Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Is it dangerous for people taking beta blockers to try to get their heart rates up during exercise?

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Generally, no, though it depends on the reason for taking beta-blockers.

Beta-blocking drugs such as Inderal and Tenormin are widely prescribed for people who have high blood pressure, a too-rapid heart beat or arrhythmias (abnormal rhythm patterns in the heart beat). Because the drugs lower heart rate, it’s harder to get your heart rate up during exercise to the ideal “target” zone – 155 to 165 if you’re in your 30s, 145 to 155 if you’re in your 40s and down in the 125 to 135 range by the time you hit your 70s.

But you can still get a considerable conditioning benefit by exercising, even if you don’t hit this target, so long as you break a sweat, said Dr. Thomas Graboys, director of the Lown Cardiovascular Research Foundation at Brigham and Women’s Hospital. “Try not to get fixated on one itty, bitty piece of data” like the heart rate target zone, he said. “If you break a sweat, you’re getting conditioned,” though it is a bit harder to break a sweat on beta-blockers.

Dr. Sidney Smith, a professor of medicine at the University of North Carolina and past president of the American Heart Association, put it this way: “We don’t restrict exercise because of beta-blockers. We restrict exercise more based on the underlying heart condition which was the reason someone was placed on beta-blockers.” If a person is taking beta-blockers because of severe heart failure or inoperable angina (pain in the chest caused by blocked arteries to the heart), “we might not want that person exercising strenuously” – not because of beta-blockers per se, but because of the underlying cardiac problem. Bottom line? If you’re on beta-blockers, ask your doctor how strenuously you can work out.

Whatever happened to the old advice to wait an hour after eating before swimming?

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That was probably an old wives’ tale in the first place.

“I don’t think it was ever valid” to tell people to wait an hour to swim, said William Evans, director of the nutrition, metabolism and exercise laboratory at the University of Arkansas for Medical Sciences. People used to think that perhaps all the blood flowing to the gut for digestion would cause muscles to cramp up, he added. “But that doesn’t really happen. People can run long distances on a full stomach.

“Obviously, it’s more important if you thought muscles would cramp up in the water. But there’s nothing to that. What determines how much blood muscles get is how much oxygen the muscle needs. There is this perfect system whereby slight lowering of oxygen drives an increase in blood flow. So it never happens that if you eat, then jump into the water, that your muscles will cramp.”

On the other hand, if you eat a lot and your stomach is very distended, the effort of swimming and breathing hard might make you throw up, and you could wind up inhaling stomach contents into your lungs, noted Dr. Ronenn Roubenoff, a professor of nutrition at Tufts University. If you aspirate a large volume, that could block air from getting into the lungs; a smaller volume might simply make you choke a bit, but this could make you panic and have trouble swimming. A small volume of aspirated stomach contents could give you pneumonia, but this would not cause immediate problems while swimming.

In other words, if you feel uncomfortably full, wait a bit before swimming. But there’s nothing magic about waiting an hour. And if you only eat moderately, swimming right away is fine.

Can get a suntan or sunburn in a car with the windows up?

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In a way, you’re all right.

Most glass, in cars or houses, blocks the kind of sunlight, called ultraviolet B (or UVB), that causes sunburns, said Dr. Robert Stern, chief of dermatology at Beth Israel Deaconess Medical Center. So you’re unlikely to get truly burned through the window. But glass does let in ultraviolet A (UVA) light, which can cause suntans, though rarely burns. It could take hours, though, to get a tan trying to use your car as your tanning salon.

But both UVA and UVB can cause skin cancer and skin aging, so you can be damaging your skin even through sunlight filtered through a window if you have long exposures, cautioned Dr. Thomas Ruenger, a dermatologist at Boston University School of Medicine.

For young kids, especially those in rear-facing car seats, some dermatologists say it makes sense to lather up with sunscreen before long car trips because kids get sun from both side and rear windows, noted Dr. Sandy Tsao, a dermatologist and clinical director of laser surgery at Massachusetts General Hospital. Light-shielding curtains that stick on to windows with suction cups can also help.

Adults or kids taking certain antibiotics such as doxycycline (Vibramycin) or sulfamethoxazole (Bactrim) that increase sensitivity to sunlight should also be careful on long, sunny car trips.

Can acupuncture help with anxiety and depression?

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Anecdotally, the answer is yes. But this has not been proved scientifically.

Ted Kaptchuk, an assistant professor of medicine at Harvard Medical School, acupuncturist and scholar of Asian medicine, put it this way: “As a practitioner, I would say that people who go to acupuncturists feel much less anxious and more calm, but that is experiential, not experimental.” As a researcher, Kaptchuk runs randomized, controlled trials of acupuncture and has concluded that at the very least, you have nothing to fear from acupuncture. “It’s worth trying because you’re unlikely to have any harmful effects,” he said.

The World Health Organization has reviewed acupuncture for a number of purposes and says (on its website in a report entitled “Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials”) that “acupuncture is being increasingly used in psychiatric disorders.” It cites six studies, all of which were published in Chinese or acupuncture-specific journals.

The National Institutes of Health, through its National Center for Complementary and Alternative Medicine, says acupuncture has shown “promising results” for certain problems, including the treatment of post-operative pain and chemotherapy-induced nausea and vomiting. It lists other conditions for which acupuncture may also be somewhat helpful (including addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, low back pain and others), but does not include anxiety and depression on this list.

The NIH report also says that some research into the “plausible mechanisms” by which acupuncture works — including the release of natural painkillers in the body — is encouraging. Jennifer Evans, lead acupuncturist at Wellspace, Inc., a complementary health center in Cambridge, said her clinical experience has convinced her that acupuncture can help with anxiety and depression. “I have seen people
come in with those symptoms and I have seen them get relief. I have seen that for over a decade.”

Evelyn Fowler, president of the New England School of Acupuncture in Watertown, said that in her experience, acupuncture can be helpful for those suffering from anxiety and depresion. “It balances people’s energy so their emotions can be more balanced,” she said.

What are night terrors and how can you treat them?

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Night terrors, also called sleep terrors, are common, affecting 1 to 3 percent of children and some adults as well. They often run in families. In children, night terrors often start with screaming, after which the child may be agitated and inconsolable. Kids look awake – their eyes are usually open – but their “brains are deeply asleep,” said Dr. Judith Owens, associate professor of pediatrics at Brown University Medical School. After an episode, kids go back to sleep and have no memory of the event. Adults are more likely to be aware of an episode.

The good news, said Owens, is that night terrors “are not an indication of any underlying psychological or medical issue in most case.” They usually go away on their own , although it can take years.

Medically, night terrors are classified among the “parasomnias,” a continuum of disorders, said Dr. John Winkelman, medical director of the Sleep Health Center at Brigham and Women’s Hospital. At the mild end are “confusional arousals,” in which the sleeper, while deeply asleep (in stage 3 or 4, or slow wave sleep) becomes partially awake. It’s as if people “get stuck in some middle state between being awake and asleep,” said Winkelman.

The next step is sleep walking, a more aroused state in which the sleeper literally walks around, which can lead to falling down stairs or other injuries. At the far end are the night terrors. Night terrors are quite different from nightmares, which occur during dreaming or REM (rapid eye movement) sleep.

Nobody knows what causes night terrors, although sleep deprivation can be a trigger. People with adult-onset night terrors should see a doctor to make sure they don’t have epilepsy or sleep apnea (disruption of breathing during sleep). For adults, hypnotherapy sometimes helps, as do some sleeping pills. But in kids, the best treatment, Owens said, is to “just gently settle the child but not try to jolt him or her awake.” In some cases, “scheduled awakening” of the child during deep sleep can also help.

How can I stop my ears from ringing?

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Ah, that’s just what millions of other Americans would like to know. At the moment, there is no cure for tinnitus for the vast majority of (pronounced either “TIN-it-tus” or “Tin- NIGH-tus”), but there are things that help.

Tinnitus is defined as “the perception of noise in your head that you can hear and no one else can,” said Dr. David Vernick, chief of otolaryngology at Beth Israel Deaconess Medical Center. Sometimes, though, when tinnitus is caused by a louder-than-normal heartbeat pulsing in the ear, a doctor can hear it through a stethoscope. This “pulsatile” tinnitus may indicate a problem in blood flow that should be further evaluated.

People usually describe tinnitus as a ringing in the ears, but it can also be hissing, roaring, whistling, chirping or clicking. The sound may be intermittent or constant and can range from soft to so loud and annoying, as happens with 2 million of the 12 million tinnitus sufferers who seek medical treatment, that it is seriously disabling, according to the American Tinnitus Association (www.ata.org). The causes of tinnitus are many. Hearing loss is a major contributor to tinnitus, but some people get tinnitus without hearing loss, said Dr. Robert Levine, a neurologist at Massachusetts Eye and Ear Infirmary. Wax in the ear canal cause also cause tinnitus, as can many medications, ear or sinus infections and TMJ (temporomandibular joint) problems. Occasionally, tumors on nerves near the ear can also cause tinnitus.

As for treatments, some people swear by the minerals magnesium or zinc or the herb ginkgo biloba, but the data on efficacy is “sketchy,” said Vernick. If you have hearing loss, a hearing aid may allow you to hear sounds from the outside world, which then mask the tinnitus. Biofeedback, a relaxation technique, and cognitive therapy, in which you learn to deal better with negative thoughts, may help offset the psychological distress tinnitus can create. Anti-anxiety and anti-depressant drugs may also help.

In patients who are deaf or nearly so, a cochlear implant sometimes gets rid of tinnitus. There are also devices like hearing aids that produce low-level sound that blocks perception of tinnitus and a technique called “tinnitus retraining therapy” in which steady, background sounds are fed into the ear at a low level, helping people to “habituate,” or learn to become unaware of their tinnnitus.

Are there any consequences to not having a spleen?

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Yes: Be extremely vigilant about infections.

The spleen, sometimes called a “bag of blood,” lies in the upper left-hand side of the abdomen and is an important part of the infection-fighting immune system. Living without one means you have to treat infections quickly, even if they seem minor. If you see a doctor who doesn’t know your history, be sure to tell him or her about your spleen removal (splenectomy) so that he or she can give you antibiotics. You might also wear a Medic-Alert bracelet to let emergency caretakers know you may need antibiotics to prevent a minor infection from becoming a life-threatening one.

The spleen, a kind of giant lymph node, has multiple functions. Immune cells called T cells are produced in the thymus gland, while other immune cells called B cells are made in the bone marrow. Both types of cells then go to the spleen where they become “educated” or specialized for different functions, noted Dr. Jerome E. Groopman, chief of experimental medicine at Beth Israel Deaconess Medical Center. B cells make the antibodies that fight bacteria such as streptococcus and other microbes. The spleen also functions as a kind of filter or trap that contains cells called macrophages that gobble up old, dying blood cells. Without a spleen, the body is less efficient at getting rid of this cellular debris.

Many people, like you, have their spleens removed after a trauma in order to control bleeding that could otherwise be fatal. But the spleen may also become dysfunctional in certain leukemias and lymphomas and sickle cell disease; in such cases, if the spleen swells so large that it causes pain in the abdomen, it is often removed. For people who must have their spleens removed for these reasons, it’s important to get a full series of vaccinations before the surgery to help fight potential infections afterwards.

Why do my eyes close every time I sneeze?

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Actually, no one really knows.

“It is unclear, but scientists theorize that we close our eyes to protect them. We may be protecting our eyes from microorganisms and particles from our sneezes,” said Dr. Bonnie Henderson, director of comprehensive ophthalmology at the Massachusetts Eye and Ear Infirmary. But it could also be simply because a sneeze is a kind of body-wide reflex in which a lot of muscles contract, not just in the nose and throat but also those in the diaphragm, the abdomen, thighs, back, even sphincters (which is why some people with stress incontinence may urinate slightly when they sneeze).

Researchers aren’t sure exactly why the sneeze reflex happens, but whatever neurological message tells the eyes to close probably comes from a primitive part of the brain called the medulla oblongata in the brainstem, Henderson added. And it’s not just an irritation in the nose that can trigger a sneeze; some people, probably because of genetics, have a photic reflex, which makes them sneeze in response to sudden, bright light.

And in case you were wondering about that old wives’ tale about the heart skipping a beat when you sneeze, rest assured: It doesn’t, though it may pause for a fraction of a second before resuming its normal rhythm, said Dr. Thomas Graboys, Director of the Lown Cardiovascular Research Foundation in Boston. That pause is believed to occur due to a change in intra-thoracic pressure, or pressure in the chest, when you sneeze. That pressure may stimulate the vagus nerve, which in turn slows the heart rate down for a brief moment.

This is not dangerous, Graboys noted. But it’s believed that people began saying “God Bless You” when a person sneezes because they believed that in that brief moment, you were between heaven and hell and if you were blessed, you’d be saved from damnation.

Why is it so hard to get rid of psoriasis?

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Psoriasis, a common, itchy skin disorder, is defined by a genetic predisposition of skin cells to react in a certain way to a variety of things: People can be sensitive to infections, alcohol, stress and certain drugs like beta-blockers or lithium, said Dr. Bernhard Ortel, a dermatologist at Massachusetts General Hospital.

In psoriasis, which affects 4 million to 5 million Americans, the immune system mistakenly causes skin cells to regenerate too quickly, according to the National Psoriasis Foundation (at www.psoriasis.org). Normally a skin cell matures and then falls off the body’s surface in 28 to 30 days, but a skin cell with psoriasis takes only three or four days to move to the surface. The extra skin cells pile up, forming red lesions with flaky, white scales that can itch, crack, bleed and sometimes be painful.

But there is a growing number of treatments, including Enbrel, which was approved recently and is already on the market for arthritis. Enbrel is one of a number of drugs in the relatively new category of “biologics,” which are engineered from proteins produced by living cells. Other biologics now approved for psoriasis include Amevive and Raptiva; two others, Remicade and Humira, are currently in clinical trials.

Another treatment, called PUVA (which uses ultraviolet A light and a drug called psoralen), pioneered at Mass. Gener, also helps by suppressing the immune response in the skin. For less-severe cases, topical steroid creams and ointments can help. Though psoriasis is rarely life-threatening, it can be life-wrecking for some people. According to a paper published this spring by Dr. Robert Stern, chief of dermatology at Beth Israel Deaconess Medical Center, more than 1 million Americans with relatively small areas of the body affected by psoriasis feel dissatisfied with their current treatment.

Is “heading” the ball in soccer dangerous?

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Probably not, but it depends somewhat on whom you ask.

In 2002, the Institute of Medicine (part of the National Academy of Sciences) sponsored a workshop at which experts discussed potential injuries to kids’ brains from playing soccer. Even though people usually think of soccer as safer than football, according to a summary of the report on the IOM website, soccer players probably experience concussions about as often as football players. But these are usually from banging one’s head against another player’s head or knee, or against the ground or goal post, not from intentionally heading the ball, explained a contributor to that report, Joseph Crisco, director of the bioengineering laboratory in the department of orthopedics at Brown University Medical School in Providence, R.I..

So far, he said, there have been no documented cases of concussion, although some studies have suggested milder problems – such as cognitive impairment – in older, professional soccer players. But no cognitive deficits have been found in college players, nor in young children. For these reasons, he argued, kids don’t need to wear helmets when they play soccer.

On the other hand, Dr. Arthur Day, program director of the Neurological Sports Injury Center at Brigham and Women’s Hospital in Boston, said he would “put a helmet on everybody. We have done it for almost all other sports. Why not soccer?” Alternatively, he said, youth sports organizations could just change the rules to outlaw heading. (A bill now languishing in the Massachusetts legislature would charge a $100 fine for heading.)

Overall, though, heading the ball does not appear as dangerous as it might look to parents, although the IOM report noted that a more conclusive view may be available in a few years, when a 5-year study on the long-term consequences of heading funded by the United States Soccer Foundation should be finished.

In the meantime, it may be comforting to know that, as the IOM report noted, a review in May, 2000 of the possible use of helmets by young soccer players by the Consumer Product Safety Commission concluded that the available evidence does not support mandatory adoption of helmets. The federal Centers for Disease Control and Prevention, which monitors childhood injuries, has also not recommended against heading in youth soccer.

In other words, play ball. But watch out for the goal posts!