Andy Jordan at Shop To The Beat Party

Andy Jordan lived up to his Made In Chelsea credentials and was spotted quaffing Champagne at George Lamb’s Shop To The Beat Party

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Can surgery help my spinal stenosis?

Posted May 08, 2013, 2:00 am

I’m a man in my 70s with spinal stenosis. What are my surgical options?

Your spine is made up of a column of bones called vertebrae. The vertebrae are separated by tough little shock-absorbing disks that keep the bone of the vertebra on top from rubbing against the bone of the vertebra beneath it. The vertebrae and disks have a circular space in the center, called the spinal canal, through which your spinal cord (the long nerve that extends from your brain down your back) passes. For much of your life, your spinal canal is wide enough that it doesn’t touch or push on your spinal cord.

However, as the bones and disks grow older, in some people they begin to break down. The disks may bulge out and push on the spinal cord, or pinch a nerve root coming out of the spinal cord. Ligaments, which connect your vertebrae to one another and allow them to move flexibly, may thicken, or small bony growths may develop and protrude into the spinal canal.

Spinal stenosis is a narrowing of the spinal canal caused by the problems with aging disks, ligaments or bones that I just mentioned. (I’ve included an illustration depicting spinal stenosis below.) It causes low back pain and discomfort in the thighs or lower legs when you stand up straight, bend backward or walk even short distances. You’re probably more comfortable sitting or leaning forward.

Spinal stenosis, a narrowing of the spinal canal, usually results from degeneration of the disks, the ligaments, or the facet joints on the posterior (rear) part of the spine. Age-related changes can cause the disks to shrink, which reduces the space between the vertebrae and the facet joints. Stress on these joints can lead to arthritic changes, which can cause one vertebra to slip forward, a condition called spondylolisthesis. In this example, the fifth lumbar vertebra (L5) has slipped forward a few millimeters with respect to the first sacral vertebra (S1).

For some people, symptoms improve substantially over time without treatment. If your stenosis is fairly recent, give yourself some time to see if your symptoms improve on their own.

If you are overweight, weight loss can help. The heavier you are, the more pressure one vertebral bone puts on the bone below it.

Exercises and physical therapy are the most widely used treatments. My impression, and that of most of my colleagues, is that they are effective. However, there aren’t many large, rigorous scientific studies to confirm that opinion.

Exercises that are less likely to cause the vertebral bones to pound on each other are preferred. So rather than jogging, try swimming, bicycling or using equipment such as an elliptical cross-trainer.

If your symptoms don’t improve, surgery to remove the structures that are pressing on your spinal cord is often successful. People who have this surgery can usually be physically active, with few or no restrictions, for a long time. However, up to one in four patients need a second surgery within 10 years of their initial surgery.

Sometimes the changes that cause spinal stenosis cause a vertebra to slip forward. If that’s true in your case, you might consider spinal fusion surgery. This fixes the position of the vertebrae permanently, preventing future displacement. By reducing motion in the affected area of the spine, spinal fusion relieves the pain caused by abnormal movement.

So even though you asked about surgery, you should know that most people with spinal stenosis never need it. Fortunately, simpler approaches work for most people.

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Pixie Lott at the Shop to the Beat party in London

Pixie Lott wears a black bow cardigan and black and white checked trousers to the Shop to the Beat party in London - vote on celebrity fashion, style and red carpet looks in GLAMOUR.COM’s Dos and Don’ts

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Should I worry about the glycemic load of foods I eat?

Posted May 11, 2013, 2:00 am

Can you explain the importance of glycemic load, as opposed to glycemic index, when judging carbohydrates?

Carbohydrates, along with proteins, fats, vitamins, minerals, water and oxygen, are nutrients: We need them to live and grow. But even though we need carbohydrates, there still are carbohydrate-rich foods that are “good carbs” and “bad carbs.”

Carbohydrates are the main nutrient in bread, pasta, cereals, beans, vegetables and dairy foods. All sugars are carbohydrates. When you eat, your body breaks carbohydrates down into sugar molecules. The smallest sugar molecule, glucose, is absorbed from your gut into your blood. It travels through the blood to every cell, providing an important source of energy to each cell.

Some foods are easily and rapidly digested into glucose. Such foods have a high glycemic index. With other foods, the process of digestion goes slower. These foods have a low glycemic index.

To give a cell energy, glucose has to get from the blood to the inside of the cell. That’s the job of insulin, a hormone made by the pancreas (a small gland in your abdomen). Insulin also travels in the blood, and when insulin attaches to a cell, it allows glucose to get inside it.

OK, those are the basics. When you digest carbohydrates, a certain amount of glucose will enter your blood. How much, and how rapidly, depends on two things: how much carbohydrate there is in the food, and the glycemic index of the food. Together, these two measures determine the glycemic load. If there are a lot of carbs in a food and the glycemic index of that food is high, then there will be a rapid, high spike of sugar in your blood: The glycemic load will be high.

When your blood levels of glucose rise, your pancreas senses this and promptly releases insulin. Foods with a high glycemic load cause your pancreas to suddenly work very hard to make and release insulin. In general, a lower and slower conversion from carbohydrate to blood sugar is better for your health. In other words, foods with a low glycemic load are better.

Here are some examples of foods with different glycemic loads:

Low glycemic load (10 or lower): lentils and beans, fruits and vegetables, nuts and seeds, whole grains.Medium glycemic load (11 to 19): steel-cut oatmeal, whole-wheat pasta, some breads, fruit juices without extra sugar, brown rice, sweet potatoes.High glycemic load (20 or higher): Soda, energy drinks and other sugar-sweetened beverages, candy, white rice, French fries and baked potatoes, sugary breakfast cereals.

(I’ve put a table showing the glycemic index and glycemic load values of many commonly eaten foods below.)

Don’t misunderstand: I’m not saying it’s dangerous to eat foods with a high glycemic load. But your diet, on average, should favor carbohydrate-containing foods that have low glycemic loads.

The glycemic index and glycemic load offer information about how a food affects blood sugar and insulin. The lower the glycemic index or glycemic load, the less the food affects blood sugar and insulin levels. Scientists have calculated glycemic index and glycemic load for more than 2,500 foods. A sample is provided in the table below. The University of Sydney in Australia maintains a free searchable database of glycemic index and glycemic load values at www.glycemicindex.com. The healthiest choices are those with a glycemic index below 55 and a glycemic load below 10.*Glycemic load is calculated by multiplying grams of carbohydrate by glycemic index and dividing by 100.Source: Atkinson FS, Foster-Powell K, Brand-Miller JC. “International tables of glycemic index and glycemic load values: 2008,” Diabetes Care (2008), Vol. 31, No. 12, pp. 2281–83. window.fbAsyncInit = function() { FB.init({appId: "199616670120169", status: true, cookie: true, xfbml: true});}; (function() { var e = document.createElement("script"); e.async = true; e.src = document.location.protocol + "//connect.facebook.net/en_US/all.js"; document.getElementById("fb-root").appendChild(e);}());

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Spine MRIs Often Show Harmless 'Defects,' Study Finds

After treatment, many people have visible evidence of a herniated disc without any symptoms

By Serena Gordon

HealthDay Reporter

WEDNESDAY, March 13 (HealthDay News) -- Even though expensive MRIs produce very detailed images for assessing back pain, they may not be very good at evaluating results after treatment, research suggests.

Many physicians order an MRI before and after treatment of patients with lumbar-disk herniation and persistent sciatica. But some experts say spine imaging is overused and not necessarily accurate in certain cases.

This new study used MRI scans from a study initially designed to compare surgery to conservative care for sciatica, which is pain or weakness that radiates from the back down the leg. The researchers compared a person's first MRI to their follow-up MRI taken a year later. They couldn't tell from the follow-up MRIs who had good results and who didn't.

"The discriminative power of MRI is much less than expected in patients who had sciatica before or who have had persistent complaints for more than one year," said the study's senior author, Dr. Wilco Peul, professor and chairman of neurosurgery at Leiden University Medical Center in the Netherlands.

Peul said that the decision to have a second surgery shouldn't be based on MRI findings alone.

Even if it appears from a follow-up MRI that surgery is necessary, he said people should be advised that their continued pain may be caused by inflammation rather than nerve compression, and in that case, it's unlikely that surgery would relieve their symptoms.

Results of the study are published in the March 14 issue of the New England Journal of Medicine.

Sciatica is a common problem, affecting as many as 40 percent of adults at some time in their lives. Sciatica is commonly caused by a herniated disc in the back as it presses down on the sciatic nerve, according to background information in the study. These discs are located between each of the vertebra, or bones, in the spine.

For most people, sciatica is a short-lived problem. Within eight weeks, most people no longer have sciatic pain, according to the study. For some people, however, sciatic pain can be long-lasting.

When sciatic pain doesn't go away, doctors often recommend imaging tests, such as MRIs, to rule out serious causes of the pain, such as a tumor, said Dr. Devon Klein, chief of musculoskeletal radiology at Lenox Hill Hospital in New York City.

The problem is that many people have herniated discs, often without any symptoms. Previous research has found that between 20 percent and 76 percent of people who don't have symptoms will show signs of disk herniation on an MRI, the study found.

Klein confirmed this. "If you take all comers and give them an MRI, you will see disc disease in most of them," he said. "Everyone hurts their back at some point."

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David Walliams and Lara Stone at a Comic Relief event in London

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Should I use mouthwash, in addition to brushing my teeth?

Posted May 10, 2013, 2:00 am

I brush and floss regularly. Do I need to use mouthwash too?

Judging from the ads, you need mouthwash to prevent plaque (the yellowish film of bacteria that attaches to your teeth and leads to cavities) and gingivitis (inflammation of the gums). But mouthwash actually plays a fairly minor role in the prevention of plaque and gum disease. Brushing and flossing are much more important.

Cavities, gingivitis and bad breath are all caused by certain bacteria that live in every person’s mouth. You can’t eliminate them, but you can reduce their number and prevent the damage they can cause.

Mouthwash has a history that goes back thousands of years. People have used rinses made with everything from betel leaves to dill and myrrh dissolved in white wine. Listerine was first developed in the late 19th century as a surgical antiseptic. It was named after the British surgeon, Sir Joseph Lister, who pioneered the prevention and treatment of bacterial infections that occurred following surgery.

These days, many mouthwashes are highly artificial concoctions that contain sweeteners for taste and artificial colorings for a bright hue. Alcohol is often included as well.

It’s true that mouthwash will make your breath smell better for a while. The question is whether that’s achieved by killing off odor-producing bacteria or merely masking the problem. More effective than mouthwash at masking the problem are breath mints. It’s easier to use them repeatedly during the day than to swish mouthwash repeatedly.

The most effective way to reduce bad breath is to brush your tongue when you’re brushing your teeth. Most of the bacteria that cause bad breath reside in a small area near the back of the tongue. Brushing them away with a toothbrush is more effective than rinsing with a mouthwash.

On the other hand, some research has found that two antibacterial ingredients most commonly used in mouthwashes may reduce the levels of bacteria that produce bad breath. What’s more, other mouthwash ingredients (zinc and chlorine dioxide) may neutralize other smelly compounds.

What about gum disease? There are about a dozen species of bacteria, found in plaque, that cause gum disease. They cause inflammation that can break down gum tissue and the bone that holds teeth in place.

Brushing and flossing are the best ways to remove plaque, but the antibacterial ingredients in some mouthwashes do have a modest effect. Look for mouthwashes that have the American Dental Association’s (ADA’s) “Seal of Acceptance” as a plaque fighter.

Finally, most mouthwashes do not prevent cavities — nor do they claim to. Some newer mouthwashes contain fluoride, and some of them have the ADA’s blessing as proven cavity fighters.

So it’s fine to use mouthwash, but brushing and flossing are still the mainstays in preventing cavities and gum disease.

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Eva Mendes at the LA launch of Vogue Eyewear

Eva Mendes wears a multi-coloured lace dress and maroon velvet heels to the LA launch of Vogue Eyewear - vote on celebrity fashion, style and red carpet looks in GLAMOUR.COM’s Dos and Don’ts

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Can good posture ease back pain?

Posted May 14, 2013, 2:00 am

I have mild back pain. I sit at a desk all day and tend to slouch. My mother says that sitting up straight may help. Is she right?

I hope it’s true. Otherwise, my mother (like yours) was wrong. And I think it is true.

Most of us get back pain at some point in our lives. It’s usually not caused by an accident. Rather, it develops because, in going about our regular activities, we strain muscles and ligaments in the back that support our spines. This happens during the course of day-to-day life. Repetitive activities at work or home, such as sitting at a computer or lifting and carrying, may produce tension and muscle tightness that result in backache.

Fortunately, there’s a lot we can do to prevent back pain. Most of all, it’s important to be physically fit and to maintain a healthy weight. Minding your posture helps, too.

Posture is the way you hold your body while standing, sitting or performing tasks such as lifting or bending. If your posture is good, the bones of your spine align correctly. If your posture is bad and the spinal bones are not in proper alignment, there is extra stress on the muscles and ligaments. They try to correct for the bad posture and become injured from the strain. This is how poor posture can both cause back pain and make it worse. (I’ve put an illustration showing good posture while sitting and standing below.)

Try the following exercises. They can help improve your posture and head off back pain:

Imagery. Think of a straight line passing through your body from ceiling to floor. Your ears, shoulders, hips, knees and ankles should be even and line up vertically as you stand. Now imagine that a strong cord attached to your breastbone is pulling your chest and rib cage upward, making you taller.Shoulder blade squeeze. Sit up straight in a chair with your hands resting on your thighs. Keep your shoulders down and your chin level. Slowly draw your shoulders back and squeeze your shoulder blades together. Hold for a count of five; relax. Repeat three times.Upper-body stretch. Stand facing a corner with your arms raised, hands flat against the walls, elbows at shoulder height, with your right foot forward. Bend your right knee, but keep the left knee straight. Keep your back straight and your chest and head up. You should feel a nice stretch across your chest. Hold this position for 20 to 30 seconds. Relax.

Now and then, you’ll meet someone who has perfect posture and hasn’t had to work on it. It’s just comes naturally. Most of us, however, tend to slouch. Our mothers really were right: Good posture not only makes us look better, it also protects us against back pain.

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Candice Swanepoel V Michelle Dockery

who wore it best? Latest celebrity style brought to you by Glamour.com. Visit Glamour.com for the latest celebrity styles, fashion and gossip.

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Exercise is good, not bad, for arthritis

Posted May 08, 2013, 2:38 pm

When pain strikes, it’s human nature to avoid doing things that aggravate it. That’s certainly the case for people with arthritis, many of whom tend to avoid exercise when a hip, knee, ankle or other joint hurts. Although that strategy seems to make sense, it may harm more than help.

Taking a walk on most days of the week can actually ease arthritis pain and improve other symptoms. It’s also good for the heart, brain, and every other part of the body.

A national survey conducted by the federal Centers for Disease Control and Prevention showed that more than half of people with arthritis (53%) didn’t walk at all for exercise, and 66% stepped out for less than 90 minutes a week. Only 23% meet the current recommendation for activity—walking for at least 150 minutes a week. Delaware had the highest percentage of regular walkers (31%) while Louisiana had the lowest (16%). When the CDC tallied walking for less than 90 minutes a week, Tennessee led the list, with 76% not walking that much per week, compared to 59% in the  District of Columbia.

This map shows the percentage of adults with arthritis in each state who walked less than 90 minutes per week during 2011.

The findings were published in the journal Morbidity and Mortality Weekly Report, one of its contributions to Arthritis Awareness Month.

Walking is good exercise for people with arthritis, but it isn’t the only one. A review of the benefits of exercise for people with osteoarthritis (the most common form of arthritis) found that strength training, water-based exercise, and balance therapy were the most helpful for reducing pain and improving function. “Swimming or bicycling tend to be better tolerated than other types of exercise among individuals with arthritis in the hips or knees,” says rheumatologist Dr. Robert H. Shmerling, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center.

Exercise programs aim to help people with arthritis:

increase the range of motion in the affected jointstrengthen musclesbuild enduranceimprove balance

You can create an exercise program of your own, with help from a trusted doctor, nurse, or physical therapist. Or you can try one that’s been developed by arthritis experts. Examples include the Fit and Strong! program from the University of Illinois at Chicago, or one of several programs developed by the Arthritis Foundation: its Exercise Program, Walk with Ease program, or Aquatics program.

The fatigue, pain, and stiffness caused by many types of arthritis present a barrier to exercise—but these are the same symptoms that tend to improve with regular exercise.

If you have arthritis and don’t currently exercise, start slow. Take a five-minute stroll around your block, swim, or workout on an exercise bicycle. Do it every day, and then gradually increase the time spent exercising or how hard you exercise, but not both at once. If you have heart disease or other health issues, check with your doctor before embarking on an exercise program.

“If exercise was a newly developed medicine, it would be a blockbuster,” says Dr. Shmerling. “It has an excellent safety profile, and enormous benefits for people with arthritis, heart disease, and a long and growing list of other health problems.”

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Genes vs. Lifestyle: What Matters Most for Health?

Does an illness like heart disease or cancer run in your family? Don't assume that your genes control your destiny. Experts say the lifestyle choices you make every day can help keep you healthy.

There's no doubt that some genes do lead inevitably to disease. "But for most people, a healthy lifestyle trumps inherited risk," says cardiologist Donald Lloyd-Jones, MD. He is chair of preventive medicine at Northwestern University Feinberg School of Medicine. "Even if a disease runs in your family, there's a lot you can do to avoid it."

Here's a look at how lifestyle changes can cut your risk of disease.

About 25% of colon cancers are in people with some family history of the disease. In the rest of people who get colon cancer, genetics doesn't seem to play a role.

But lifestyle may be a factor. Studies show that most people can dramatically lower their colon cancer risk by taking these steps:

Eat very little red or processed meat.Exercise.Keep a healthy weight.Drink alcohol in moderation or not at all.

Other cancers are even more influenced by the choices we make. A good example is lung cancer.

80% to 90% of lung cancers are caused by smoking.Men who smoke are 23 times more likely to develop lung cancer than nonsmokers.Women who smoke are 13 times more likely to get lung cancer.

The longer you smoke and the more cigarettes you smoke, the greater your risk.

Still, genes do play some role. Some people who get lung cancer never smoked. Other people smoke and don't get lung cancer. But the biggest risk factor by far is smoking.

With heart disease, more than 100 types of genes may play a small role in a person's risk, Lloyd-Jones says. "But by far the biggest factor is lifestyle."

Lloyd-Jones and colleagues analyzed data from the Framingham Heart Study. The study followed three generations of families. The researchers found that:

Family history made up only 17% of a person's heart disease risk.Poor lifestyle choices, such as lack of exercise, made up a whopping 83% of the risk.

A heart-healthy lifestyle can lower your risk of heart disease.

For example, one type of gene strongly linked to heart disease is called 9p21. On average, it raises your risk of having a heart attack by about 20%.

But if people who carry this gene eat a diet with lots of fruits and vegetables, research shows, they cut their risk back down to normal. People with that type of gene who eat a poor diet, on the other hand, have two times the normal risk of having a heart attack.

Type 2 diabetes is influenced by a combination of genes and lifestyle. Between 30% and 70% of the risk of developing type 2 diabetes is shaped by inherited genes.

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Few plan for long-term care though most will need it

Posted May 06, 2013, 2:09 pm

Two of every three Americans who reach age 65 will at some point need long-term care for up to three years. Yet the majority of those age 40 and older have done “little or no planning” for how they might pay for long-term care when they get older.

That’s a key finding from a new survey of 1,019 Americans over age 40 on the topic of long-term care. The survey was done by the Associated Press and NORC at the University of Chicago. Other interesting results:

Most people underestimate the cost of nursing home care (it averages $6,700 a month) and overestimate what Medicare will cover.Few people are setting aside money for long-term care even as most worry about key issues of aging such as memory loss or being a burden to family members.Many people support public policy options for financing long-term care, either through tax incentives to encourage saving for long-term care or a government-administered plan.

As a primary care doctor, I see my patients struggle with how the cost of age-related care affects their lives and their financial realities. Long-term care costs are huge. We can’t afford not to think about them.

The U.S. Census Bureau estimates that $217 billion will be spent in 2015 on nursing home and residential care. This includes assisted living facilities and board and care homes. Currently, about 25% of these costs are paid out-of-pocket by older adults and their families. Almost two-thirds of the cost is paid by Medicaid and Medicare combined.

Medicare only pays for short-term care—20 days in a nursing home—when illness causes disability. After that, patients or their families must meet these costs out-of-pocket. Most older adults with chronic needs then “spend down” their funds to pay for long-term care until the money runs out. At that point, at poverty level, Medicaid support may be available.

Without a crystal ball, it’s tricky to plan for the future. It’s easy to convince yourself that you or a partner won’t need long-term care. But the statistics suggest you should start planning now, even if your plan isn’t perfect.

1. Talk with your family. Nearly 60% of older people who need long-term nursing or personal care rely fully on unpaid caregivers, usually their children or spouses. Sometimes this is an obvious arrangement. But your family must be flexible and committed. If a caregiver must stay at home, some family income will be lost. This is rarely a comfortable situation if everyone did not agree ahead of time.

2. Consider long-term-care insurance. Fewer than 3% of American adults have purchased a long-term care insurance policy. The average cost is high. A typical plan might cost $3,300 a year for a healthy 60-year-old couple. And it might pay only a $150 a day for up to 3 years. For a person who buys this insurance at age 65, there is a 45% chance of making a claim. If you never need long-term care, the payments you made to the plan are lost.

3. An “age in place” retirement arrangement might be right for you. Some campus-like retirement communities are designed to permit an older adult to “age in place.” This means you can go from a relatively independent life to a more dependent life while staying in the same community. Services often include recreation for the active elderly and 24-hour skilled nursing or rehabilitation services for the frail elderly. These organizations are called continuing care retirement communities. They are always expensive. Usually, they charge an up-front fee of $25,000 to $500,000. Then you pay a membership fee or rent each month.

4. Build up your savings. Making ends meet is a challenge. But in your working years, don’t underestimate how much you need to save. Many of us think, “After we no longer have our mortgage, we should be able to live on our savings.” It’s a good idea to factor long-term care into your savings plan. If disability strikes, you will need it.

5. Write an advance directive (“living will”). Some people receive intensive medical care after they become profoundly disabled. By then, some people who are in this situation are no longer able to communicate their wishes to family members and doctors. If you know that you would not want life-sustaining treatments in this condition, it is wise to record your wishes in a legal “advance directive.”

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How Much Does It Cost to Have a Baby? Hospital Costs, Baby Supplies, and More

The expenses you’ll face when you have your first baby, and tips for spending wisely on your newborn.

If you're thinking about having a baby, you're probably thinking of the joy of holding your newborn in your arms -- not the financial costs.

But sooner or later, you run into the expenses involved with a pregnancy. And although the experience of becoming a parent is priceless, you'll also want to make sure your money is well spent.

From the price of diapers to the going rate for a cesarean section, here's the bottom line on what it costs to have a baby, as well as how to save wisely on those costs.

It's easy to get excited about buying baby supplies. But your top priority for pregnancy spending should be on health -- of mother and baby.

"Early and continuous prenatal care is essential both before and throughout your pregnancy to help ensure a healthy delivery and healthy baby," says Jeanne Conry, MD, an obstetrician with Kaiser Permanente in Sacramento, Calif.

If you have health insurance, prenatal visits and any diagnostic tests (such as ultrasounds) will likely be covered. They are generally considered "preventive" care.

If you don't have health insurance, the average cost of prenatal care is about $2,000.

One of the most important parts of prenatal care is a prenatal vitamin. You need one that contains at least 400 micrograms (mcg) of folic acid to help prevent neural tube birth defects.

This is one cost you should start paying even before you get pregnant. About half of all pregnancies are surprises. So all women of childbearing age should take a multivitamin that contains folic acid, Conry says.

For an over-the-counter option, the cost ranges from $10 to $20. If it's prescribed by your doctor and covered by your insurance you'll pay whatever the co-pay price is. Either way, this could be one of the most important pregnancy investments you make.

Shopping for a newborn baby can be overwhelming. You don't want to go overboard on expensive baby luxuries that aren't must-haves.

"There are thousands of baby products on the market for new moms to consider, but frankly speaking, most are nice-to-haves," says Lori Hill, a certified doula in Williamsburg, Va.

You should first focus on what you and your baby must have, she says. Then figure out how much you have left over to spend on accessories.

Some basic supplies to consider buying include:

Car seatCribDiapers and wipesChanging tableA few baby clothes to get you startedBaby monitor

A thrifty parent can buy these for about $450 by shopping for bargains.

But don't sacrifice safety to save a buck, especially on the car seat and crib. The American Academy of Pediatrics recommends that you avoid older, used car seats to get maximum protection for your child. Use cribs certified by the Juvenile Products Manufacturers Association (JPMA).

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