Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

What is the Alexander Technique?

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The Alexander Technique applies heightened self-awareness of posture to change the way one moves and sits. It is taught in a series of lessons, usually private, during which the teacher watches how you stand, walk, sit, and move your body to see where you unconsciously hold muscle tension, said Jill Geiger, a certified practitioner in Newton.
The teacher also places his or her hands on your body to detect areas of tension and guides you, with words and gentle hands, to realign your body to achieve better posture and relieve tension. The lessons cost about $70 each and may or may not be reimbursed by insurance.

The technique was developed a century ago by F.M. Alexander, who used it to aid his career as an actor and orator.

New data suggest the Alexander Technique can ease back pain for at least a year. In the randomized study, which involved 579 people with chronic back pain and was published this summer in the British Medical Journal, six lessons proved almost as effective as 24 if patients also did 30 minutes of brisk walking or the equivalent every day. Massage helped pain, too, but the effects wore off quickly.

Overall, exercise alone (such as brisk walking) led to a 17 percent improvement in back pain, said Dr. Paul Little, the lead author of the study and a professor of primary care research at the University of Southampton in England, in an e-mail. Six lessons of the Alexander Technique alone also led to a 17 percent improvement.

Twenty-four Alexander lessons, even without walking is more than twice as effective as either walking or six lessons alone. But you can get almost as good results – for much less money – by combining six Alexander lessons with brisk walking.

Does exercise increase or decrease your appetite?

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Immediately after vigorous exercise, appetite decreases, probably because of a temporary rise in body temperature, specialists say. But as soon as body temperature normalizes, appetite goes up.

So if you’re trying to lose weight, exercise alone – without calorie restriction – doesn’t help much. Exercise increases appetite because the body burns calories as you exercise, and this stimulates appetite to make up for the expended calories, said Dr. James Fries, a professor of medicine at Stanford University School of Medicine.

The real issue “is whether the extra calories taken in are more or less than the increased ones being burned,” Fries adds. If you exercise away 300 calories and only compensate by eating 200 more, you can lose weight.

“Even if you do not lose weight, regular exercise will greatly reduce your risk of chronic disease and extend your life expectancy,” says William J. Evans, an exercise physiologist and chair of nutritional longevity at the University of Arkansas for Medical Sciences.

Exercise burns fewer calories than many people think. “Walking for 40 minutes a day may spend an extra 150 calories” says William J. Evans, an exercise physiologist and chair of nutritional longevity at the University of Arkansas for Medical Sciences. That’s less than the average chocolate chip cookie.

“There is also evidence,” says Evans, “that many people who initiate an exercise program compensate by becoming less active for the rest of the day, thinking, “No, I don’t really want to go for a walk, I have already done my exercise.”

Weight lifting, as opposed to aerobic exercise, does increase lean body mass and metabolic rate, which can result in the body’s burning more calories per day. “However, I don’t think that either form of exercise has much of an effect on appetite,” Evans says.

Bottom line? Exercise because it’s terrific for your general health. To lose weight, though, you have to eat right as well.

I’ve had insomnia for years. Is there a biological cause?

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There may be, according to preliminary research published over the weekend by researchers from Brigham and Women’s Hospital in the journal SLEEP.

Using a novel form of magnetic resonance technology, the team, led by Dr. John Winkelman, a psychiatrist in the division of sleep medicine, discovered that some people with chronic insomnia have lower brain levels of a neurotransmitter called GABA.

GABA is the brain’s major inhibitory transmitter, meaning that it helps reduce activity in the brain’s neural circuits. Low levels of brain GABA in people with insomnia may lead to their nervous system being in high gear, both day and night. “Insomnia may be not just a disturbance of sleep but may be a 24-hour a day disorder, one of whose manifestations is insomnia,” Winkelman said.

The study is believed to be the first to link insomnia with a particular biochemical glitch. Although small – 16 people with chronic insomnia and 16 good sleepers – the study is interesting because the people with insomnia were not depressed or anxious.

Historically, psychiatrists have believed chronic insomnia – which affects about 10 percent of adults – was linked to depression or anxiety.

The fact that low GABA levels may be linked to insomnia fits with the fact that many sleeping pills such as Ambien, Halcion, Restoril, Lunesta, Ativan act indirectly via GABA receptors, perhaps by flipping a chemical switch in the hypothalamus.

Winkelman notes that, while sleeping pills can often be helpful, nondrug treatments such as cognitive behavioral therapy also can reduce insomnia.

Clifford Saper, a neurologist at Beth Israel Deaconess Medical Center who has studied this sleep-wake switch, cautions, “We are only now beginning to work out the complex circuitry in the brain that causes insomnia. There are very few studies in humans, so new data are very welcome.”

Should breast cancer patients have chemotherapy before or after surgery?

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That’s a tricky question and, ultimately, each woman needs to make that decision with her doctor. But there are some advantages to having chemotherapy first.

It may be a good option “in women who have a tumor that is too big in relation to the breast size for conservative surgery[lumpectomy] but who want to have conservative surgery,” said Dr. Eric Winer, director of breast cancer oncology at Dana-Farber Cancer Institute. In these cases, chemotherapy can often shrink a tumor enough to allow breast-conserving surgery. Women who get such surgery typically get radiation afterward to prevent local and regional recurrence.

If it’s clear, on the basis of various tests, that a woman is going to need chemotherapy regardless of what kind of surgery she has, having chemotherapy before surgery may also allow her to avoid radiation therapy, said Dr. Kuan Yu, an assistant professor of radiation oncology at M.D. Anderson Cancer Center in Houston. Yu is the lead author of a paper recently presented at a meeting of the American Society of Therapeutic Radiology and Oncology in Boston. Pre-op chemotherapy appears to allow a woman to skip radiation only if she has a mastectomy, not a lumpectomy, Yu said.

Although pre-op chemotherapy is increasingly being used, “there are still many unanswered questions” about it, said Winer. Some clinical trials routinely use pre-op chemotherapy. Whether or not a woman is in a clinical trial, he said, it’s crucial for her to discuss all the treatment options with her doctor, he said.

If I have trouble hearing in one ear, is it dangerous?

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It can be.

Sudden deafness is fairly common, and most of the time, it’s a benign problem caused by the build-up of wax in the ear canal, water in the ear, or congestion from a head cold or allergies. In these circumstances, the nerves in the inner ear are working fine, but sound doesn’t get through, a situation called “conductive” hearing loss, said Dr. Steven D. Rauch, an otolaryngologist at the Massachusetts Eye and Ear Infirmary. Usually these problems resolve themselves on their own.

But sometimes sudden deafness is “sensorineural,” meaning that the inner ear nerve endings are damaged, which is a genuine medical emergency. Typically, the cause of this sudden damage is an infection deep in the inner ear, said Dr. David Vernick, an otolaryngologist in private practice in Chestnut Hill. “There’s a window of only about seven to 10 days to treat this. If you miss this window, you could be permanently deaf in the affected ear.”

“The problem is, you can’t always tell which kind of sudden hearing loss you have,” said Vernick, which means if you’re in any doubt, “you need to have it checked out.”

There is, however, one simple test you can do at home that can give you some guidance: “Hum aloud,” said Rauch. “If you hear your voice louder in the blocked ear, there is conductive hearing loss and no emergency. If you hear your voice louder in the good ear, there’s sensorineural loss on the blocked side, and it is urgent that you have it evaluated and treated. In other words, when you hum, hearing your voice in the bad ear is good and hearing it in the good ear is bad.”

Am I more likely to get pregnant if I take a fertility drug such as Clomid?

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No, at least not if you take it alone, without other interventions, according to a new study by Scottish researchers in the British Medical Journal.

Neither Clomid (clomiphene citrate) – which is an ovulation stimulator – nor artificially inseminating women with sperm injected directly in the uterus, resulted in more live births than simply continuing to try to have babies the old-fashioned way, concluded the study. It was led by Siladitya Bhattacharya, a professor of reproductive medicine at the University of Aberdeen.

The study involved nearly 600 women who were unable to conceive for more than two years. These women had normal ovulatory cycles, open and healthy fallopian tubes and their partners had normally functioning sperm.

One group of women was randomly assigned to take Clomid. Another group was artificially inseminated (without the use of drugs to produce multiple eggs). A third group continued to try to get pregnant with intercourse but without using methods to predict ovulation such as taking the woman’s basal temperature, or using a urine test to detect the hormonal surge that precedes ovulation.

The women in the “just keep trying” group were unhappy about not getting more aggressive treatment. But in the end, their outcomes were no different than the other two groups.

One key lesson from this study, said Dr. Aaron Styer, a reproductive medicine specialist at Massachusetts General Hospital, is that none of these relatively low-tech approaches may be good enough. The pregnancy rates for Clomid, artificial insemination and “keep trying” are all fairly low, other research suggests.

If you have tried for one or two years to get pregnant and are approaching your mid-30s, you might consider talking to your doctor about more aggressive therapies – such as drugs that produce super-ovulation, or vitro fertilization (IVF) – although these approaches carry the risk of mutiple pregnancies.

Why is there no vaccine against infectious mononucleosis?

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Finding a safe, effective “mono” vaccine has proved devilishly complicated – although the need is obvious: Every year, a new crop of college students comes down with mono, which causes a terrible sore throat, enlarged spleen and debilitating fatigue that can last for weeks. Spread by saliva (kissing, sharing beer bottles, etc.), mono is so ubiquitous that by adulthood, 90 percent of American adults have had it.

In 80 percent of cases, mono is caused by the Epstein-Barr (EBV) virus, a member of the herpes family; most of the rest are caused by cytomegalovirus (CMV), also a herpes virus. To date, there has been only one successful vaccine against a herpes virus. It is the one that at low doses protects kids against chicken pox, and, at a 10 times higher dose, protects older adults against shingles. There are no vaccines against any other herpes viruses.

There are no vaccines against any other herpes viruses – and one reason is that all herpes viruses can, after an acute infection, hide in cells for decades. The Epstein-Barr virus not only hides, but can also trigger a rare kind of cancer, Burkitt’s lymphoma. That means that any vaccine based on live Epstein-Barr virus could theoretically also carry this cancer risk, said Dr. Mark Pasternack [cq], chief of pediatric infectious diseases at Massachusetts General Hospital. Researchers have trying to get around this problem, with mixed results.

And there’s another serious roadblock to a mono vaccine. As with AIDS (caused by an altogether different virus), a potential vaccine, to be fully protective, has to induce two separate types of immunity – antibodies, to keep the virus from infecting cells, and so-called T-cells, that would also attack virus-infected cells. So far, no one has been able to find a safe mono vaccine that could produce both antibody and cellular immunity, said Dr. Clyde Crumpacker [cq], an infectious disease specialist at Beth Israel Deaconess Medical Center.

Unfortunately, there’s not a lot you can do to protect yourself against mono. Even after the acute symptoms go away, people with mono can carry the virus in their saliva for months. “You don’t have to be symptomatic to be infectious,” said Pasternack. So to avoid being exposed, or exposing others, on a college campus would mean living a restricted lifestyle – something that is not likely to happen anytime soon.

How and why does the body create fever?

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Fever happens when the immune system senses a threat such as infection, and pumps out chemicals called cytokines. They, in turn, set in motion a series of chemical reactions that turn up the body’s thermostat.

All of this takes place in a tiny spot in the brain’s hypothalamus called the median preoptic nucleus, according to new research on mice by Dr. Clifford Saper, a neurologist, and his team at Beth Israel Deaconess Medical Center.

The goal of a fever is to raise body temperature – temporarily – to prompt infection-fighting white blood cells to fight harder. Even just a few degrees over the normal 98.6 degrees Fahrenheit makes a difference.

Some people believe that only bacterial, not viral, infections cause fevers, but both can, so you can’t use fever to figure out which kind of infection you have, said Dr. Nesli Basgoz, associate chief for clinical affairs in the division of infectious diseases at Massachusetts General Hospital.

Fever can occur in response to problems other than infection, including such problems as drug allergies, autoimmune diseases, some hormonal conditions, and heat stroke, said Basgoz.

Does running increase the risk of knee injury or osteoarthritis?

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No. Contrary to widespread belief, running vigorously well into your later years does not raise the risk of knee osteoarthritis (swelling of the joint, with pain and stiffness, caused by wear and tear) or other disabilities. To the contrary, it can improve overall health, cutting the death rate in half, according to two new studies by Dr. James Fries, a professor of medicine at Stanford University. Both studies bolster previous research on exercise, disability, and longevity.

“The persistent myth about exercise – and running, in particular – is that it increases joint problems, arthritis, and will ultimately destroy joints and lead to disability,” said William J. Evans, an exercise physiologist and chair of nutritional longevity at the University of Arkansas for Medical Sciences. Not only is this “not true,” he said, but the opposite is true: “There is decreased disability after decades of running.”

Both Fries and Evans noted that while the two new papers focus on running, they believe the results apply to all aerobic exercise. “This study has a very pro-exercise message,” said Fries, a mountaineer and longtime runner. “If you had to pick one thing to make people healthier as they age, it would be aerobic exercise.”

In one of his new studies, published in the Archives of Internal Medicine, Fries gave annual questionnaires to 538 runners and 423 healthy men and women. All were at least 50 years old when the study began in 1984. After 21 years of follow up, only 15 percent of the runners had died, compared to 34 percent of the non-runners, a greater than two-fold difference.

Just as important, Fries said, the runners were less likely to be disabled. They were able to delay disability – defined as anything that can make it more difficult to perform normal daily tasks – by 16 years.

In the other study, published in the American Journal of Preventive Medicine, Fries focused on 45 runners and 53 non-runners, all aged 50 or more in 1984, and gave them periodic knee X-rays to detect possible osteoarthritis. After 18 years of testing, there was no increase in risk among runners, he said.

Bottom line? Get up and exercise, at least half an hour a day, at least five days a week, Fries said. And go at a speed that causes you to break and maintain a sweat, but not so fast that you can’t talk to an exercise partner.

What is a calcium scan for heart disease, and who should undergo the test?

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A coronary artery calcium scan is a CT scan that looks for calcium deposits in the arteries that supply the heart. It is noninvasive and is often promoted commercially – for roughly $300 per scan – as a way to screen for the buildup of plaque in arteries, a condition called atherosclerosis. Calcium often – though not always – builds up in plaque the longer it sits in artery walls. Thus a high score on a calcium scan can indicate long-lasting plaque and – perhaps – elevated risk of heart attacks or sudden death.

But calcium scans may not be a good idea, or prove terribly useful, for most people. For one thing, the scans expose a patient to significant radiation – equivalent to roughly 50 chest X-rays – said Dr. Warren Manning, chief of noninvasive cardiac imaging at Beth Israel Deaconess Medical Center.

For another, it’s not clear what to do with the results from a calcium scan. If you have diabetes, high cholesterol, high blood pressure, or a family history of heart disease, you already know – or should know – that you are at increased risk of heart problems and should lower these risk factors. So, a calcium scan provides little additional information, Manning said.

Moreover, even a high score doesn’t necessarily mean that the calcified plaque in your arteries is obstructing blood flow, said Dr. Adolph Hutter, a cardiologist at Massachusetts General Hospital.

“The vast majority of people with high calcium tests don’t have obstructions and they do fine long-term. So you’d have to test lots and lots of people to prevent one heart attack or sudden death,” said Manning.

And if you get a low calcium score, a sign of little or no calcification of plaques, that’s not very useful, either, because it could be wrong, or it could be right but lull you into believing you do not have to exercise and watch your diet, cholesterol, and blood pressure levels. “You can still be at risk even if your calcium test is negative,” Hutter said.

Some doctors believe that knowing your calcium score may motivate you to live a heart-healthy lifestyle, but studies suggest that patients are motivated for only a few months. Besides, we should all be living that way anyway. So, save your money and skip the calcium scan unless your doctor specifically recommends it.