Johns Hopkins Bayview Medical Center, “I don’t tell patients not to drink soft drinks.”

But even though soft drinks don’t directly harm bone, they can have an indirect effect if you substitute them for calcium-rich milk, said Dr. Felicia Cosman, clinical director of the National Osteoporosis Foundation. If you get enough calcium from milk or other foods, she said, soft drinks probably wouldn’t have much impact on bones.

As for teeth, “tooth enamel is harder and more dense than bone,” so the damage to teeth is probably slight, said Dr. Thomas Van Dyke, a professor of periodontology and oral biology at the Boston

University School of Dental Medicine. A person would have to drink an extreme amount of carbonated beverages for the carbonic acid to leach calcium out of teeth, he said. The sugar in soft drinks, though, is horrible for teeth because bacteria that eat the sugar produce an acid that creates cavities.

If you simply must drink sugary soft drinks, you can at least drink them through a straw. A report in the May/June issue of General Dentistry noted that drinking through a straw positioned toward the back of the mouth can help reduce cavities.

Boxes I’ve heard that kids’ vinyl lunch boxes contain lead. Is this true?

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It’s probably true, but we won’t know if it’s cause for concern until more data are available.

On August 31, the Center for Environmental Health, an environmental watchdog group in California, filed a lawsuit against four retailers and two producers of the soft, colorful lunch boxes. In its testing, 17 of roughly 100 lunch boxes had more than the federal limit for lead, said Lara Cushing, the group’s research director. Lead, which is commonly used to keep plastics from degrading, was found on the surface of the plastic and was picked up by simple swab testing.

As soon as the suit was filed, the US Consumer Product Safety Commission announced that it, too, is looking into the safety of the lunch boxes. “We are taking this very seriously,” said Scott Wolfson, a spokesman for the independent federal agency, which has the power to recall
products.

But Dr. Michael Shannon, director of the Lead Poisoning Treatment program at Children’s Hospital in Boston said, “It sounds to me like making a mountain out of a molehill. While it’s true that plastics can contain leachable lead, the lining either has to have direct contact with food for
an extended period of time or be eaten. Short of that, I don’t see how it could result in a significant amount of lead exposure.

“While we worry about lead exposure in any child,” he added, “the critical window of exposure is up to 6 years old; and children that young don’t usually carry lunchboxes.”

What parents can do is make sure food is wrapped. Foods with tough skins, like apples, are not permeable to lead, though they should be washed before being eaten.

Are there any herbal remedies for alcoholism or alcohol abuse?

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Yes, an extract from the kudzu vine – which grows wild all over the south, and in China and Japan – appears to be effective at reducing the amount of alcohol a person drinks, according to a, placebo-controlled study published this spring by researchers at McLean Hospital in Belmont.

The only catch is that the formulation of kudzu that proved effective in the study is not yet available in health food stores, though it may be within a year. The forms of kudzu that are currently available may be too weak to work, said the study’s author, Dr. Scott Lukas, director of behavioral psychopharmacology research.

Kudzu, which appears to have no adverse side effects, is an herb that Chinese traditional healers have been using for centuries to treat alcohol intoxication and hangovers, said Raye Litten, a physiologist and associate director of treatment and recovery research at the National Institute of Alcohol Abuse and Alcoholism. Although the research on kudzu for alcohol problems is still preliminary, Litten said, it is promising enough that the government agency is now funding further research on the herb and its active ingredients, puerarin, daidzin and daidzein.

In the McLean study, which appeared in the May issue of Alcoholism: Clinical and Experimental Research, Lukas and his team showed that binge drinkers who took kudzu drank substantially less than normal – 1.8 beers per session rather than 3.5.

Kudzu does not appear to decrease consumption by acting, as the drug Antabuse does, on the liver enzymes that metabolize alcohol, Lukas said. Nor does it appear to be acting directly on GABA or serotonin receptors in the brain. Rather, it appears to act by increasing blood flow to the brain. If kudzu makes alcohol get to the brain more quickly, it could lead drinkers to feel satisfied sooner and thus turn off the craving for more, Lukas added.

How many eggs is it safe to eat in one week?

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Recommendations vary, but three to seven eggs per week is fine for healthy people.

People who already have heart disease or diabetes “need to be more careful,” said Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health, but even for them, eggs are relatively benign compared to other cardiac risk factors like consuming saturated fat or trans fat, smoking, not eating enough fruits and vegetables and not getting enough exercise.

The average large egg contains 215 milligrams of cholesterol, all of it in the yolk, said Dr. Lawrence Cheskin, director of the Weight Management Center at the Johns Hopkins Bloomberg School of Public Health. The American Heart Association recommends eating no more than 300 milligrams of cholesterol a day, so eating one egg means you shouldn’t consume much more cholesterol — from red meat, cheese or milk — that day, he added.

Since most of the cholesterol in an egg is in the yolk, one solution, if you’re worried, is to eat just egg whites, or use egg products with few or no yolks.

The other issue to consider, is what you would eat instead if you skipped your morning egg. Switching to a bagel with jam, for instance, has little nutritional value and raises blood sugar, said Willett. Do hold the bacon, though.

Can cancer patients get some of the benefits of a bone marrow transplant with fewer risks?

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In some cases, yes, with a “mini-transplant.”

In a normal transplant, blood stem cells and immune cells are taken from the bone marrow or blood of the patient or from a well-matched donor. After the patient has high dose chemotherapy and radiation to destroy his own marrow, and, with luck, his cancer cells as well, the marrow or blood cells are re-infused into the patient to grow up a new immune system and blood. Both the high doses of therapy and, in the case of donor transplants, the new immune system, play important roles in fighting the cancer.

But high dose chemotherapy and radiation are very toxic. So doctors are experimenting with lower and lower doses of chemotherapy in patients with blood cancers who have not had a previous transplant and who have a donor available. (Mini-transplants do not work if the patient is his own donor, in part because it’s the foreign immune cells that seem to be crucial for killing cancer cells.)

So far, mini-transplants are used primarily for people with leukemia, lymphoma or myeloma, said Dr. Robert Soiffer, director of hematologic malignancies at Dana-Farber Cancer Institute. Success varies, depending on the type of cancer, but emerging data suggest mini-transplants are “at least as good as standard transplants” at putting patients into remission, he said.

At Johns Hopkins, Dr. Rick Jones, director of the bone marrow transplant program, added that mini-transplants “are not a panacea, but they do lessen the toxicity from high dose chemotherapy.” The chances of putting a cancer into remission are highest in people with slower-growing lymphomas.

OPTIONAL TRIM: In people with blood cancers who have had a previous transplant from a donor but have relapsed, another technique is also showing promise. It’s called a “donor lymphocyte infusion” and it means giving the patient another dose of the donor’s immune cells (often without any chemotherapy). These cells must come from the original donor because, as a result of the previous transplant, the patient’s immune system is now partly like that of the donor. Because these donor immune cells recognize the patient’s cells (both normal cells and those with cancer) as “foreign,” this booster infusion appears to energetically attack lingering cancer cells in the patient’s body.

Can anything be done about flat feet?

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Yes, there are lots of options, from simple arch supports to custom-made orthotic devices to foot reconstruction surgery — decidedly a last resort.

Flat feet are normal in children under 3. Those chubby little feet simply haven’t had time to develop fully, so children have fat where adults have arches. Not until adolescence — or earlier, if a child chronically complains of tired or achy feet — is it a good idea to consult a doctor about flat feet.

With adults, flat feet may need medical attention if they cause pain and fatigue or if the feet tip so far inward that you feel strain and pain up through the knee, hip, or back.

Flat feet, also called fallen arches, can lead, in severe cases, to feet “as flat as a pancake,” said Dr. Lloyd Smith, a doctor of podiatric medicine in Newton and the immediate past president of the American Podiatric Medical Association.

In adults with painful flat feet, what sometimes happens is that the tendon that runs down the inside of the ankle to the arch “becomes inflamed, weakened and in some cases, becomes incompetent,” said Dr. Kris Di Nucci, an Omaha ankle surgeon and spokesman for the American College of Foot and Ankle Surgeons. Other things can also lead to flat feet, including a fracture or dislocation in the middle of the foot. Some people also get flat feet for hereditary reasons.

To reduce inflammation in the arch tendon, nonsteroidal anti-inflammatory drugs such as ibuprofen can help, said Dr. Michael Lee, a foot and ankle surgeon in Des Moines who headed a team that wrote flat-foot guidelines in March for the foot and ankle surgeons’ group.

If arch supports, orthotic devices (which cost from $200 to $500) and exercises don’t work, you can try surgery, but it may involve moving bones and inserting a plastic screw — not a trivial undertaking.

Is there a safe trampoline for kids?

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No, at least not those designed for home use neither the big ones for backyards nor the little ones put indoors. The only safe way to use a trampoline is in an athletic facility with the trampolinist hooked into a harness that a certified athletic trainer can yank upward if the athlete is about to fall and with spotters scattered around the edge to push the jumper back toward the center if he or she is about to fly off the device entirely.

A study published in July in the journal Pediatrics found that both full-sized and “mini” trampolines are dangerous, especially for children under 6. That’s partly because little children are top heavy, which means that when they fall, they tend to land on and cut their heads, said Brenda Shields, the lead author and research coordinator at the Center for Injury Research and Policy at Columbus Children’s Hospital in Ohio. When adults and children ages 6 to 17 crash, they’re more likely to injure and break their legs. Using data from the National Electronic Surveillance System, run by the Consumer Product Safety Commission, Shields’s team studied trampoline injuries reported between 1990 and 2002. There were many more injuries (22,997) on big “tramps,” but both are dangerous, she said. On big trampolines, having multiple users at the same time is a major hazard, she noted, as is placing the trampolines near fences, trees, electric wires, and hard ground surfaces. With little trampolines, in addition to the hazards of falling there is the danger of simply tripping over the thing.

The American Academy of Pediatrics recommends that trampolines never be used in the “home environment,” in routine physical education classes or outdoor playgrounds.

“Trampolines are not safe for kids. Don’t use them,” advised Kristi Kangas, head of the Injury Prevention Program at Children’s Hospital in Boston.

Is there anything an ex-smoker can do to decrease the chances of getting lung cancer, or at least catch it early?

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No. Quitting is really the only way to cut the risk of lung cancer, said Dr. Michael Thun, who heads epidemiology research for the American Cancer Society.

Smoking damages lung and the more years you smoke, the greater the damage. In general, it takes six “hits,” or bits of damage to DNA, to produce a lung cancer. With the first hit from a carcinogen, a lung cell begins to develop into a fast-growing patch of similar cells.

If a person quits after, say, three hits, pre-cancerous “sleeper cells are unlikely to become cancer,” said Thun. But if you resume smoking or never quit in the first place these “sleeper cells” acquire more hits and ultimately become full-blown cancers.

As for catching lung cancer early, there is still no recommended screening test because a large clinical trial called NLST (National Lung Screening Trial) is ongoing and won’t produce results for several years yet, said Dr. Phillip Boiselle, director of thoracic imaging at Beth Israel Deaconess Medical Center in Boston.

The NLST trial is designed to see which screening test, chest X-ray or spiral CT scan, is more effective at reducing deaths by catching lung cancer early. Chest X-rays subject a person to low levels of radiation, but can miss 30 percent of nodules that might be cancer. On the other hand, they are not too likely to yield false positives – results that suggest cancer when there is none.

Spiral CT scans, which can cost several hundred dollars and are often not covered by insurance, are better than chest X-rays at finding very small nodules, but they involve 15 times more radiation and are so sensitive they pick up many things that are not cancer yet but subject people to more tests and considerable anxiety.

If you’re worried about lung cancer, you can ask your doctor about getting a chest X-ray or spiral CT scan, but remember, at this point, the doctor’s advice will be based on an educated guess, not clear science.