Friday, December 21, 2007

by Arthur Elkind, MD. Elkind Headache Center. Mount Vernon, NY
reprinted with permission from ACHE - American Council for Headache Education, Mt. Royal, New Jersey

For many people, as we get older (and better) our headaches may improve too. Migraine headaches often become less severe and less frequent. The nausea, vomiting, light sensitivity and other symptoms may also lessen with age. Tension-type headache may continue unchanged if the individual has had it for much of his or her adult life.

Occasionally the headaches may change in character or an older person who never had a significant problem before will suddenly develop headaches. When this occurs, it is important to have the headaches evaluated to rule out any underlying health problems.

Tension-type headache

It is not unusual for someone who had been largely headache-free to develop a chronic tension-type headache in their senior years. Often this headache follows a major life change, such as retirement or a serious illness that has reduced mobility or independence. Someone who has just settled down to retirement may be puzzled and distressed at the onset of "tension" headache when all the pressure of the workplace is finally out of their lives.

On careful questioning, it often becomes clear that the headaches are related to an overall lowering of mood or a loss of enjoyment of life——to depression that may be slight or severe. Depression is only one of many possible causes of tension-type headache, but it should be suspected in the headaches follow some major change in situation. Retirement is often more stressful than many people expect, particularly if their work was important to their self-esteem. Treating the depression will generally relieve the headache.

A different kind of migraine

Older individuals will sometimes begin to have symptoms similar to a migraine aura (for example, weakness in the extremities, visual or sensory changes) with little or no headache. In many cases this turns out to be a peculiar form of migraine, called transient migraine accompaniments, that generally occurs after age 50. However, older persons who have these aura-like symptoms should not assume they are simply experiencing a different kind of migraine. The headaches should be carefully evaluated to rule out the possibility that the individual is experiencing episodes of a type of small, short-lasting stroke called transient ischemic attack (TIA).

A new study just published by Dr. Kathleen Merikangas offers the good news that migraine sufferers are not more prone to stroke as they grow older. On the contrary, the risk of stroke in a migraine sufferer is greater at 40 than at 70.

Headache as symptom

As we get older, the chance that headache may be a symptom of some other problem becomes a greater concern. Whenever a patient reports a more severe or changed headache pattern, the doctor should do a careful history and examination to rule out the possibility that the headaches are related to some underlying disease.

Suspicion is greater if the elderly individual has other symptoms suggestive of illness, such as fatigue or unexplained weight loss. There is a condition called temporal arteritis or giant cell arteritis that occurs more often in older persons (over age 55), in which the larger arteries of the head become inflamed. Headache is often an early sign, with or without other symptoms such as joint pain, difficulty chewing, fever, blurred vision, weakness and weight loss. Typically the headache is a continuous throbbing pain in the temples. If untreated, temporal arteritis can result in blindness and other serious complications. Fortunately, it responds well to treatment and is usually cured. Since early diagnosis is essential to preventing complications, you should see your doctor promptly if you develop throbbing temporal headaches accompanied by any of these other symptoms. Unexplained weakness or weight loss should always be brought to your physician’’s attention.

The possibility that your headaches might be related to underlying disease should not make you fearful of seeing the doctor and "learning the truth." On the contrary, you may discover that your headaches arise from something so simple as poorly fitting dentures, which put pressure on the teeth and gums that can translate into pain in the head and sinus region.

Headache as side effect

Older individuals are more likely to taking drugs for other chronic disorders, and headache is a known side effect of many medications. If you have reason to believe a needed medication may be linked to an increase in headache frequency, you should contact your doctor. A reduction in dosage or change to a related medication can be tried to see if the headaches respond. For example, some medicines for high blood pressure may cause increased headache as a side effect, but others are effective in controlling both blood pressure and chronic headache. Do not stop your medication or skip doses without consulting your doctor.

Headache management

It’’s important for the older individual who begins having chronic headaches or experiences a different kind of headache to see the doctor for a thorough evaluation. While a younger person with occasional headaches may do very well just taking over-the-counter pain relievers, this is not a good option for the older person. People often assume that drugs that are sold without a prescription are perfectly safe. However, older individuals in particular may be more prone to develop bleeding ulcers with overuse of aspirin-containing drugs, and many of the common anti-inflammatory drugs can make high blood pressure worse.

The doctor treating the older patient for headache must do a more careful history and physical examination than may be required in a healthy young person. It is necessary to rule out any disease that may be related to the headache, such as temporal arteritis. Also, any other medical conditions that would limit the choice of headache medication, such as diabetes, chronic lung disease, glaucoma or enlarged prostate, need to be identified.

Individuals in the elderly age group will differ greatly in their ability to tolerate drugs at doses normally used in young or middle-aged adults. A 60-year-old may not be much different from a 40-year-old, but an 80-year-old will need to be treated more cautiously, starting with minimal doses and going up slowly. Liver and kidney function slow down with age, so that a drug is not processed and eliminated from the body quite as quickly. Too much of the drug may accumulate in the bloodstream, resulting in more severe side effects. This is a risk with the common over-the-counter pain medicines as well as prescription drugs.

Many headache medicines can be safely used even in the very old. Acetaminophen (Tylenol, Excedrin, and many prescription drugs) is generally safe for occasional use, and some older migraine sufferers can take sumatriptan (Imitrex) or an ergot drug (Cafergot, Wigraine, Bellergal or DHE) without excessive side effects. When a daily medication is needed to prevent frequent headaches, often it’’s possible to choose one that has other important benefits, such as controlling blood pressure.

Even more than younger age groups, the elderly may find that complaints of chronic headache are not taken seriously by those around them. There are effective treatments for all ages, and older persons who suffer from headache should find a sympathetic and knowledgeable doctor to help them.

by Arthur Elkind, MD. Elkind Headache Center. Mount Vernon, NY

* keep in mind that this is a US related article and medications will appear differently. Always consult a headache neurologist or physician interested in headaches.

Tension headaches

What are tension headaches?
Most people describe a tension headache as a constant dull, achy feeling on both sides of the head. Some people with tension headaches also have a tight feeling in their head or neck muscles. Tension headaches usually begin slowly and gradually. They often start in the middle of the day.

Another name for this type of headache is "stress headache." When people say they have a stress headache, they usually mean they have a tension headache. Tension headaches may be mild or severe.

How are tension headaches diagnosed?
Your doctor often can tell what kind of headache you have by examining you and hearing your description of the pain. Blood tests, x-rays or brain scans--such as computed tomography (CT) or magnetic resonance imaging (MRI)--usually are not needed.

How are tension headaches treated?
If you only have tension headaches occasionally, an over-the-counter (available without a prescription) pain reliever can probably help. When choosing an over-the-counter pain reliever, check the label for possible side effects or interactions with other medicines you are taking. Always read and follow the directions on the label carefully. If you have any questions, ask your doctor or pharmacist.

If you have tension headaches often or over-the-counter medicines don't help your pain, you should see a doctor. He or she may prescribe some medicine that you take only when you have a headache to relieve the pain. It's best to treat tension headaches when they begin and are still mild--before they get more painful.

Your doctor may also prescribe a medicine that you take every day, even when you don't have a headache, to help prevent tension headaches. Your doctor will tell you which type of medicine he or she is prescribing for you.

If your tension headaches don't get better, or if they get worse, call your doctor for further advice.

What else can I do to ease the pain of a tension headache?
Besides taking medicine, other things you can do to ease the pain of a tension headache include the following:

* Put a heat pack or an ice pack on your head or neck.
* Take a hot shower.
* Get enough rest or sleep.
* Take time away from things that are stressful. This could mean doing anything from taking a brief walk to going on a long vacation.
* Get regular exercise of all types. Work up to exercising for 30 to 60 minutes, 4 to 6 times a week.

Source :

Summarized by Robert W. Griffith, MD
July 16, 1999 (Reviewed: January 21, 2005)

There's one good thing about getting older - you don't get headaches so often. However, although they are less frequent, they can still be extremely annoying, and can sometimes be a sign of some underlying, more serious, condition. In 1997 an article was published on the special features of headaches in older persons.

Most headaches in both young and old persons are caused by non-serious changes in the blood flow over the surface of the brain. These types of headache include migraines, tension headaches and "cluster" headaches. They account for 9 out of 10 headaches in younger people, but only about two-thirds of those in the elderly. It is the remaining one third of headaches that are important, as they may signify a medical condition that requires treatment, or a change in existing treatment.

To make matters more complicated, the symptoms of migraine can change with age in some patients. Indeed, very occasionally migraine occurs for the first time after the age of 50. If you are a migraine sufferer whose symptom-pattern has changed, or if your first migraine occurred after the age of 50, your physician should do further tests to make sure there is no underlying disease. Medication for migraine should be specially tailored for older patients as well - anti-migraine drugs may worsen some medical conditions, while some drugs for other conditions can make a migraine worse.

Diseases that can cause headache in older people include:

* giant cell arthritis (or temporal arthritis) -- a very rare inflammation of the head arteries which can be treated successfully with steroid drugs
* brain tumors (either originating in the brain, or spread from a tumor somewhere else in the body)
* blood clot accumulation (a subdural hematoma, which results from bleeding caused by injury)
* changes in the blood flow to the brain due to arterial disease of the brain arteries
* arthritis of the spine in the neck
* chronic obstructive pulmonary disease (COPD, a troublesome breathing condition caused by chronic bronchitis, emphysema, prolonged heavy smoking)

In badly ventilated homes, especially if the heating arrangements are poor, there is a risk of buildup of carbon monoxide. This can cause dull, diffuse (all over the head) morning headaches, which get better when the person goes outside or opens the windows.

Quite a few medications can cause headaches, which are usually dull, diffuse, and sometimes throbbing. The drugs responsible are either for lowering blood pressure, treating irregular heart beats, treating Parkinson's disease, sedatives, stimulants, pain killers, anti-ulcer drugs or anti-asthma drugs. Your physician may be able to help, by changing the medication, or the dose.

There is a rare condition called hypnic headache, which has been reported in people over 65. The patient is woken up once or twice a night, almost every night, with a headache that lasts half-an-hour or more. The headache usually involves both sides of the head, and causes some nausea. These headaches can be treated with lithium or indomethacin, with a good chance of success.

To summarize, headaches in older persons are more likely to be caused by an underlying disease than is the case in younger people. This means that, if you as an older adult are troubled with headaches, you should visit your physician and ensure that he/she considers the possibility that you may have another, more serious problem, before prescribing "2 aspirins".

* Headaches in older people. How are they different in this age-group? J. Edmeads, Postgrad Med, 1997, vol. 101, pp. 91--100

Wednesday, November 21, 2007

Basic Skin Types

There's not much you can do about the skin type you're born with. But by taking care of it properly, you can control and maintain texture and radiance from your 20s right through to your 50s and over.
The types of skin are normal, oily, dry and combination.

They are determined according to the degree of oiliness or dryness. Generally, skin type correlates with pore size. To determine your own skin type, wash your face and wait 30 minutes. Then put a single piece of tissue paper against each area of your face: forehead, nose, chin, cheeks. Your oily areas will leave oil on the tissue paper.

Dry skin has a rough texture and may become flaky. There are no shiny areas; in fact, the skin looks dull. Pores tend to be smaller because less oil is produced. Without adequate moisture, dry skin can easily become chapped. As dry skin ages, it’s more likely than other types to become wrinkly.

Normal skin has an equal balance of water and oil, making it naturally well moisturized. The pores are medium-sized. When you pull the skin away from the bony structure, it springs back to normal position. Lines and wrinkles are appropriate for age.

Oily skin has a coarse texture. Usually oily areas tend to shine. Oily skin results from overactive oil glands; the oil helps retain dead skin cells in the hair follicles. Pores tend to be larger. The dead skin cells may darken with exposure to the air, forming blackheads. Often, individuals with oily skin have a tendency to develop acne in their teen and middle years, and overgrown oil glands, or sebaceous hyperplasia, in the middle and late years.

Combination skin is a mixture of dry and oily areas of differing degrees. Usually the T-zone -- the forehead, nose and chin -- is prone to oiliness, whereas the cheeks and neck tend to be dry. More people have combination skin than severely dry or oily skin. Ideally you would need to treat these two areas separately.

Help your skin by…
Sticking to a healthy diet – beta carotene converts to vitamin A (essential in strengthening the skin tissue); vitamin C helps collagen production; vitamin E is good for conditioning; and vitamin B is good for repairing.
Supplementing your diet with evening primrose oil; it contains gamma-linolenic acid (GLA), a fatty acid that strengthens the skin cells and stimulates moisture content.
Getting enough sleep, allowing the skin to repair itself.
Exercising, which boosts blood flow.
See also "Good Skin is a Reflection of Inner Health".

Tuesday, November 20, 2007

Acne is the most common skin disease treated by physicians. It is a chronic condition that affects over 85% of adolescents and young adults. One study showed that two-thirds of teenagers with acne wanted to talk to their physician about their acne, but only one-third actually did.

Types of Acne
Not all acne is the same. Simplistically, acne can be divided into red bumps and blackheads/whiteheads. This division is important because each type is treated differently. Blackheads and whiteheads, known as comedones, can be more numerous on the face and shoulders than red bumps filled with pus. Good, consistent skin hygiene can help improve this condition. Therefore, knowing more about what causes comedones and how to treat them is a step towards clearer skin.

Why Does Acne Occur?
This article walks through step-by-step how acne is formed.

Blackheads, also known as open comedones, are follicles that have a wider than normal opening.
They are filled with plugs of sebum and sloughed-off cells and have undergone a chemical reaction resulting in the oxidation of melanin. This gives the material in the follicle the typical black color.

- Picture of several blackheads
- Picture of blackheads close-up

Whiteheads, also known as closed comedones, are follicles that are filled with the same material, but have only a microscopic opening to the skin surface. Since the air cannot reach the follicle, the material is not oxidized, and remains white.

Skin Care for Blackheads and Whiteheads
The key to skin care for acne is consistency. An overnight cure has not been found. But using good skin care methods aids in the daily, steady improvement of follicle health. Since acne is not caused by eating certain foods, restricting the diet is not helpful. Since it is also not caused by "dirty" skin, excessively scrubbing does not help and can even make the skin more irritated.

The best skin care for comedones consists of once-a-day cleansing with a mild soap or facial scrub to aid in the removal of excess sebum and dead skin cells. Oil-based makeup should not be used since these can contribute to the buildup of oil in the follicles. Water-based makeup labeled as non-comedogenic can be used safely.

Treatment of Blackheads and Whiteheads
Treatment of whiteheads and blackheads takes time. Most treatments take several weeks to months before a noticeable change is seen.

Benzoyl Peroxide
Benzoyl peroxide has an antibacterial effect and may also decrease the chemical reaction that changes the lining of the hair follicle. This may help reduce the plugging that causes comedones. Benzoyl peroxide may be used for a mild case of comedones or to help prevent formation of others.

Tretinoin (Retin-A)
Tretinoin (Retin-A, Avita, Renova) is the mainstay of treatment for whiteheads and blackheads. Tretinoin is a derivative of vitamin A and works by increasing cell turnover and reducing the "stickiness" of the sloughed cells. It helps expel the plugged material returning the pore to normal. Tretinoin can be irritating, so specific instructions on how to use it can be found here.

Prescription topical antibiotics or oral antibiotics might be used if some of the blackheads and whiteheads are infected, but antibiotics do not help with comedones that are not infected.

Isotretinoin (Accutane)
Isotretinoin (Accutane) is used for severe cystic acne and has many side effects. It is very effective for comedones when used properly, but is not usually prescribed for mild acne of either type.

Extraction may be used by a health care provider on open comedones. This process is performed using a device called a comedone extractor. This is a small, metal, circular instrument that is centered on the comedone and pushes down the surrounding skin, causing the plug to extrude.

No Need to Suffer
Whiteheads and blackheads are types of acne that affect many people. There are good treatment options available, so there is no need to suffer with this condition in silence. A primary care provider can initiate treatment for acne and follow mild to moderate cases. Severe cases or those resistant to treatment should be seen by a dermatologist.

Feldman, Steven, et al. "Diagnosis and Treatment of Acne." American Family Physician 69(2004): 2123-36.

Habif, Thomas. "Acne, Rosacea, and Related Disorders." Clinical Dermatology, 4th Edition. Ed. Thomas Habif, MD. New York: Mosby, 2004. 167-71.

Haider, Aamir, and James Shaw. "Treatment of Acne Vulgaris." Journal of the American Medical Associaion 292(2004): 726-35.

Zaenglein, Andrea and Diane Thiboutot. "Acne Vulgaris." Dermatology. Ed. Jean Bolognia. New York: Mosby, 2003: 531-5.

Sunday, November 18, 2007

Recent scientific research on Bird's nest found it contained rich amino acids and rich in antioxidant. The two essential elements which help to generate new cell and counter free radicals in our body.


Bird's nest is rich in antioxidant. Antioxidants are substances or nutrients in which can prevent or slow the oxidative damage to our body. Health problems such as heart diseases, macular degeneration, diabetes, cancer etc are all contributed by oxidative damage. Antioxidants may also immune defense and therefore lower the risk of cancer and infection.

Amino Acids

Bird's nest contain amino acids like Leucine, Lysine, glycine,glutamine,tyrosine,arginine, cystein,histidine, tryptophan etc. Amino acids best be described as the construction blocks from which protein is made.

In general, edible bird's nest cna be divided into cave nests and house nests. Cave nests are mainly harvested from natural caves. Since cave nests are 'made' by free,naturally-living swiflets, some consider them to be more valuable than house nests. Hence, they fetch a higher price. However, hte truth is cave nests generally contain more foreign materials and feathers than house nests. Besides,cavenests are exposed to the risk of heavy metal contamination from the environment.

House nests are made by swiflets (Collocalia, sp.) in the attice of countryside houses. Now ,human has acquired the knowledge of cultivating the swiflets in control buildings. Generally, the texture of house nests are smoother compared to those of cave nests,with less feathers and other contaminants.

Bird's nest is an expensive and nutritive product. Thus it is important to distinguish the genuine bird's nest. In the market, there are many producers who would increase the weight of bird's nest by adding additives like white fungus,jelly and skin.

Appearance:- Good and genuine nests consist of two main types of filaments. The outer layer that has longer and bigger filaments whereas the inner part has finer, shorter filaments.

Cooking:- When double boiled for an hour the bird's nest inner filaments become water soluble. The outer filaments contain mainly minerals, it is less soluble but gives bird's nest its signature fibrous taste and appearance.

Odour:- During double boiling a fine scent of near albumin odour will occur.

Bird's nests contain gycoprotein. This special glycoprotein has mitogenic effect properties named as Epidermal Growth Factor(EGF) which can stimulate cell growth. The tonic powers of bird's nests are believed to improve skin complexion and slow down the aging.

In traditional Chinese medicine, bird's nest is believed to offer good effect for treating tuberculosis,dry coughs, asthma,and general weakness due to bronchial ailments. It is also traditionally used to nourish the kidney, lung, heart and stomach. Consumption of bird's nest is also recommended to complement other treatments to combat degenerative diseases such as cancer and also for convalescence or to recover health after illness or surgery.

I am Dr Tan Boon Siong, graduated from University of St. Clements. My dissertation is "The critical review and analysis of organization behaviour in Malaysia. I am running a few bird's farms, which can produce 10 kgs of bird's nest per month. We are cooperating with local university to under study and analysis of bird's nest. We provide guaranteed product.

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Sleep is essential to having good health; however, as people get older, many times they find themselves sleeping less and less at night. When the body does not get enough sleep it can make the brain slower to react and can slow down on the repairing of the body that is to occur during sleep. As you approach old age, you may already be dealing with health issues and problems remembering things at times, but believe it or not, getting a good night’s sleep each night can really help. There are a variety of steps that you can take to help you achieve a deep, quality sleep that will have you waking up fresh and full of vigor. Instead of counting sheep, use the following tips every evening and you should begin to notice a difference in the amount and the quality of your sleep.

Tip #1 - Eat a Light Evening Meal - The first thing you need to do if you want to get a better night’s sleep is to eat a light evening meal. If you eat too much in the evening, your body has to digest this large amount of food, and this can end up keeping you awake for a good portion on the night. Start eating lighter meals and it will help you get to sleep faster.

Tip #2 - Avoid Drinking Too Much - Drinking too much liquid before bedtime can be causing you to have sleepless nights as well. As you get older, usually your bladder gets a bit overactive, and if you drink a great deal before bedtime you may end up getting up to use the restroom every hour or so. You can avoid this problem by doing most of your drinking during the day and avoiding having too much to drink before bedtime.

Tip #3 - Do Some Exercising - While you may think that exercise is the wrong thing to do in the evening, exercising can actually have a positive effect. Although right after you exercise you will probably feel a bit revved up, after about an hour or so your body will start cooling down and you will probably begin feeling sleepy. Just a brisk walk or a nice jog a couple hours before you go to bed can really help.

Tip #4 - Have a Glass of Warm Milk - Believe it or not, just having a simple glass of warm milk can help reduce your sleeplessness at night as well. With the modern convenience of the microwave, you can quickly warm up a nice glass of milk in just seconds. The milk will sooth your stomach and should make you start feeling sleepy.

Tip #5 - Take a Warm Bath - Another tip that can help you sleep better at night is to take a warm bath before bedtime. The warm water will sooth your body and relax your muscles. Many people have a problem sleeping because their body hurts or they cannot relax, but taking a warm bath can sooth these problems and help you get relaxed enough so you can quickly drift off to sleep, once you get in bed.

Tip #6 - Sleep in a Firm Bed - A firm bed is extremely important to getting a good night’s sleep as well. If your bed is too soft and saggy it can cause you to have a great deal of back pain, which can lead to many sleepless nights. You may want to consider investing in a new mattress that is firmer, or consider purchasing one of the mattresses that allow you to adjust the firmness to your comfort. Even though purchasing a new mattress can be a bit expensive, remember that your sleep is important, and an investment in your sleep will be worth the money that you spend.

When you consider just how important sleep is to your well being, investing a bit of time and money in getting good sleep will be 100% worth it. Start using these tips in your life and no doubt you will begin to see a huge difference in the amount and quality of sleep that you get on a nightly basis.

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