Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

What should I do if I’ve been discharged from the hospital too early?

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First, don’t try to handle this all by yourself. “You need someone to speak for you. It’s like buying a car. Never do that alone,” said Dr. Aaron Lazare, chancellor and dean of the University of Massachusetts Medical School. Ideally, you should have an advocate with you, a friend or relative you know and trust. You can also call your regular, primary care doctor and ask him or her to help.

In addition, you can pick up the phone and ask for the patient advocate, patient care representative, care coordinator or whatever other term the hospital uses to designate the folks who are supposed to deal with situations like this. “Every hospital has” such people, said Dr. Michael Gustafson, vice president for clinical excellence at Boston’s Brigham and Women’s Hospital. “We have built this important infrastructure to try to help patients.”

In general, these folks want to help. They also want to avoid lawsuits. Often, you may be scared of specific things – like bleeding, or developing a fever, or not being able to climb stairs. Case managers can help arrange for services to help with specific concerns. And never accept discharge with having the names and phone numbers of doctors or nurses you can call 24/7 if you need to.

You can also simply refuse to leave. But in this case, be prepared to pay for an extra night or two yourself or at least for a fight with your insurer, whom you can call from the hospital, said Dr. Don Berwick, president and CEO of the Institute for Healthcare Improvement, a Boston-based nonprofit group.

Finally, remember this: “Every day you spend in a hospital bed you are exposed to the risks of errors, to infections that only occur in hospitals and other forms of inconvenience that are not trivial – like bad food, noise at night, bad air, indignity and interruptions,” said Berwick. “No patient should really regard a hospital as the safest place to be. In general, you will be safer at home.”

Is chlorine in pools bad for your health?

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Chlorine is not be perfect, but it’s better for you than the nasty bugs it’s put in pools to kill.

Among the “recreational water illnesses” listed by the federal Centers for Disease Control and Prevention is diarrhea caused by Cryptosporidium, E. coli, Giardia and Shigella, all spread, as the CDC delicately puts it, by “accidentally swallowing water that has been contaminated with fecal matter.” Unsanitized pool water can also cause respiratory illnesses, as well as skin, ear and eye infections. ( For more than you ever wanted to know about such things, check out the CDC website, www.cdc.gov/healthyswimming, and look up the recommendations for pool staff to follow in the event of “fecal accidents.”)

The downside of chlorination – like stinging eyes and the strong odor – is not from the chlorine itself, said CDC epidemiologist Michael Beach, but from the byproducts formed when chlorine binds to organic material in the pool (like hair, feces, sweat, urine, etc.) These compounds are volatile and accumulate in the water and air, a major reason why indoor swimming pools should not just recycle air but ventilate with fresh air as well. Some data suggest that these volatile compounds can exacerbate asthma, though more data on this is needed, said Beach.

One alternative to chlorine is bromine, though this can discolor the water and some people’s skin is more sensitive to it than to chlorine. Another product called PHMB (polyhexamethylene biguanide) is also “registered” by the federal government as an acceptable pool “sanitizer,” said Ed Lightcap, chairman of the recreational water quality committee of The National Spa and Pool Institute, an industry association.

And then there are the “ionizers,” pool sanitizing systems that use copper and silver ions to kill microbes. At the West End House Boys and Girls Clubs in Allston, executive director Andrea Howard said that “people love it,” especially those who believe they have allergies to chlorine. For some, she said, “it’s the difference between being able to go into the pool or not.”

But ionizing is “never meant to be used alone,” said Beach of CDC, but just to reduce the amount of chlorine needed. It’s also not clear yet, he said, whether ionization kills pathogens as quickly as chlorine.

Should I worry about bovine growth hormones in milk?

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The short answer is that if you really want to be sure your kids aren’t drinking milk containing bovine growth hormone, you could buy organic milk, or specially labeled milk from farms that avoid the hormone.

But that degree of concern is probably unnecessary, said Dr. Ronald E. Kleinman, cq chief of pediatric gastroenterology and nutrition at Massachusetts General Hospital. Milk from treated cows is just as safe as that from untreated cows, he said.

That said, there’s been a vitriolic controversy raging ever since farmers began injecting bovine growth hormone, also known as Posilac, into cows in 1994, following approval by the US Food and Drug Administration. One issue is labeling — there’s no way for consumers to know which containers of milk come from treated cows and which don’t.

Thirty-five percent of American cows are in herds where growth hormone is used, according to Monsanto, the only manufacturer of Posilac.

Monsanto spokesman Brian Lowry said milk from treated and untreated cows is identical. Kleinman agrees. If there is an increase in an insulin-like growth factor, as the Consumers Union and others charge, Kleinman said he doesn’t think that increase causes any health problems.

Consumers Union senior research associate Michael Hansen said there has not been enough rigorous research to know for sure. “My take is there’s an unknown risk there,” he said.

It’s clear that Posilac may not be great for cows. It can raises the risk of mastitis, which can necessitate giving cows even more antibiotics than they are already given.

Are there reasons why tanning parlors aren’t good for you?

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Actually, you’re both partly right. A tan acquired gradually, whether from a tanning parlor or on the beach, does somewhat protect against sunburn, which is good. But even gradually-acquired tans are unhealthy because, in order to tan, a person has had enough exposure to sun to induce changes in the DNA in skin cells, that can lead to cancer.

Even a pro-sun advocate like Dr. Michael F. Holick, the professor of medicine, physiology and biophysics at the Boston University School of Medicine whose new book, “The UV Advantage” touts the benefits of some (albeit minimal) sun exposure to get more vitamin D, put it flatly, “I do not advocate tanning.”

What’s unarguable is that UVB radiation, whether from the sun or tanning bulbs, is linked to two, usually non-fatal, kinds of skin cancer: squamous cell and basal cell carcinomas. Squamous and basal cell cancers may be more tied to cumulative exposure that does not necessarily cause sunburn, said skin cancer specialist Dr. Howard Koh, the former commissioner of public health for Massachusetts and now associate dean for public health practice at the Harvard School of Public Health.

Melanoma is trickier because it often occurs on parts of the body that are not usually exposed to the sun, though it may be tied to “harsh, episodic” ( as opposed to cumulative) sun exposure, Koh said.

Bottom line on tanning parlors? Probably no worse than lying on the beach: Getting a tan is bad, either way. To be on the safest side, said Dr. Barbara Gilchrest, chairman of dermatology at the Boston University School of Medicine, slather on the sunscreen – and in thicker doses than most people do to get the advertised protection. Or, if you really want to look tan yet avoid skin damage and the cancer risk, consider a “sunless tanning” cream, which merely changes the color of the dead, outer layer of the skin. But beware: a “tan” acquired this way will not protect against sunburn or permanent sun damage.

Is there a vaccine for poison ivy?

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Nope, sorry. And you must have been one of the lucky ones even as a kid.

In decades past, doctors did try exactly what you remember – giving small but increasing oral doses of the allergy-causing substance from poison ivy in hopes of “desensitizing” people, that is, making their immune systems more “tolerant” or less reactive, to poison ivy. But these attempts usually failed, and sometimes made people worse, said Dr. Robert Stern, chief of dermatology at Beth Israel Deaconess Medical Center.

If doctors gave the substance orally, it passed through the digestive system and caused a red, itchy rash in a particularly unpleasant place, the rectum. If they tried to desensitize people topically, that is, by rubbing a tiny bit of poison ivy on the skin, that elicited exactly the response they were trying to avoid- a red, itchy skin rash.

An allergic reaction to poison ivy is different from allergic reactions to things like pollen. Depending on your genetic makeup, pollen from a particular kind of tree, say a birch, may cause an immune reaction – release of a type of antibody called IgE. This antibody sits on the surface of mast cells, immune cells that line the nose, throat, gastrointestinal tract and skin. The next time pollen enter the system, it combines with these antibodies, causing the mast cells to release histamine and other chemicals that make blood vessels dilate and leak proteins into tissues, causing swelling – the stuffy noses of allergy suffers.

With poison ivy, the exaggerated immune response is not triggered by antibodies, but by cells called T cells. The first exposure to poison ivy won’t do much, but the second time around, the T cells are primed to pump out chemicals -cytokines and interleukins- that trigger inflammation.

Even if there were a good way to desensitize a person to poison ivy, it might be dangerous, said Dr. Mariana Castells, co-director of the allergy and clinical immunology training program at Brigham and Women’s Hospital. T cells trained to ignore the nastiness of poison ivy might also ignore viruses and bacteria. “If you tolerized people” to the substance in poison ivy, “you might tolerize people to things they should be reacting to,” she said.

Bottom line? Stay away from poison ivy if you can (and don’t burn it if you’re cleaning up your garden!) If you do get a poison ivy rash, wash it gently with water (no soap), take oral antihistamines like Benadryl to help with the itching or anti-itch lotions and topical steroids like Clobetasol. If that fails, your doctor may prescribe oral steroids like Prednisone.

Is there a relationship between not smiling as a baby and depression later in life?

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“Oh, no. That fact alone – not smiling much as an infant – is insufficient” to predict such outcomes later on, said Jerome Kagan, a psychologist at Harvard University who has studied child development for decades.

But Kagan’s research has shown that infants as young as four months old do show clear differences in temperament, probably based on the inherited biology of the brain, and that these differences can persist. About 20 percent of healthy, Caucasian babies raised in a nice, nurturing environment are nonetheless easily over-stimulated – kids that Kagan calls “high reactives.” When these babies are shown an interesting sight or sound, they thrash their arms and legs around and cry, perhaps, Kagan’s work suggests, because a sensitive structure in the brain called the amygdala is more excitable than normal.

Babies who are “high reactives” at four months often go on to smile and laugh less at one, two and three years of age, Kagan said. They do smile sometimes, but “they are less joyous. Their mothers see these children as ‘serious.’ By 10 or 11, these children may feel a “private mood of high tension” and often describe themselves “as thinking too much, or not feeling relaxed.” At age 11, these children also show a larger brain response to sounds in part of the brain that is “primed” by the amygdala, suggesting that this extra excitability is retained.

Because “high reactive” babies are somewhat tense to start with, if their life circumstances “are oppressive or full of personal loss” as well, they “would be at a slightly higher risk of depression than the average person,” Kagan said. “But you’d lose money if you said that every time you saw a high reactive baby, he or she would be depressed by age 20.”

The bottom line, said Dr. Robert Sege, associate chief of general pediatrics at Tufts-New England Medical Center, is that smiling is a baby’s way of initiating a “conversation” with parents. “If you’re worried about your baby not smiling, smile more at your baby. That’s the cure. The baby’s brain doesn’t grow in isolation.”

Is it okay to work out hard while on a low-carb diet?

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If you’re a really serious athlete, the answer is probably no. The problem, says William Evans, chief of the nutrition, metabolism and exercise lab at the University of Arkansas for Medical Sciences, is that “whenever you work out hard, you use glycogen, the body’s stored form of glucose (sugar). If you don’t eat much carbohydrate, your muscles will have ever-diminishing levels of glycogen and it will be difficult to continue exercising. There’s a lot of research that demonstrates that a high carbohydrate diet is important for people who do a lot of exercise.”

For people who aren’t serious athletes but exercise moderately and want to lose weight via a low-carb diet, there may be enough carbohydrates from the fruits and vegetables you get in the later stages of low-carb diets, says Barry Braun, an exercise biochemist at UMASS/Amherst. The real value of such diets is probably “more mental than biochemical,” he adds. They work “by making people more aware of what they’re eating and helping them cut out junk food and sugary snacks.”

But beware. There is a lot of water tied up chemically with glycogen, says Evans. So you may lose weight early on. “But as soon as you start eating carbs again,” he says, “you replenish glycogen and the water comes back with it. What you haven’t lost is fat.”

The bottom line, once again, is not news. Exercise for half an hour a day and eat sensibly.

Do iron supplements make sense when in high altitudes?

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Probably not, especially if you’re only going to be at altitude for a week or so. The The only reason to take supplements before going to high altitude is if you had iron-deficiency anemia to begin with, said Dr. James Levine, a hematologist, or blood specialists, at Beth Israel Deaconess Medical Center in Boston.

It takes two to four weeks for the body to make enough extra red blood cells, which carry oxygen, to compensate for the thinner air at high altitude, said Dr. David Kuter, chief of hematology at Massachusetts General Hospital. The percentage of red cells in the blood is measured by a test called a hematocrit. “Taking iron to make the hematocrit rise is not going to help,” he said.

What does happen right away in conditions of low oxygen is that red cells begin pumping out a substance called 2,3 DPG, which makes the hemoglobin transport oxygen more efficiently. Over time, the body also begins pumping out another substance called erythropoietin (sold in medications such as Procrit and Epogen), which stimulates production of red blood cells. Some athletes who compete at high altitudes do take erythropoietin, but most doctors don’t recommend this for ordinary travelers because it’s expensive, takes too long to work, requires injection. And most travelers don’t go to high enough altitudes, anyway.

If you’re planning a long stay at altitude, you might consider getting tested for levels of stored iron, called ferritin, because it is this stored iron that the body draws on when it needs it, noted Barry Braun, an exercise biochemist at UMASS/ Amherst. If your ferritin is low, you might consider taking iron supplements before your trip or eating foods high in iron, such as red meat and spinach. But it’s very important to talk to your doctor before taking extra iron: too much iron, a condition called, hemochromatosis, or iron overload, which an be dangerous.

Will ibuprofen block muscle building after intense exercise?

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Yes, but there’s a catch.

A study published in 2001 by exercise physiologist William J. Evans of the University of Arkansas for Medical Sciences and his colleagues showed that both ibuprofen and, to the researchers’ surprise, acetaminophen (Tylenol), blocked new muscle synthesis after intense weight training exercise.

Evans’ group studied 24 men in their twenties and divided them into three groups, one that got ibuprofen, one that got acetaminophen and one that got placebo, a dummy drug, after an intense weight workout of the legs – to the point of exhaustion. The drugs were given at doses of 1,200 milligrams a day for ibuprofen and 4,000 milligrams for acetaminophen. The researchers also took muscle biopsies – small samples of muscle tissue – before and after the exercise bout and did numerous other tests.

They found that both ibuprofen and acetaminophen suppress the body’s normal response to muscle damage (and thus repair) after exercise. Although the men getting placebo had robust levels of protein synthesis in muscle tissue after exercise, the two groups getting drugs did not. The fact that ibuprofen inhibits muscle synthesis was not a surprise because the inflammatory process is involved in muscle repair and ibuprofen blocks the inflammatory reaction. But acetaminophen is known as a painkiller and fever-reducer, not as a direct inhibitor of inflammation.

So, should you skip the over-the-counter painkillers after a tough strength-training workout? Probably, if you can stand the muscle soreness and really want to bulk up.

On the other hand, even people who routinely take ibuprofen to control pain, such as those with chronic arthritis, can build muscle mass very well, notes Dr. Ronenn Roubenoff, an associate professor of medicine and nutrition at the Friedman School of Nutrition, Science and Policy at Tufts University. So far, he says, people with rheumatoid arthritis seem to “do as well or better than healthy people not taking” ibuprofen in terms of muscle protein synthesis. Perhaps the difference in findings comes from studying people after one hard exercise bout versus muscle building over time.

Can TUMS damage teeth?

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Probably not. TUMS are made of calcium carbonate in chewable form, notes Dr. Michael F. Holick, director of the bone health care clinic at Boston University Medical Center. As such, TUMS are a good source of calcium, particularly for people who don’t make enough stomach acid, because the calcium in TUMS is easily absorbed by the body.

TUMS are a bit “gritty,” notes Holick, “but there’s no evidence that this damages teeth. It’s probably more cleansing than damaging to teeth. I have had lots of patients on TUMS without complaints.” Calcium carbonate is basically ground-up oyster shells, which accounts for the grittiness, adds Holick, a professor of medicine, physiology and biophysics.

Dr. Sadru Kabani, director of oral and maxillofacial pathology at the Boston University School of Dental Medicine, mostly agrees, saying he could find no mention of adverse effects from TUMS on teeth in the American Dental Association Guide to Dental Therapeutics. The grittiness of TUMS, however, could in theory be abrasive to teeth, he says. And the calcium in TUMS may bind to certain antibiotics such as tetracycline, perhaps making them less effective. But the only potential dental problem linked to TUMS, he says, would be cavities because TUMS contain sugar.