Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Do you have to rub contact lenses to clean them if your cleanser is “no rub?”

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Yes, according to a new consumer “reminder” from the US Food and Drug Administration. The agency became concerned about the risk of infection in contact lens wearers after an outbreak of fungal infections in 2006 and an outbreak of amoeba infections in 2007. The FDA recalled two products after those outbreaks.

The agency convened an advisory panel in 2008 and an expert workshop last February to address concerns about eye infections among America’s 30 million contact lens wearers. Based on those recommendations, the FDA is now advising lens wearers to rub as well as rinse lenses, a policy supported by the American Academy of Ophthalmology and the American Optometric Association.

The new recommendations apply even if your product is advertised as “no rub,” and also include throwing out cleansers by the discard date, washing your hands when handling lenses, and allowing your lens storage case to dry (upside down, so water can drain) when lenses are removed. Never clean lenses with nonsterile water, which includes water from the tap, bottled water, water from lakes or oceans, or homemade saline solution. Saliva, of course, is not sterile, either.

Dr. Kathryn Colby, an eye surgeon at the Massachusetts Eye and Ear Infirmary, said that “rubbing lenses removes more debris than simply rinsing” – similar to washing dishes, where scrubbing removes more stuck food particles than just rinsing. “Less debris means cleaner lenses.”

This month, the FDA wrote to the nine companies allowed to market “no rub” lenses. The letter is not an official enforcement action, but asks the companies to “come in” to discuss the new data on lens cleaning, said Dr. Dan Schultz, director of the FDA Center for Devices and Radiological Health.

Is it OK to take ibuprofen if you have a broken bone?

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It’s not a great idea. Ibuprofen – and other NSAIDs (non-steroidal anti-inflammatory drugs) – can impede healing.

“Smoking and NSAIDs are probably the most important causes of failure in bone healing,” says Dr. Malcolm Smith, chief of the Orthopedic Trauma Service at Massachusetts General Hospital. In fact, he said, with a patient who has had surgery to remove bone, “we give them NSAIDs to make sure the bone doesn’t grow back.”

NSAIDs inhibit bone healing by blocking a natural substance in the body, prostaglandin, which supports the activity of bone-building cells, called osteoblasts. Without it, osteoblasts can still make new bone, “but not as robustly,” said Dr. Thomas Einhorn, chairman of orthopedic surgery at the Boston University School of Medicine.

High-quality human studies are scare, but animal studies, including work in Einhorn’s lab, clearly demonstrate that NSAIDs inhibit healing. The good news, he said, is that once NSAIDs are discontinued, bone healing resumes.

“In the absence of good human data, I now tell people that if they have arthritis and need to take NSAIDs regularly but then break a bone, they should try to stop the NSAIDs until the fracture heals,” Einhorn said. If you do have to continue taking NSAIDs for arthritis despite a broken bone, bone healing will probably eventually catch up, he added. “But all this is inference from animal studies.”

Aspirin also inhibits prostaglandin and therefore theoretically might retard bone healing, said Einhorn. But people who regularly take low-dose aspirin typically do so to prevent blood clots that can cause a stroke or heart attack. “If you’re taking low-dose aspirin to prevent stroke or heart disease,” he said, “don’t stop if you have a broken bone because that’s a very important preventive reason and we don’t know for sure if that would inhibit bone healing.”

What constitutes constipation and what are the best treatments?

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Ubiquitous as it is, there are many misconceptions about constipation and what to do about it.

Many people think having a bowel movement more or less frequently than once a day is not normal. In truth, roughly three times a day to roughly three times a week is all normal. In fact, consistency of the stool is more important than frequency. Smooth, soft and sausage-shaped is the ideal, according to the seven-point scale that doctors use. (If you’re curious, Google “Bristol Stool Scale.”) Straining can also be part of constipation.

Constipation is often caused by medications, says Dr. Robert Burakoff, clinical chief of the division of gastroenterology at Brigham and Women’s Hospital. These include calcium channel blockers used for heart disease and hypertension, narcotic pain relievers, and older antidepressants such as Elavil. Age contributes, too, because intestinal muscles don’t work as well as we grow older. Pelvic floor problems in women can contribute to constipation, as can excessive iron in the diet or supplements.

Fiber is a good first step in treatment, both fiber that comes naturally in fruits and vegetables and over-the-counter drugs like Metamucil containing psyllium, says Dr. Braden Kuo, a gastroenterologist at the Digestive Healthcare Center at Massachusetts General Hospital. But too much fiber can cause bloating and gas, so don’t overdo it. Other over-the-counter fiber medications such as Citrucel and Benefiber may cause less bloating.

If fiber doesn’t help enough, try over-the-counter laxatives such as MiraLAX, Dulcolax, Correctol, or an occasional dose of milk of magnesia (too much of the latter is bad for the kidneys). Senna products can also work, but they stain the inside of your colon, though doctors now think this is not dangerous. Don’t use any of these medications chronically, though, because you can get diarrhea and cramping, and if you use laxatives too often, you may make it harder for your colon to contract naturally.

If all these treatments fail, you can try the prescription drug Amitiza. Most people with constipation don’t need to see a doctor. But you should if constipation is chronic and there’s no obvious reason for it, to make sure there is no bowel obstruction.

Do I have to eat a special diet to achieve the right acid balance in my body?

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No, because the body has an exquisite system for making sure that the blood maintains the proper pH, the chemical term for the concentration of hydrogen ions.

A pH of 7 is considered neutral. A pH of lower than 7 is acidic, higher than 7, basic or alkaline. Normal blood pH is tightly controlled so that it stays between 7.35 and 7.45.

“But you don’t have to do anything to achieve the right pH – nothing is as powerful as your intestinal tract to make sure the proper balance of acids and bases enters your bloodstream,” says Dr. George Blackburn, associate director of the division of nutrition at Harvard Medical School. If, by chance, the intestines fail to get it right, the kidneys also have a powerful ability to fix it, he says.

Some people fear that eating acidic foods promotes cancer, but that is false, says Karen Collins, a nutritional advisor to the American Institute for Cancer Research. The myth about acidity and cancer comes from valid observations that cancer cells thrive in an acidic environment. But that only applies to isolated cancer cells in the laboratory.

Some also fear that an acid-producing diet may trigger loss of calcium from the bones, potentially increasing the risk of osteoporosis. The data on this point are conflicting. A study published in May, in which data from five other studies were pooled, disputed this idea. But Bess Dawson-Hughes, director of the bone metabolism laboratory at the USDA Nutrition Center at Tufts University, published a study in January suggesting that increasing the alkali content of the diet may attenuate bone loss.

Bottom line? Eat lots of fruits and veggies – for many reasons. They won’t make your body too acid – in fact, quite the opposite, they are broken down in the body to “bases,” the chemical opposite of acids.

Should teenagers be routinely screened by doctors for depression?

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Yes, according to a new report from the US Preventive Services Task Force – an independent panel of private-sector experts convened by the government.

The panel, whose recommendations are considered the “gold standard” for medical screening, said all 12- to 18-year-olds should fill out standard questionnaires for major depressive disorder, which can be seriously disabling and, in some cases, lead to suicide.

“We pay a lot of attention to physical health, even though the vast majority [of adolescents] are in one of the healthiest periods of life. However, we have never been very good as a nation about checking for mental and emotional problems, yet these are more likely in this age group than physical problems,” said Laurie Flynn, executive director of the TeenScreen National Center for Mental Health Checkups at Columbia University. The group has set up mental health screening programs in more than 500 communities nationwide.

Dr. Michael Jellinek, chief of child psychiatry at Massachusetts General Hospital and the author of the Pediatric Symptom Checklist, a leading child mental health screening questionnaire, agreed the new recommendations are “good news.” Ten percent of children and adolescents have emotional disorders and many never get diagnosed and treated, he said.

But he cautioned against “a number of difficulties,” including potential over diagnosis. Many teens feel temporarily sad, anxious, or hopeless because of troubles at home or school, but do not have a depressive disorder, said Jellinek.

There aren’t enough psychiatrists and psychologists available to help depressed teenagers, he said, and pediatricians – who are not trained to treat depression – might be tempted to write prescriptions for antidepressants “too readily,” he worried.

“We . . . don’t have a good system of caring for teenagers with depression,” he said.

Bob Lichtenstein, director of the school psychology program at the Massachusetts School of Professional Psychology, shared that concern: “While universal screening may be valuable, it is essential that there be sufficient mental health services in place to meet the needs that are uncovered.”

Is it OK to eat nuts, corn, and popcorn if you have diverticulitis?

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There are new reasons to think it may indeed be OK – a sharp reversal of past advice.

For years, doctors assumed that chunky little foods such as nuts and corn were bad for people with diverticulosis or diverticulitis – diseases of the colon in which tiny pouches, which can trap undigested food, develop in the colon wall. (Diverticulosis is the mere presence of the pouches; diverticulitis is when they become inflamed.)

But doctors’ original thinking has been turned on its head by a study published last year that showed nuts, corn, and popcorn do not increase the risk.

The study was done by Dr. Lisa Strate, a gastroenterologist at the University of Washington, in Seattle, and colleagues from the Harvard School of Public Health. They sent questionnaires every four years from 1986 to 2004 to more than 47,000 male health professionals, all of whom were free of diverticulosis and diverticulitis when the study began.

They then compared men who developed the colon conditions with men who did not, and analyzed what they ate. They found no correlation between consumption of nuts, corn, and popcorn and development of diverticulosis or diverticular complications.

While that research focused on the potential risk of colon disease – rather than the effect on people who already suffer from it – the findings have prompted reconsideration of recommended diet restrictions. Whether colon disease patients can eat nuts, corn, and popcorn “needs to be revisited,” said Strate.

Nuts, in particular, are now known to be an important part of a healthy diet, she adds.

Dr. Braden Kuo, a gastroenterologist at the Digestive Healthcare Center at Massachusetts General Hospital, says, “People can rejoice. This study debunks the common perception that nuts, corn, and popcorn are bad for people with diverticulosis and diverticulitis. There is no evidence that eating these foods will make these conditions worse.”

Is there a downside to using a CPAP machine for sleep apnea?

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CPAP, or continuous positive airway pressure, devices are commonly used by people with obstructive sleep apnea, a serious condition that affects 12 million Americans. It causes people to stop breathing many times a night as the soft tissues in the throat collapse and close up, blocking the airway.

Untreated sleep apnea can cause high blood pressure, heart attacks, and stroke, according to the National Heart Lung and Blood Institute. Poor sleep also leads to daytime drowsiness, which impairs job performance and increases the risk of traffic accidents.

Using a CPAP machine, which involves wearing a mask over the face and breathing through a tube that pushes in air at a pre-determined pressure, allows a person to stay asleep all night – instead of waking up repeatedly gasping for air. They also reduce snoring, a big plus for the spouse.

But a significant portion of CPAP users – 50 percent, by some estimates – give up on the machines because of side effects, which can include a dry or stuffy nose, irritated skin on the face and discomfort.

Claustrophia is also a common problem, says Dr. Kenneth Sassower, a sleep neurologist at Massachusetts General Hospital. So is distress triggered by the fact that air is pumped in as the person exhales, making it slightly more difficult to exhale, says Dr. Geoffrey Gilmartin, director of the Sleep Disorders Center at Beth Israel Deaconess Medical Center. Trouble exhaling can lead to swallowing air and stomach bloating.

But there are ways to adjust to a CPAP machine, such as working closely with sleep lab experts until you get a mask that fits and getting the device’s air pressure set properly, says Dr. Aaron Waxman, director of the pulmonary vascular disease program at Massachusetts General Hospital.

It can also help to have the air pressure ramp up gradually so you can adjust to it as you’re trying to fall asleep. If you can’t adjust to the CPAP machine, a dental appliance like a retainer that thrusts the lower jaw forward may help keep the throat open.

Is there any early way to tell if a toddler might have autism?

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There is no standard test yet for autism, a brain development disorder in which children have impaired social interactions, difficulty communicating, and use repetitive words or actions. But new findings from researchers at the Yale Child Study Center in New Haven hint at one possible way to identify autism earlier: track a child’s eye movement.

If someone is talking to the child, and the child’s attention is focused more on the speaker’s mouth than the eyes, that may be an early sign of autism, researchers say.

Normal children focus on the eyes, and autistic toddlers, by failing to do so, “are missing rich social information,” said psychologist Ami Klin, director of Yale’s autism program.

“The mouth is the place where there is the greatest amount of audiovisual synchrony,” he said, “which raises the hypothesis: What is the experience these children have when facing another human being?”

Dr. Thomas R. Insel, director of the National Institute of Mental Health – which partially funded the latest study, published online in the journal Nature – said in a statement that the research shows for the first time “what grabs the attention of toddlers” with autism spectrum disorders. Not only does this suggest potential diagnostic tests, he noted, but it may also suggest ways to re-direct visual attention in these children.

Usually, children with autism are not diagnosed until they are 2 or 3, partly because their language skills are not developed sufficiently until then, said Dr. Christopher Walsh, a geneticist and neurologist at Children’s Hospital who studies autism.

But there is great interest, he said, in diagnosing children earlier because intensive behavioral intervention done in the early years seems to help them later in life.

The challenge now, said Klin, is to see if doctors can tell soon after birth if a child is at risk for autism. By using the quantitative methods from the new research, he said, hopefully “we will be able to do so, even with children at only a few months of life.”

Is walking good for preventing osteoporosis in the spine?

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Yes.

“Anything that makes bone bear weight is good for bone quality,” said Dr. Kirkham Wood, head of orthopedic spine surgery at Massachusetts General Hospital. “All bones – spine bones and big leg bones – will respond to pressure from weight by forming more bone.”

And walking, though not as good for bones as jogging or jumping, is far better than just standing, he said. “It’s the cyclic loading and unloading of weight, not simple compression, that keeps bones strong,” he added. If a person simply stands, the muscles accommodate and do most of the work, he said – with no benefit to the bone.

An estimated 10 million Americans, 80 percent of them women, have osteoporosis, sometimes referred to as the “bone-thinning disease.” Another 34 million are at risk because they have low bone density.

Walking has not been shown to restore bone that is already lost to osteoporosis, but it can help preserve the bone density that a person has, said Dr. Carol Hartigan, a spine specialist at New England Baptist Hospital. Everyone loses some bone with aging – women abruptly at menopause when estrogen levels decline, men more slowly as male hormones decline over time.

Beyond walking, weight lifting and other resistance training may improve bone mineral density in the lower back, and maintain bone density in the hips. Resistance equipment that addresses this area includes the back extension, abdominal and leg press, hip abduction and adduction, and hamstring and gluteal press machines. Other exercises – such as front and lateral raises with free weights – focus on the spine at chest level.

If you already have osteoporosis, check with your doctor before embarking on a weight lifting program because if you try to lift too much weight too soon, you could fracture a bone. But remember: Not exercising also puts you at risk.

Should you walk for exercise even if blocked arteries in your legs make it painful?

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You bet, counterintuitive as it may seem – although always check with your doctor first.

With supervised training on a treadmill, people with blocked arteries in the leg – also known as peripheral artery disease, or PAD – can significantly improve the distance they are able to walk, with and without pain, according to a study published in January in the Journal of the American Medical Association.

The findings confirmed what doctors have long suspected: Exercising leg muscles by walking, especially on a treadmill, helps ease the condition.

Blocked arteries in the legs affects an estimated 8 million Americans. Most people with PAD have lower blood pressure in the ankle than in the arm, a sign that leg arteries are partially blocked by the same kind of fatty deposits that cause obstructions in coronary arteries.

Many people with PAD have no leg pain. But many others have leg pain that starts with walking, then abates with rest. As walking increases leg muscles’ demand for oxygen, blockages mean insufficient blood is getting through, causing cramps. Still others have atypical symptoms: leg pain that begins at rest.

The six-month study, led by Dr. Mary M. McDermott, a professor of medicine at Northwestern University Feinberg School of Medicine, involved 156 men and women with PAD, with and without symptoms. The subjects were randomly assigned one of three activities: supervised treadmill walking three times a week; thrice-weekly supervised strength training that did not involve the treadmill; or attending nutrition classes.

Those who got treadmill training increased by about 100 feet the distance they could walk in 6 minutes. Strength training helped, but not as much. That may seem a small benefit, but it’s significant statistically and clinically. It can mean that a person with PAD can get to the store or car, said Dr. Alik Farber, chief of vascular and endovascular surgery at Boston Medical Center.

If you suspect you have PAD, see your doctor before you start an exercise program.