Acute Migraines More Apt to Turn Chronic With Poor Treatment

Study compared patients to see who made the jump to frequent headaches within year

By Robert Preidt

HealthDay Reporter

FRIDAY, June 28 (HealthDay News) -- People who receive inadequate treatment for acute migraine headaches are more likely to develop chronic migraines, according to a new study.

Researchers looked at data from more than 4,600 people with episodic migraines (14 or fewer migraine days per month) and found that 48 percent of them received poor or very poor treatment.

These patients were more likely to progress to having chronic migraines (15 or more migraine days a month) than those who received better treatment, according to the study, which was presented this week at the International Headache Congress meeting in Boston.

Within a year, about 8 percent of patients who received very poor treatment progressed to chronic migraine, compared with 4.4 percent of those who received poor treatment, 2.9 percent of those who received moderate treatment and 2.5 percent of those who received the best treatment.

Migraines are debilitating headaches involving intense pulsing or throbbing pain, and often nausea, vomiting and hypersensitivity to light and sound.

The study was conducted by a team from the Montefiore Medical Center and Albert Einstein College of Medicine, in New York City, and Vedanta Research, in Chapel Hill, N.C.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"These findings are exciting as they provide clinical targets for intervention. When we discover factors that increase the risk of progression, health care providers can focus their efforts in those areas to improve care and outcomes," study co-author Dawn Buse said in an International Headache Congress news release.

"In this case, we have found several factors in acute migraine treatment which may likely improve outcomes, including using medications that work quickly and maintain pain-free results, which allows and empowers people who live with migraines the freedom and confidence to make plans and fully engage in their lives," Buse said.

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Should I take steroids for my chronic sinus infections?

Posted June 12, 2013, 2:00 am

I have chronic sinusitis and nasal polyps. My specialist suggested trying oral corticosteroids. What do you think?

“Steroids” is short for anti-inflammatory hormones called corticosteroids, and “oral” means steroids taken in pill form. I think a short course of five to seven days of oral steroids is worth a try. That’s particularly true if your sinusitis isn’t getting any better. My colleague, Neil Bhattacharyya, an ear, nose and throat doctor and professor at Harvard Medical School, agrees. Much of what I say below is based on his advice.

As you know, sinusitis is an inflammation of the mucous membranes that line the sinuses. It often causes headaches and an uncomfortable feeling of pressure in the face. (I’ve put an illustration of how sinusitis works below.)

Sinusitis is inflammation of the mucous membranes that line the sinuses.

Chronic inflammation in the membranes of your nose and sinuses can cause fleshy growths called polyps. Not all cases of chronic sinusitis result in polyps, but when they form, polyps can block your nasal passages and sinuses. This makes breathing more difficult and can diminish your sense of smell. Polyps also make it easier for infections to start in your sinuses.

I assume you’ve tried the usual techniques for dealing with sinusitis: inhaling steam, taking extra-long showers, drinking lots of water and sleeping with your head elevated. A course of antibiotics is also often appropriate if there are clear signs of bacterial infection in your sinuses (such as green or brown discharge when you blow your nose, a fever and a rotten feeling).

Once sinusitis becomes chronic, the inflammation can take on a life of its own. Corticosteroids become an important treatment option, as they have anti-inflammatory effects.

The first type of steroid to try is one that can be inhaled into the nose. Inhaled steroids deliver the medicine directly to the inflamed tissues that need to be quieted. However, polyps can block the passage of the inhaled steroids to some of the inflamed areas.

If inhaled steroids don’t do the job, it’s worth considering a brief course of steroids in pill form. Taking an oral steroid such as prednisone for a week or so reduces the size of the polyps a little and decreases overall inflammation in the nose. Shrinking polyps and reducing inflammation allow the topical steroid to reach its target and be more effective.

The reason I and many doctors hold off on using steroids in pill form is that the medicine travels in the blood, exposing the whole body to the medication. (In contrast, topical steroids expose only the nose and sinuses.) Side effects are more likely from oral steroids than from inhaled steroids; they may include elevated pressure in the eyes (glaucoma), increased blood pressure and mood swings. But in my experience, a short course of oral steroids, such as what I’m recommending here, rarely produces serious side effects.

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What’s the best way to prepare for travel when you have chronic medical conditions?

Posted June 07, 2013, 2:00 am

In a few months, my husband and I are taking our first trip abroad. We both have chronic medical conditions. How should we prepare for our trip?

Many people with medical conditions enjoy foreign travel. But your preparation will need to involve more than just reading some guidebooks.

First, check in with your doctor. He or she may have specific concerns or advice for you. If you have diabetes, for example, your blood sugar level is affected not only by how much you eat, but by how much you exercise. And during vacations, both of these can change substantially. So ask yourself what the impact on your eating and exercise is likely to be from the vacation you have planned.

Since you’re traveling internationally, find out if you need vaccinations or preventive medications. You can check the Centers for Disease Control and Prevention (CDC) website (cdc.gov/travel), or ask your doctor. Try to get your shots four to six weeks before your trip, as some vaccinations need time to kick in.

If you take prescription medications, pack more than enough to last through your trip, in case your return gets delayed. And carry your medications in your carry-on bag, not in your checked luggage in case it gets lost. (The TSA makes an exception to the “no more than 3.4 ounces of liquids or gels” rule for prescription medications and necessary medical supplies.) That’s what I have done ever since, 20 years ago, I spent the first two days of a trip trying to get replacement medicines in a foreign country because my luggage was lost.

Also, carry a list of your medications, with both the generic and brand names. And bring along a doctor’s note if you have a pacemaker or other implanted device; you may need it when going through security checkpoints.

Get the name of a doctor or hospital at your destination. There are organizations on the Internet that maintain the names of English-speaking doctors with good reputations in many countries around the world. They also identify trusted hospitals. One example is the International Association for Medical Assistance to Travelers.

I can’t personally vouch for the quality and integrity of the doctors and hospitals linked to these organizations. I can say that many of the organizations have boards of directors populated by doctors affiliated with major U.S. academic medical centers. And check with your insurance to see what you need to do in case of an emergency.

If you easily suffer from motion sickness, take medicine in your carry-on bag. In addition, pack the following in your checked luggage:

antidiarrheal medication, a laxative and an antacid;antihistamine and 1 percent hydrocortisone cream for mild allergic reactions;cold medicine;medications for pain relief or fever;antifungal and antibacterial ointments;lubricating eye drops;basic first-aid items (adhesive bandages, gauze, elastic bandage, antiseptic, tweezers, scissors, cotton-tipped applicators).

With a little advance planning, you and your husband can enjoy a healthy and safe vacation.

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Losing Weight May Ease Chronic Heartburn

Study found shedding pounds reduced GERD symptoms among overweight, obese patients

By Kathleen Doheny

HealthDay Reporter

MONDAY, May 20 (HealthDay News) -- Obese and overweight men and women who suffer from heartburn often report relief when they lose weight, a new study shows.

The researchers tracked the effects of weight loss over a year in patients who had a persistent form of heartburn known as gastroesophageal reflux, or GERD.

"If you lose weight, you will have improvements in your reflux symptoms," said study author Dr. Preetika Sinh, a gastroenterology fellow at the University of Kansas School of Medicine. In women, but not men, long-term exercise also helped reduce symptoms, she added.

Sinh was scheduled to present the findings Monday at the Digestive Disease Week annual meeting in Orlando, Fla.

Previous research also has linked weight loss with a decline in GERD symptoms.

Heartburn, or acid indigestion, is very common, with more than 60 million Americans having it at least once a month, according to the American College of Gastroenterology. Stomach acid flows backward up into the esophagus, and the burn begins.

GERD, the more frequent, chronic form of heartburn, can lead to complications if left untreated, including a narrowing of the esophagus or precancerous changes in the esophageal lining.

Sinh evaluated more than 200 men and women with an average age of 46. At the start of the study, all were overweight or obese, with an average weight of 220 pounds.

At the beginning of the study, 38 percent had heartburn scores severe enough to be classified as GERD. After six months, the patients' average weight decreased to 183 pounds, and only 16 percent still had GERD.

During the next six months, 172 of the patients regained weight, and the percentage of those with heartburn increased again, from 16 percent to 22 percent. Even a small amount of weight gain -- less than 5 percent of their initial weight -- led to worsening symptoms, Sinh found.

Sinh then focused on the 41 patients who didn't regain their weight and found that the percentage with heartburn continued to decline and the symptoms continued to improve.

As part of the weight-loss program, the patients were told to aim for five hours a week of moderate activity such as walking or jogging. The average amount logged was a little less than four hours, Sinh said.

In women, but not men, the exercise also helped to improve heartburn.

Sinh said she can't explain the mechanisms behind either the weight loss or the exercise, or why the exercise seemed to help only women. Although the study found a link between weight loss, exercise and GERD, it did not establish a cause-and-effect relationship.

While the use of heartburn medications is common, Sinh said she can't say if the men and women improved enough to go off medication, since she didn't track those results. Only about 5 percent of the men and women were on heartburn medications in the first place, she said.

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What could be causing my chronic headaches?

Posted May 22, 2013, 2:00 am

I’ve had a headache every day for six months, despite taking painkillers every day. What could be causing the headaches? And what can I do to stop them?

At the risk of sounding like I’m fear-mongering, I’m concerned about your symptoms. That’s because most people who suffer from frequent headaches don’t have them every day. If your headaches have literally been with you “every day for six months,” and this is something new for you, consult your doctor. While your headaches still could be one of the two most common causes of headaches — migraine headaches or tension headaches — they also could point to something more serious.

If you are over 50 and had not been bothered by regular headaches earlier in life, I’d advise you even more strongly to talk to your doctor. Chronic headaches that develop for the first time after age 50 are more likely to be something serious.

Unfortunately, many people are regularly bothered by headaches. For some, that’s been true since they were young adults, or even children. We have talked in other columns about migraine headaches and tension headaches, but I want to focus here on something else: headache from medication overuse.

Taking lots of painkillers — the very things you’re taking every day to tame your headaches — could be making your headaches worse. Caffeine-containing drugs are most often to blame. (I’ve put a table listing the caffeine content of some common headache drugs below.)

Caffeine is a double-edged sword when it comes to headache drugs. While this popular stimulant helps painkillers work more quickly and efficiently, it is often a suspect in medication overuse headaches. (Note: For reference, the caffeine content in a cup of coffee ranges from 95 to 200 milligrams.)

Anacin Advanced Headache FormulaGoody’s Extra Strength Headache PowdersVanquish Extra-Strength Pain Reliever CapletsPrescription drugs (Brand name)Ergotamine/caffeine tablets (Cafergot)Ergotamine/caffeine suppositories (Migergot)Aspirin, butalbital, caffeine (Fiorinal)Acetaminophen, butalbital, caffeine (Fioricet)Aspirin, caffeine, orphenadrine (Norgesic, Norgesic Forte)Aspirin, caffeine, dihydrocodeine (Synalgos-DC)

Caffeine helps painkillers work more quickly and efficiently. But over time, caffeine builds up in your body, causing blood vessels to narrow. This makes you feel better — temporarily — because widened blood vessels contribute to headache pain. But when the caffeine wears off, your blood vessels expand and your headache returns.

Regular use of painkillers likely also interferes with your body’s natural painkilling system. Because painkillers mask symptoms, whatever is causing the pain may worsen. As the pain becomes more intense, painkillers are less able to control it.

f there’s a chance you’re overusing headache medications, the first step is to stop taking the drugs. Going “cold turkey” works best, but you can gradually wean yourself off the painkillers by cutting back a little each day.

If you’re not overusing painkillers, try a headache-prevention regimen. Start with simple pain relief treatments such as applying a heating pad daily to your neck and shoulders. Consider physical therapy, including such techniques as massage, ultrasound or gentle stretching to relieve muscle tightness that may contribute to your headaches.

Talk to your doctor about preventive medications, such as a muscle relaxant. Another effective strategy is to combine a tricyclic drug with a beta blocker. Beta blockers decrease the intensity of headaches, while tricyclics reduce their frequency.

If your headaches begin to recur, you’ll need medications to treat them. But don’t use them unless your headache becomes severe. Otherwise, you risk developing — or lapsing back to — medication overuse.

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Chronic Heartburn May Raise Odds for Throat Cancer: Study

But simple antacids appear to lower the risk, researchers report

By Steven Reinberg

HealthDay Reporter

THURSDAY, May 23 (HealthDay News) -- People who suffer from frequent heartburn may be at increased risk for cancers of the throat and vocal cords even if they don't smoke or drink alcohol, a new study says.

Interestingly, common over-the-counter antacids seemed to protect against these cancers while prescription medications such as Prilosec, Nexium and Prevacid didn't, the researchers said.

"There has been a controversy about whether heartburn contributes to cancers of the larynx or pharynx," said lead researcher Scott Langevin, a postdoctoral research fellow at Brown University in Providence, R.I.

"And we found out that it does elevate the risk of these cancers. There is about a 78 percent increase in the risk for cancer in people who experience heavy heartburn," he said. "This is important in figuring out who to monitor more closely."

The other finding, which Langevin called "surprising," was the protective effect of common antacids in reducing the risk of cancer.

"We didn't see that protective effect with prescription medications. But it should be noted that people who take them are those who get the worst heartburn, so we shouldn't read too much into that," he said.

Langevin added that it's hard to explain that medication finding, and other studies will be needed to see if it's really the case. "It's possible that these drugs didn't have that protective effect because these were the worst cases of heartburn," he said.

The report was published May 23 in the journal Cancer Epidemiology, Biomarkers & Prevention. And while it uncovered an association between heartburn and cancer of the throat and vocal cords, it didn't prove a cause-and-effect relationship.

Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society, said "the study shows that reflux is associated with an increased incidence of cancers of the larynx and pharynx."

Lichtenfeld said the role of antacids in reducing the risk of cancer needs more study. "Researchers need to determine why antacids work and, more importantly, whether antacids make a difference in also reducing cancer of the esophagus," he said.

Why other medications didn't lower the risk isn't clear, Lichtenfeld said. And it points to one limitation of this type of study: It can't take into account all the variables.

To come to their conclusions, Langevin's group compared more than 600 patients with throat or vocal cord cancer with more than 1,300 people without a history of cancer. All the patients answered questions about their history of heartburn, smoking and drinking habits, and family history of cancer.

In addition, since some head and neck cancers are caused by the human papillomavirus (HPV), the researchers tested all the participants for antigens to the virus.

The researchers found that among those who weren't heavy smokers or drinkers, frequent heartburn increased the risk for cancers of the throat and vocal cords by 78 percent.

The researchers also found that taking antacids -- but not prescription medications or home remedies -- reduced the risk for these cancers by 41 percent. The protective effect of antacids was independent of smoking, drinking or infection with HPV, they said.

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Migraine, Chronic Back Pain Tied to Higher Suicide Risk

Hopelessness, disability may play a role in feelings of despair, study finds

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, May 22 (HealthDay News) -- People who endure chronic migraines or back pain are more likely to attempt suicide, whether or not they also suffer from depression or another psychiatric condition, according to a new study.

"Clinicians who are seeing patients with certain pain conditions should be aware they are at increased risk of suicide," said study co-author Mark Ilgen, of the Veterans Affairs Serious Mental Illness Treatment Resource and Evaluation Center in Ann Arbor, Mich.

"Although undoubtedly psychiatric factors are important, there might be aspects of the pain that in and of themselves increase a person's risk," Ilgen said. "There might be something about someone with significant pain that puts them at increased risk."

The wide-ranging study, published online May 22 in the journal JAMA Psychiatry, involved more than 4.8 million people who received care from the U.S. Veterans Health Administration during fiscal year 2005. Researchers identified those suffering from chronic pain and tracked them for the next three years to see if any died from suicide.

The research team then looked for associations between suicide death -- the 10th most common cause of death in the United States -- and clinical diagnoses of chronic pain conditions, such as arthritis, back pain, migraines, neuropathy, headaches or tension headaches, fibromyalgia and psychogenic pain.

They found that all pain conditions except arthritis and neuropathy were associated with elevated suicide risk. But when they took into account the mental-health problems that chronic pain patients also had, the associations reduced for all but three types of chronic pain: back pain, migraines and psychogenic pain, which stems from psychological factors.

Dr. Elspeth Cameron Ritchie, a retired Army colonel and psychiatrist living in Washington, D.C., said the study clearly reinforces the anecdotal link between pain and suicide.

"It makes sense that pain is a risk factor for suicide," she said. "Often, suicide has several different things going on, but pain can be the straw that breaks the camel's back in terms of a person's decision not to go on."

Therapists performing a suicide-risk evaluation should consider adding a question regarding pain to the standard questions aimed at suicidal thoughts and planning, she said.

"It's not a standard question: 'Are you in pain?'" Ritchie said. "I would ask, 'Are you in pain?,' or 'Is pain an issue for you?'"

Psychogenic pain increased people's risk of suicide the most, followed by migraines and back pain. Psychogenic pain is chronic pain caused or exacerbated by mental or emotional problems, and Ilgen said it is a rare and not well understood condition.

"We think that's not so much about psychogenic pain per se, but the fact that the pain itself is poorly understood and may be poorly managed," Ilgen said. "There's not a clear treatment plan for that type of pain. It's likely that patients with this type of pain may be frustrated with their care and more hopeless and more at risk for suicide."

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Too Much Sitting Linked to Chronic Health Problems

By Mary Elizabeth Dallas

HealthDay Reporter

THURSDAY, Feb. 21 (HealthDay News) -- People who spend hours each day without getting up and moving around should take heed: A new study suggests that the more people sit each day, the greater their risk for chronic health problems, such as cancer, diabetes and heart disease.

Researchers from Australia and Kansas State University said their findings have implications for office workers, truck drivers and other people who regularly sit for long periods of time. To reduce the risk of chronic disease, the study authors concluded that people should sit less, and move more.

"We know that with very high confidence that more physically active people do better with regard to chronic disease compared with less physically active people, but we should also be looking at reducing sitting," Richard Rosenkranz, assistant professor of human nutrition at Kansas State University, said in a university news release.

"A lot of office jobs that require long periods of sitting may be hazardous to your health because of inactivity and the low levels of energy expenditure," he explained.

The study involved over 63,000 Australian men from New South Wales, ranging in age from 45 to 65. The researchers questioned the men about whether or not they had various chronic diseases. The men also reported how many hours they spent sitting down each day.

The study revealed that the men who sat for four hours or less daily were much less likely to have a chronic condition -- such as cancer, diabetes, heart disease or high blood pressure -- than those who sat for more than four hours each day. And the men who sat for at least six hours daily were at significantly greater risk for diabetes, the researchers noted.

The number of chronic diseases reported increased along with sitting time. This was true even after the investigators took the men's physical activity level, age, income, education, weight and height into account.

"We saw a steady stair-step increase in risk of chronic diseases the more participants sat. The group sitting more than eight hours clearly had the highest risk," said Rosenkranz.

"It's not just that people aren't getting enough physical activity, but it's that they're also sitting too much," he said. "And on top of that, the more you sit, the less time you have for physical activity."

The study authors noted it's not entirely clear if sitting time leads to the development of chronic diseases or if it's the other way around: "It's a classic case of, 'Which came first: The chicken or the egg?'" Rosenkranz pointed out in the news release.

The study was published online recently in the International Journal of Behavioral Nutrition and Physical Activity.

More information

The U.S. Centers for Disease Control and Prevention has more on the benefits of physical activity.

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Too Much Sitting Linked to Chronic Health Problems

Title: Too Much Sitting Linked to Chronic Health Problems
Category: Health News
Created: 2/21/2013 12:35:00 PM
Last Editorial Review: 2/22/2013 12:00:00 AM

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Magnetic Implant May Ease Chronic Acid Reflux

By Amy Norton

HealthDay Reporter

WEDNESDAY, Feb. 20 (HealthDay News) -- An implanted magnetic device could offer a new treatment option for people with chronic heartburn that is not controlled with medication, a small study suggests.

The study, reported in the Feb. 21 issue of the New England Journal of Medicine, tested a newer approach to taming stubborn cases of gastroesophageal reflux disease (GERD) -- one of the most common health conditions diagnosed in the United States.

GERD arises when the ring of muscle between the esophagus and stomach fails to close properly, allowing stomach acids to splash up into the esophagus. The main symptom is chronic heartburn.

For people who have frequent heartburn -- more than twice a week -- the go-to medications are the so-called proton pump inhibitors, such as Prilosec, Prevacid and Nexium. But studies estimate that up to 40 percent of people on those drugs do not get enough relief.

The new study included 100 such GERD patients. They all received an implant -- a bracelet-like device composed of magnetic beads -- that wraps around the portion of muscle where the esophagus joins the stomach. The point is to "augment" the muscle and prevent stomach acid reflux.

After three years, researchers found, 64 percent of the patients had their acid reflux cut by at least half. And 87 percent had been able to stop taking their proton pump inhibitors altogether.

"That's huge," lead researcher Dr. Robert Ganz said of the medication reduction.

It's estimated that Americans spend $14 billion a year on prescription proton pump inhibitors. Because of the costs and potential side effects, many people would like to drop the drugs, said Ganz, an associate professor at the University of Minnesota in Minneapolis.

He cited bone-thinning as one potential long-term side effect. "A lot of women do not want to be on proton pump inhibitors for that reason in particular," Ganz said.

The device his team studied is already approved in the United States and marketed as the LINX Reflux Management System by Torax Medical, Inc., which also funded the study.

Ganz said he could envision the device as an option for "some fraction" of the 20 million to 30 million Americans who take a daily medication for GERD symptoms.

There are, of course, less extreme ways to manage your heartburn. Diet changes and weight loss often help, and if your heartburn is milder, over-the-counter antacids or drugs called H2 blockers -- brands like Zantac and Tagamet -- may be enough.

Proton pump inhibitors, which block acid production, are often recommended for people with more frequent heartburn. If that doesn't work, surgery is typically seen as the last-ditch option.

Traditionally, that has meant a 50-year-old procedure called Nissen fundoplication, where the upper part of the stomach is stitched around the lower end of the esophagus.

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Chronic Illness and Relationships: Communicating and Managing Stress

Don't let chronic illness weaken the bond between you and your partner.Reviewed by Kimball Johnson, MD

Having a chronic illness such as diabetes, arthritis, or multiple sclerosis can take a toll on even the best relationship. The partner who's sick may not feel the way he or she did before the illness. And the person who's not sick may not know how to handle the changes. The strain may push both people's understanding of "in sickness and in health" to its breaking point.

Studies show that marriages in which one spouse has a chronic illness are more likely to fail if the spouses are young. And spouses who are caregivers are six times more likely to be depressed than spouses who do not need to be caregivers.

Making Lust Last

By Keith Ablow, M.D. Rekindling Passion For The Husband You Still Love   People sometimes tell me they know a couple married 20 years whose sex life is still as good as it ever was. Here's what I tell them in return: "There are only three possibilities. One: This couple is lying. Two: They are telling the truth, because they didn't have good sex to begin with. Or three: Sex is all they really have together. They never connected emotionally." I've drawn that conclusion by listening...

Read the Making Lust Last article > >

Clinical psychologist Rosalind Kalb, vice president of the professional resource center at the National Multiple Sclerosis Society, says, "Even in the best marriages, it's hard.  You feel trapped, out of control, and helpless."

But with patience and commitment, there are ways you and your partner can deal with the strain a chronic illness can place on your relationship.

Relationships can suffer when people don't discuss problems that have no easy or obvious solution, Kalb says. And that lack of discussion can lead to feelings of distance and a lack of intimacy.

"Finding ways to talk openly about challenges," she says, "is the first step toward effective problem-solving and the feelings of closeness that come from good teamwork."

Marybeth Calderone has limited use of her legs and hands because of a neurological disorder called Charcot-Marie-Tooth. Her husband Chris says that figuring out when to communicate is his biggest challenge.

"My wife gets frustrated with herself when she can't do things, like organize our 8-year-old daughter's desk," he says. "A lot of times, I'm not sure if Marybeth is angry at me or with her condition. Often, I try to figure it out on my own and don't say anything.”

The right level of communication is key. Boston College social work professor Karen Kayser says, "If the couple is consumed with talking about the illness, that's a problem. If they never talk about it, it's also a problem. You have to find a middle ground."

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Chronic Illness and Relationships: Communicating and Managing Stress

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Track your way to weight loss success Manage your family's vaccinations Join the conversation See more benefits Sign Up Why WebMD? My WebMD Show Menu My Tools My WebMD Pages My Account Sign Out FacebookTwitterPinterest WebMD Home Health & Sex Center Health & Sex Feature Stories Email a FriendPrint Article Health & Sex Tools & ResourcesFight ED With Exercise Sex Quiz: Fact or Fiction?Infidelity Quiz: Who Cheats?Sex and Dating After Divorce Low Testosterone ExplainedMale Orgasms: How They Change Font Size A A A 7 Ways to Keep Your Relationship Strong Despite a Chronic Illness Don't let chronic illness weaken the bond between you and your partner. ByKaren Bruno
WebMD Feature Reviewed byKimball Johnson, MD

Having a chronic illness such as diabetes, arthritis, or multiple sclerosis can take a toll on even the best relationship. The partner who's sick may not feel the way he or she did before the illness. And the person who's not sick may not know how to handle the changes. The strain may push both people's understanding of "in sickness and in health" to its breaking point.

Studies show that marriages in which one spouse has a chronic illness are more likely to fail if the spouses are young. And spouses who are caregivers are six times more likely to be depressed than spouses who do not need to be caregivers.

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By Keith Ablow, M.D. Rekindling Passion For The Husband You Still Love People sometimes tell me they know a couple married 20 years whose sex lifeis still as good as it ever was. Here's what I tell them in return: "Thereare only three possibilities. One: This couple is lying. Two: They are tellingthe truth, because they didn't have good sex to begin with. Or three: Sex isall they really have together. They never connected emotionally."I've drawn that conclusion by listening...

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Clinical psychologist Rosalind Kalb, vice president of the professional resource center at the National Multiple Sclerosis Society, says, "Even in the best marriages, it's hard.  You feel trapped, out of control, and helpless."

But with patience and commitment, there are ways you and your partner can deal with the strain a chronic illness can place on your relationship.

1. Communicate

Relationships can suffer when people don't discuss problems that have no easy or obvious solution, Kalb says. And that lack of discussion can lead to feelings of distance and a lack of intimacy.

"Finding ways to talk openly about challenges," she says, "is the first step toward effective problem-solving and the feelings of closeness that come from good teamwork."

Marybeth Calderone has limited use of her legs and hands because of a neurological disorder called Charcot-Marie-Tooth. Her husband Chris says that figuring out when to communicate is his biggest challenge.

"My wife gets frustrated with herself when she can't do things, like organize our 8-year-old daughter's desk," he says. "A lot of times, I'm not sure if Marybeth is angry at me or with her condition. Often, I try to figure it out on my own and don't say anything.”

The right level of communication is key. Boston College social work professor Karen Kayser says, "If the couple is consumed with talking about the illness, that's a problem. If they never talk about it, it's also a problem. You have to find a middle ground."

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The Treatment of Overweight and Obesity as Chronic Medical Conditions

To begin our discussion, let’s discuss the current thinking about overweight and obesity. Physicians and scientists now believe that overweight should be considered a chronic medical condition. Practically, this means that we should consider treating our weight like we would consider treating ourselves if we had high blood pressure.

For example, if you found out you have high blood pressure, most people would first go to see their primary care physician. The primary care physician would check your blood pressure and likely start out by asking you to do a few things on your own to help the blood pressure like cut out salt and decrease alcohol use. At your next visit, if the blood pressure was still high, your physician would likely prescribe medical therapy for your blood pressure in the form of a high blood pressure pill. At your follow up visit , if your blood pressure is well controlled, your physician would refill your medicine and arrange the for future monitoring. If after several adjustments in medication your blood pressure is not within normal limits or if your blood pressure is severely elevated which can lead to organ damage, your physician would then refer you to another physician, likely a nephrologist, a specialist in blood pressure control. Your blood pressure specialist will use tools and medications that your primary care does not use everyday as the nephrologist has more experience with hard to treat blood pressure. If at any time, you were decide to stop treatment with your blood pressure medicine or to have a really salty meal, it is no doubt that your blood pressure would go up again.

Let’s use weight in the same example as blood pressure. When you first seek treatment for overweight or obesity, the first person to visit is your primary physician. Your physician may recommend a particular diet and exercise regimen. Like easily controlled blood pressure, this may be all you need. If your weight does not respond adequately (your loss is not enough) or if the diet is too hard to follow or you have been on it prior and had weight regain or you have multiple medical conditions that your current weight is worsening like diabetes, high blood pressure or sleep apnea your physician should send you to a specialist in weight loss called a medical obesity specialist (see www.ASBP.org or www.ABOM.com). This physician is well trained in comprehensive medical weight loss and will use techniques not well studied or known to your primary care physician.

To treat our weight any other way than as a chronic disease (like blood pressure) would be to go against current medical and scientific thinking. Aggressive low calorie diets, exercise, behavioral modification and medical oversight including various weight loss medications are the current best known way to lose weight, and give you the best known way to keep it off. When you are successful in using dietary change, weight loss medicines, exercise and behavioral methods to lose weight, if you stop dieting, taking your weight loss medication or exercising, it is likely that you will regain your weight.

It is unfortunate that at this time we do not have a true cure for obesity. Medical science is continuing the pursuit for a cure. Until a cure is found, we will have to use comprehensive approaches to lose weight and continue these treatments for long periods of time to prevent regain.

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Yoga shown effective for treating chronic neck pain

Nov. 27, 2012 — According to published estimates, some 20 percent of the population suffers from chronic neck pain caused by a variety of structural dysfunctions in the neck, resulting in impaired quality of life and lost work time. A German study published in The Journal of Pain showed that yoga appears to be an effective treatment for neck pain and provides added benefits of improved psychological well being and quality of life.

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The Journal of Pain is the per-review publication of the American Pain Society.

The mainstay of conservative treatment for neck pain is non-steroidal anti-inflammatory medication, and the evidence of its effectiveness is contradictory while side effects, such as nausea and dizziness, are well known. The authors noted that one type of yoga, called lyengar yoga, has been shown effective in other pain syndromes, including low back pain. This activity uses supportive props and the sequences of postures can be tailored to address an individual's medical problem. No randomized controlled clinical trials have been published to assess the efficacy of lyengar yoga for adults with chronic neck pain.

Researchers at Charité-University Medical Center in Berlin and other sites in Germany and Austria studied 77 volunteer patients. Thirty-eight were assigned to the yoga group and 39 to a group treated with exercise. Unfortunately, the dropout rate was higher than anticipated as 24 subjects withdrew or were lost to follow-up. This reduced the study sample to 25 patients in the yoga group and 28 in self-care exercise. They were asked to complete a standardized questionnaire at the outset of the study, after four weeks, and after ten weeks.

The findings showed there was a significant and clinically important reduction in pain intensity in the yoga group. The authors reasoned that yoga might enhance both the toning of muscles and releasing of muscle tension. Relaxation responses, therefore, could reduce stress related muscle tension and modify neurobiological pain perception. They concluded, based on the study data, that lyengar yoga can be a safe and effective treatment option for chronic neck pain. The study results are consistent with the demonstrated benefits of yoga for treating low back pain.

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