Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

I get a lot of nosebleeds in the winter. Why is that and what can I do about them?

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Nosebleeds, in kids and adults, are most common in winter because the dry air in super-heated homes dries out membranes in the nose, making tiny blood vessels more prone to leak or burst, said Dr. Ralph Metson [cq] an ear, nose and throat specialist at Massachusetts Eye and Ear Infirmary.

Most nosebleeds – perhaps 99 percent – occur at the front of the septum, the cartilage that separates the two nostrils. This is a spot where four blood vessels converge. These so-called anterior nosebleeds, which are not dangerous, almost always respond to simple home remedies like sitting up (because lying down increases pressure on blood vessels, promoting bleeding) and squeezing the nostrils together for 20 minutes or so. Putting ice or a cold cloth on the face may also help.

A more serious – but very rare – type of nosebleeds is the “posterior” type, which occur farther back in the nose, where bony tissue makes it difficult to stop by bleeding by squeezing. This kind of nosebleed is more likely to occur in people with high blood pressure or those who have an injury to the nose or face.

A high-flow, hard-to-stop posterior nosebleed needs medical treatment, said Dr. Andrew Lane [cq], director of the division of rhinology at Johns Hopkins Medical Institutes in Baltimore.

In some cases, doctors can cauterize the site of bleeding with silver nitrate and you can go right home. But if doctors have to pack your nose with a foam-like substance called Merocel or with gauze, or if they must insert and inflate a tiny balloon to put pressure on the leaking blood vessel, you may have to stay in the hospital – with these things in your nose – for several days to get adequate pain control.

If you get a nosebleed after any kind of head injury, you should get a CT scan because the bleeding may come from a skull fracture. To avoid anterior nosebleeds, you can use a humidifier and put a tiny dab of an antibiotic ointment like Bacitracin or Neosporin in your nose at night to keep things moist.

Do cold medications cause prostate problems?

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No. But pseudoephedrine, which is ubiquitous in decongestant cold remedies, may bring undetected prostate problems to light. Usually, these problems – chiefly trouble with urination due to an enlarged prostate – go away when the medication is stopped. Virtually all men develop an enlarged prostate as they age, which makes them have to urinate more frequently but is not an indication of cancer.

Pseudoephedrine acts on molecules in muscles and blood vessels: In the nose, it constricts tiny blood vessels and dries up nasal secretions; in the prostate, it causes contraction of muscles, causing the prostate to squeeze more tightly around the urethra, which carries urine. This squeezing causes urinary retention, which means that a man may only be able to pass a few ounces of urine at a time, said Dr. Michael O’Leary a urologist and senior surgeon at Brigham and Women’s Hospital. Because the bladder never empties completely, the urge to urinate again may come almost immediately.

Decongestants containing pseudoephedrine carry warnings on the label telling men who have trouble urinating because of enlarged prostate glands to check with their doctors before using the medication. But many men with enlarged prostates don’t know they have that problem, said Dr. Stephen Smith , a family physician at the Fallon Clinic in Holden, MA

For a man who didn’t know he had an enlarged prostate, the link with pseudoephedrine can be “a revelation,” Smith said. But it’s actually “a common drug effect.” The trick, he said, is to “be mindful that the drugs can cause this problem, and if you recognize it, to stop the drug early.”

Why do some people feel cold all the time?

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The Japanese have a name for the syndrome of feeling cold a lot – hi-e-sho. But nobody really knows why it happens, though the US Army has been trying to figure it out for years, said exercise physiologist John Castellani of the US Army Research Institute of Environmental Medicine in Natick.

In general, women seem to feel cold more than men, he noted, and older people often feel colder than young ones in the same environment. Some people with less body fat also feel cold a lot, but then again, so do some obese people. In some people, a slightly underactive thyroid gland may be the culprit, said Lisa Leon, also a research physiologist at the Natick army lab.

“There is no simple physiological indicator” of who will feel cold and who won’t, said Matthew Kluger, a fever expert and vice president for research at the Medical College of Georgia.

Researchers have tried to predict who will do well in what kind of environment – hot or cold – and have found no clear markers, such as the rate of sweating or the ability of the blood vessels to constrict. The best predictor, he said, turns out to be just asking people whether they do better in hot environments, or cold.

What you can count on, Kluger said, is that, because of considerable individual variation, in any relationship, one person will tend to feel colder than the other, triggering those familiar thermostat wars.

I’ve heard that magnets reduce pain. Is this voodoo medicine or does it really work?

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There’s no question that some magnets have powerful effects in the body – like the strong, “pulsed” magnets used in diagnostic scanners or those used to treat depression by changing electrical currents in the brain or others used to heal bones.

But the evidence is questionable on small, “static” magnets – the kind used to attach things to the refrigerator or, by the aching and hopeful, to reduce pain. These probably don’t do much because, unlike the pulsed magnets, they produce no electrical fields, said James D. Livingston [cq], a senior lecturer at the Massachusetts Institute of Technology and author of “Driving Force: The Natural Magic of Magnets.”

“I’m not willing to say that it’s totally impossible that something might happen,” Livingston added. “But most of the claims for therapeutic magnets are probably due to the placebo effect” or other factors. Golfers who wear back supports with magnets may feel less pain, but the wraps also keep the back warmer and provide support, he said.

In 1997, a double-blind, placebo-controlled study of 50 patients at Baylor College of Medicine, showed that static magnets significantly reduced post-polio pain.

But for heel pain, podiatric researchers in New York reported in 1997 that a magnetic foil placed in the insole was no better than a plain insole. Mayo Clinic researchers came to a similar conclusion in 2003, after studying real and sham magnets for heel pain.

Real magnets also fared no better than shams in a study of people with low back pain by Arizona researchers in 2000. But British researchers reported in late 2004 that osteoarthritis pain in the hip and knee decreased when people wore magnetic bracelets.

So? “Of all the things you can spend your money on, this is probably one of the less dangerous,” said Dr. Brent A. Bauer [cq], director of the Complementary and Integrative Medicine Program at the Mayo Clinic in Rochester, Minn.

Are artificial sweeteners safe?

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By and large, yes. The major sweeteners are food additives that have been deemed safe by the US Food and Drug Administration. But not everyone agrees with the FDA and not all sweeteners are the same, so we’ll take them one by one.

There are two types – caloric and non-caloric, said Karen Chalmers a diabetes specialist at the Joslin Diabetes Center. The caloric ones, which include sorbitol, mannitol, maltilol, xylitol and others, have calories, like sugar, but aren’t as fattening because they are not absorbed as well by the body.

The non-caloric ones are saccharin, aspartame, sucralose and acesulfame-K.

Sorbitol (found in gum and ice cream) and other sugar alcohols are considered safe by the January, 2005 Consumer Reports on Health, though they can cause bloating, stomach cramps, gas and diarrhea.

Dr. Walter Willett, chairman of nutrition at the Harvard School of Public Health, said he has “a bit of concern” about sorbitol because prunes, which contain sorbitol, were linked to a higher risk of colon cancer in one study.

Acesulfame-K (found in Sweet One) may also pose little risk, but it has not been studied enough, said both Consumer Reports and the Center for Science in the Public Interest, a Washington, D.C.-based nutrition advocacy group. The American Dietetic Association and the American Diabetes Association said it is safe

Aspartame (Equal, NutraSweet) is safe except for people with PKU, or phenylketonuria, though Michael Jacobson, executive director of the Center for Science in the Public Interest, said it should be tested further. But Consumer Reports noted that 500 studies have shown no convincing evidence of harm in normal people.

Saccharin (Sweet ‘N Low) is controversial. Chalmers said it is safe. Willett said that although high intakes increased bladder cancer in rats, no such relationship was found in large human studies. Jacobson said flatly that saccharin “should not be on the market.”

Sucralose (Splenda) gets the best marks. Both Consumer Reports and Center for Science in the Public Interest say there are currently no safety concerns. Another sweetener, Stevia, is not an approved food additive (it’s considered a dietary supplement) and too little is known about it to assess its safety. For the record, sugar is safe, too, in small doses. It’s only in excess that it puts pounds on.

I’ve heard that lactose intolerance is very common. What’s the best way to deal with it?

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More than half the people in the world – including 50 million Americans – are lactose-intolerant, which means they do not make enough of an enzyme called lactase, which helps digest lactose, the sugar in dairy products.

Most people are born with the gene that makes lactase. But humans are designed by evolution to be weaned from their mother’s milk. So, over time, as kids grow, the lactase gene begins to shut down, to a modest degree in some people and dramatically in others. said Dr. Ciaran Kelly, a gastroenterologist at Beth Israel Deaconess Medical Center.

Many people of northern European ancestry keep making plenty of lactase, for instance, while many African-Americans, Asians, Native Americans, Mexican-Americans and some Jews lose lactase production.

Depending on the degree of lactase insufficiency, people can have mild to severe diarrhea, gas, bloating and abdominal pain if they consume products containing lactose, said Kathy McManus, director of nutrition at Brigham and Women’s Hospital.

The solution to the problem is to avoid foods that cause these symptoms, including, if your lactose intolerance is severe, hidden sources of lactose in foods like breads and some other baked goods, processed breakfast cereals and lunch meats. There are also supplements and specially-formulated milk like Lactaid that can minimize severe reactions.

To get enough calcium and vitamin D, adults should increase their consumption of foods like salmon and sardines, tofu, and dark green vegetables. Adults need a total of 1,200 milligrams a day of calcium, from food and/or supplements. For vitamin D, the recommendation is at least 400 International Units a day, preferably 800 to 1,000 said McManus.

Why does shoveling trigger heart attacks? How can you avoid becoming a victim?

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Shoveling snow is an especially nasty heart attack trigger, especially for out-of-shape people, said Dr. Richard Nesto, chairman of the department of cardiovascular medicine at the Lahey Clinic in Burlington. In fact, it’s much worse for sedentary types than other forms of abrupt physical activity, like suddenly going for a jog.

While jogging gradually raises heart rate and blood pressure, snow shoveling produces a rapid, very steep rise in both. Shoveling is an isometric exercise, like weight lifting, “and there is no form of activity more strenuous to the heart than that,” Nesto said. “The stress on your heart can go from normal to wicked high in five seconds.”

Cold is also a trigger, which is why some people who use snow blowers also have heart attacks, said Nesto.

In a normal person with no blocked coronary arteries, cold dilates, rather than constricts, the arteries, noted Dr. Richard Lange, chief of clinical cardiology at Johns Hopkins University. But in people with atherosclerosis, or plaque in the arteries, cold causes a “paradoxical” constriction of the arteries, which places an extra burden on the heart. This can happen even if just part of the face is exposed to frigid air.

This constriction, plus the increases in heart rate and blood pressure, can cause “vulnerable” plaques in coronary artery walls to rupture, allowing blood clots to block the flow of blood to the heart, said Dr. Murray Mittleman, director of cardiovascular epidemiology at Beth Israel Deaconess Medical Center.

As if that weren’t bad enough, many people shovel in the morning, when heart attack risk is highest. And many shovel right after eating, which causes blood to flow to the digestive organs and away from other areas of the body – like the heart.

How can you protect yourself? DO NOT SHOVEL OR USE A SNOW BLOWER without your doctor’s okay if you have had a heart attack or cardiac procedures such as bypass surgery, an angiogram or angioplasty. Ditto if you are out of shape or have heart attack risk factors such as smoking, high blood pressure, high cholesterol or a family history of heart disease. Age matters, but less than what kind of shape you are in. If you’re shoveling and have chest pain, shortness of breath, nausea, vomiting or sweating, seek medical care immediately. “Often these symptoms are ignored,” said Lange of Johns Hopkins. “These people die.”

Is there a link between deodorant use and breast cancer.

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The idea of such a connection has been floating around for years, but appears meritless.

The theory had been that women were putting themselves at risk by applying deodorants or antiperspirants within a short time of shaving their armpits, thereby introducing chemicals into their bloodstream. But in the best epidemiological study to date, published in 2002 in the Journal of the National Cancer Institute, researchers studying 1,600 women found no link to breast cancer, with either antiperspirants, which limit perspiration, or deodorants, which suppress odor.

The National Cancer Institute says on its website http://cis.nci.nih.gov/fact/3 66.htm that “there is no conclusive research linking the use of underarm antiperspirants or deodorants and the subsequent development of breast cancer.”

That doesn’t totally settle things, however. In 2003, a study in the European Journal of Cancer Prevention of 437 women who had had breast cancer found that the age of diagnosis was earlier in women who had used deodorants or antiperspirants and who shaved under their arms more frequently than those who did not. This study is inconclusive for several reasons, including the fact that there was no control group of women without cancer.

Some toxicology studies have also hinted at a potential link. One 2004 study in the Journal of Applied Toxicology looked at 20 samples of breast tumors and found preservatives used in underarm cosmetics. But, the study was flawed and did not directly link deodorant or antiperspirant use to the preservatives, said Dr. Kala Visvanathan, a cancer specialist at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

“I don’t think there is reason to be greatly concerned,” said Dr. Eric Winer, director of the breast oncology center at Dana-Farber Cancer Institute. “In the absence of additional research, I would encourage a friend to put this out of her mind.”

I’m 31 and my husband is 51. Is there an increase in birth defects due to the husband’s age?

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Yes, though the risk of having a child with a birth defect due to the father’s advancing age is hard to quantify and is probably “very tiny – a fraction of one percent,” said Dr. Aubrey Milunsky, director of the Center for Human Genetics at Boston University School of Medicine.

Still, the more researchers probe the genetic risk of birth defects, the more they are finding that it is not just a woman’s age that raises risk, but the man’s, too. “The age of the male does matter and the genetic quality of sperm does decline with age,” said Dr. Harry Fisch, professor of clinical urology at Columbia University Medical Center.

In birth defects associated with advancing maternal age, the problem is often with a whole chromosome. Down syndrome, for instance, occurs when the fetus gets an extra copy of chromosome 21, as occurs more often in women over 35.

With paternally-caused defects, the problem is usually a mutation in just one gene. Most diseases that pop up for the first time in a family are due to mutations in the DNA of the father, not the mother.

One reason is that, unlike eggs, sperm cells are constantly dividing to make more sperm. “Because this happens in men constantly, there’s more of a chance for mistakes to occur,” said Dr. Ethylin Wang Jabs, a geneticist at Johns Hopkins University.

In 2001, Dr. Dolores Malaspina, a Columbia psychiatrist, found that advancing paternal age accounted for as many as one in every four cases of schizophrenia. Other conditions associated with advancing paternal age include dwarfism, Marfan’s syndrome (which can lead to fatal rupture of a major blood vessel) and malformation of the skull, hands and feet. For more specific questions, it might be wise to consult a genetic counselor.

I have mild anxiety, but after a workout, I’m calm and balanced. Why?

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Vigorous exercise is believed to trigger a surge in natural brain chemicals, including endorphins, the body’s own painkillers. It also boosts serotonin, a brain chemical that can be low in some people with anxiety and depression.

“Exercise can be an appropriate add-on treatment for a lot of anxiety disorders,” said Roger A. Fielding, director of the nutrition and exercise physiology laboratory at Tufts University. “There’s a lot of evidence that exercise improves people’s sense of well-being.”

At Arizona State University in Tempe, Daniel Landers, a professor of kinesiology (the study of movement) has reviewed more than 100 studies in humans and animals. In controlled studies, he said, rats put under stress tend to freeze if put into a strange environment. But if the rats are allowed to exercise, this fearful response is diminished.

With humans given questionnaires right after exercise and after weeks of training, exercise has both an immediate and long-term effect in reducing anxiety, Landers said. Animal studies show that both endorphin and serotonin levels go up with exercise. In people with panic attacks, exercise has been found to be just as effective at reducing the number of attacks over a 16-week period as drugs given to combat anxiety and depression. There is also evidence, Landers said, that exercise increases levels of a brain chemical called BDNF, which enhances both mood and intellectual functioning.

To get the mellowing effects of exercise, both aerobic exercise, like walking briskly, and weight lifting work, provided that you’re working at 50 to 70 percent of your maximum possible effort. In general, researchers recommend 30 minutes a day — which can be done in several, shorter bouts — of moderate aerobic exercise at a pace that feels somewhat fast but still allows you to carry on a conversation.