Healthy Aging - Sexual Vitality

Because sexuality tends to be a private matter, it's likely that you've heard less about sexual change than any other element of aging. Fortunately, the news is good-for most healthy adults, pleasure and interest don't diminish with age. Most people are sexual throughout their lives, with or without a partner, and some feel greater sexual freedom in their later years. On the other hand, some men and women are content to be sexually inactive.

Around age 50, men and women typically begin to notice changes in their sexual drive, sexual response, or both. Like so many other physical changes that evolve over time, these aren't signs that you are losing your sexuality. Rather, these changes are simply something to adjust to and discuss openly with your partner and/or health professional.

Normal sexual changes in men

As you age beyond your 50s, you may find that:

• Male sex drive is minimally affected by age (although health problems, certain medications, or relationship stress can lower sex drive).
• Erections become less firm and tend to take more time than when you were younger.
• You may be able to delay ejaculation for longer than when you were younger.

Normal sexual changes in women

After menopause, estrogen and androgen levels drop, causing physical changes. You may find that:

• It can take longer to become sexually excited.
• Your skin may be more sensitive and easily irritated when caressed.
• Intercourse may be painful because of thinning vaginal walls (regular sex often helps prevent this from becoming severe). If a water-based lubricant (such as Astroglide or Replens) isn't enough, talk to your health professional about vaginal estrogen cream, which reverses thinning and sensitivity. For more information, see the topic Menopause and Perimenopause.
• You are less interested in sex.

If you have noticed sexual changes that don't seem to be linked to normal aging, talk to your health professional. There are a number of medications that can cause sexual problems, as well as health conditions that can cause sexual problems.

Adjusting to age-related sexual changes

With a little experimentation and patience, you can adjust to sexual changes and satisfy your sexual and intimacy needs. If you think your sexual interest might be affected by a medication or health problem, work with your health professional to correct or treat it. Talk with your partner about any misgivings you might have so you can handle them together.

With your partner, take your time to set a relaxed mood and engage in foreplay. Use a lubricant if vaginal dryness or irritation is a barrier to enjoying sex. If you drink alcohol, remember that a small amount may relax you and increase your responsiveness, but too much alcohol is likely to work against you.

Sexually transmitted diseases (STDs) are a risk no matter what age you are. Unless you and your partner have recently been tested or you are 100% sure that you both have been monogamous for many years without infection, make sure that you practice safe sex to prevent STDs.

WebMD Medical Reference from Healthwise

Last Updated: June 22, 2006

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

@ 1995-2007, Healthwise, Incorporated. Healthwise, Healthwise for every health

Your Pregnancy Week by Week: Weeks 1-4

If you are newly pregnant, or trying to conceive, you have many questions about what to expect. How will your body change? What's happening inside you? WebMD has teamed up with experts from The Cleveland Clinic to guide you, week by week, through the nine months of pregnancy. Each week offers information about your body and baby's, as well as invaluable tips. Let's start with a peek inside the womb.

Weeks 1 and 2

Baby:Your baby is still just a glimmer in your eye. Although it's confusing to think about a pregnancy starting before your child is even conceived, doctors calculate your due date from the beginning of your last cycle since it's hard to know exactly when conception occurred.

Mom-to-be: At the beginning of a cycle, about 20 eggs called ova begin to ripen and occupy fluid-filled sacs called follicles. One of these follicles matures and ruptures, releasing an egg that will travel down the fallopian tube, where it awaits fertilization. This all takes place about 14 days before the end of your cycle. This is the time you're most fertile, so light some candles, take the phone off the hook, and set aside some intimate time. An egg can be fertilized for only about 12 to 24 hours once the ovum is released. Don't be disappointed if it doesn't work the first time. You have only about a 20% chance of getting pregnant each month.

Tip for the Week: Make sure you've scheduled a preconception visit with your OB-Gyn to determine risks of genetic diseases, environmental hazards and lifestyle changes necessary to ensure a healthy pregnancy and baby. Most important, make sure you've started taking 0.4 milligrams, or 400 micrograms, of folic acid a day. Folic acid taken a few months before conception has been shown to dramatically reduce the likelihood of neural tube defects, such as spina bifida.

Week 3

Baby:Congratulations! If your egg and your partner's sperm have joined successfully, your embryo is really there, although it's very small -- about the size of the head of a pin. It doesn't look like a fetus or baby; it's just a group of about 100 cells multiplying and growing rapidly. The outer layer of cells will become the placenta, and the inner layer will become the embryo.

Mom-to-be: You won't notice any changes. It's too soon. Remember, you haven't even missed your period yet.

Tip for the Week: Home pregnancy tests are about as reliable as a urine test or blood test done in the doctor's office and can give you more immediate results than waiting for a doctor's visit. To ensure accuracy, make sure you've read the directions carefully and that all equipment being used is clean

Week 4

Baby:Your baby is still very small, only about 0.014 inches to 0.04 inches in length. The embryo, probably in about its second week of development, has multiplied to about 150 cells. Your baby is being nourished by secretions from the uterine lining. Layers of cells already are specialized according to functions. The outer layer will become the nervous system, skin and hair; the inner layer will be the breathing and digestive organs; and the middle layer will become the skeleton, bones, cartilage, muscles, circulatory system, kidneys and sex organs.

Mom-to-be:You're probably expecting your period this week, and if it doesn't occur it might be one of the first signs that you're pregnant. You may also notice light spotting as the embryo implants itself in your uterus. You might not feel any different yet, but the amniotic cavity, which will be filled with fluid, and the placenta, which will bring oxygen and nutrients to nourish your baby, are forming in your uterus.

Tip for the Week:Try to eat healthfully, which means choosing a variety of foods from the recommended food groups and drinking at least six to eight 8-ounce glasses of water a day. But you don't really need to "eat for two." You need only an extra 300 calories per day during pregnancy. And don't worry if your food intake drops a little in the beginning because of morning sickness. If you've been eating right already, your baby will get what it needs.

What’s Happening Inside You?

As the fertilized egg grows, a water-tight sac forms around it, gradually filling with fluid. This is called the amniotic sac, and it helps cushion the growing embryo.

The placenta also develops. The placenta is a round, flat organ that transfers nutrients from the mother to the baby, and transfers wastes from the baby.

A primitive face takes form with large dark circles for eyes. The mouth, lower jaw, and throat are developing. Blood cells are taking shape, and circulation will begin.

By the end of the first month, your baby is about 1/4 inch long - smaller than a grain of rice!

Reviewed by The Cleveland Clinic Birthing Services and the Department of Obstetrics and Gynecology

Too Sick to Work?

How sick is too sick to go to work? Advice on when you should just stay home.

By Susan Seliger
WebMD Feature

Reviewed by Louise Chang, MD

What’s a good enough reason to call in sick? If you wake up feeling sneezy, sleepy, dopey and grumpy, as if you've turned into nearly all of Snow White’s dwarves overnight, you might be wondering whether you should tough it out or just stay home. Here’s some advice on how to tell when your symptoms warrant staying at home – or when you have to roll out of bed and get to work.

#1 Good reason to call in sick: You’re a danger to others

“You have to ask yourself the key question: Are you a danger to yourself or to others?” says Michael Bagner, MD, attending physician at St. Luke’s/Roosevelt Hospital and Medical Director of Roosevelt Hospital Doctors Offices in New York.

If, for example, you have an earache that affects your balance or concentration, you can’t do much harm sitting at your computer.

“But for someone who drives a bus or is a pilot, that earache could be very dangerous, for everybody,” Bagner explains. Also, if you are taking medication that can make you so groggy as to make it dangerous to perform your routine duties, you should do everyone a favor and stay home.

#2 Good reason to call in sick: You’re contagious

Contagion is another critical deciding factor – but not always an easy one to determine.

“A lot of diseases are contagious before you realize you’re sick,” Bagner tells WebMD. “Once you know you’re sick, you may not be contagious any more, and may as well go to work.”

But it pays to err on the side of staying home “if you work in close quarters with your co-workers – or you work with elderly or small children or people with cancer or chronic conditions —those are the most vulnerable people in our society,” says Bagner. “A minor nuisance of an illness to you could be fatal to them.” (Check out the symptoms below to help you determine contagiousness.)

#3 Good reason to call in sick: You won’t be productive

The third issue to consider is how productive you will really be. Ask yourself whether showing up just to prove you are a team player could make things worse.

“Sometimes people come back too soon and they get even sicker and wind up staying out longer,” says Paula H. Harvey, a human resources consultant with K & P Consulting and Adjunct Professor at Winthrop University as Rock Hill, SC.

It’s no wonder many people make decisions based on the health of their bank accounts rather than that of their bodies. About one-third of companies offer no sick leave pay at all, according to a 2006 study by the Society for Human Resource Management.

“If you have less than a year’s tenure in some companies they may terminate you if you have been out of work for three days – that’s common in manufacturing,” Harvey says. So if you stay home and snooze, you lose.

Symptoms to Help You Decide – Should You Call in Sick?

Your symptoms can provide the clearest clues as to whether you may be dangerous, contagious or unproductive enough to stay at home. Here’s how to decode the most common symptoms as you decide whether you have good reason to call in sick, get to a doctor, or just get up and go.

Sniffles, Sneezes, Fever and Coughs

If you are sniffling but have no other symptoms – no aches or fever -- it’s likely to be allergies. No excuse – grab a tissue and go to work.

If you have a stuffy nose, a productive cough, stuffed up sinuses and you feel achy and tired, it is likely a cold. Sometimes there will be a low-grade fever as well.

“Colds are most contagious early on – even before you are symptomatic,” says Bagner, so if you recognize the symptoms early enough, stay home for a day or two and see if you improve. You should also stay home if you are taking cold medicines that make you so drowsy that you are likely to make serious, even dangerous errors, at work.

The best thing you can do to keep from spreading the disease to others, at home or at work, is wash your hands as well as objects that you share with others.

“I read one study that said the dirtiest thing in a hotel room is the remote control – the cleaning staff cleans the bathroom but not the remote control,” says Susan Kahn, MD and Fellow of the American Academy of Pediatrics with a practice in Pelham ,NY.

“Wash your hands and also elevator buttons, light switches, computer keyboards, the handle of the coffee pot, to keep from spreading your illness to others,” Kahn says.

Hand sanitizers couldn’t hurt either, says Bagner: “They really work -- they contain antiseptics and alcohol that kill the germs.”

Flu symptoms tend to be more severe than cold symptoms and usually come on fast, within several hours. In addition to the aches common to the cold, you may have a fever, chills, a dry cough, and extreme tiredness.

“This is the most important time to stay home as you can get dehydrated from the fever,” says Bagner. And you are even more contagious than cold carriers.

Coughing alone doesn’t mean you should stay home, Bagner says, but you should see a physician if it lasts more than a couple of days.

“It could be a sign of anything from postnasal drip from a cold or allergies, to undiagnosed asthma, acid reflux or heartburn – and on the more serious side, emphysema or lung cancer,” says Bagner. “If you are also experiencing shortness of breath, and green mucous, stay home until you get a doctor’s appointment,” advises Bagner. It could be more than a lingering cold – perhaps bronchitis or pneumonia.

A fever plus a sore throat and white patches on your tonsils may indicate a strep throat. This is highly contagious. So stay out of work and get to the doctor for a strep test.

Back Pain

Going to work could merely prolong the pain, especially if you have a job that requires either physical exertion or the opposite -- prolonged sitting or standing. “You may not think of a desk job as strenuous, but it’s worse for your back sometimes than a physical job,” Bagner says.

Stay home for a day or two – but don’t stay in bed. “We no longer recommend bed rest for backaches,” Bagner says. “You are better off staying at home and doing some normal activities but don’t sit at the computer for long and don’t do exercise or heavy lifting.”

Headaches and Migraines

If your headache is combined with other cold and flu symptoms, you’re contagious and should stay home. If it’s a migraine, where the extreme pain and sensitivity to light and noise make it hard to get any work done, you probably shouldn’t bother heading in to work either.

“If it’s a migraine, lying in a cool, dark, quiet area, with a cool compress over the forehead can help,” Bagner says. There is also a wide array of medications and treatments that can help – so see a doctor.

Earache

If you have an earache with no other symptoms – and the pain is intense – see a physician. “Sometimes pain in the ear is not really from the ear – it could be a throat infection or sinus pain or inflammation of the jaw,” Bagner says, and antibiotics may be necessary.

If the earache is mild and accompanies other cold symptoms, you should probably stay home for the first day to see if the earache goes away – and to keep from spreading the cold to others, says Bagner.

Ear infections are not contagious but the pain can become intense quickly -- and you won’t be much good on the job.

Pinkeye

If your eyes are red, and your eyelashes feel sticky and matted, think pinkeye. It can be viral or bacterial.

“It’s no more contagious than a cold, just more obvious,” says Kahn. “Go see a doctor -- if antibiotic drops are called for, you will no longer be contagious after 24-to-48 hours.”

But until then, she says, it is wise, not to go to work, wash your hands frequently, and don’t rub your eyes or you might spread it from one eye to the other.

Sprains/Strains

It’s OK to go to work if you can sit comfortably all day. But if you have to stand or move in a way that puts pressure on the injured limb, the resulting swelling and discomfort could retard the healing process – and delay your return to productivity and good health. Ice packs and anti-inflammatory pain relievers can help reduce swelling and inflammation.

Poison Ivy

Poison ivy can be uncomfortable and unsightly – but if you’re looking for an excuse to stay home, keep looking – you are not contagious. “The rash is an allergic reaction to the oils in the plant – the reaction usually occurs three to four days after exposure. By that time the oil from the original poison ivy is not present [as long as you have washed the clothes you were wearing several times], so you can’t spread it to others or spread it further on yourself,” says Bagner.

7 Most Effective Exercise

Experts offer their favorite moves for making the most of your workout time.

By Barbara Russi Sarnataro
WebMD Weight Loss Clinic-Feature

Reviewed by Louise Chang, MD

Experts say there is no magic to exercise: You get out of it what you put in. That doesn't mean you have to work out for hours each day. It just means you need to work smart.
That said, experts agree that not all exercises are created equal. Some are simply more efficient than others, whether they target multiple muscle groups, are suitable for a wide variety of fitness levels, or help you burn calories more effectively.
So what are the best exercises? We posed this question to four fitness experts and compiled a list of their favorites.

1. Walking.

Any exercise program should include cardiovascular exercise, which strengthens the heart and burns calories. And walking is something you can do anywhere, anytime, with no equipment other than a good pair of shoes.

It's not just for beginners, either: Even the very fit can get a good workout from walking.

"Doing a brisk walk can burn up to 500 calories per hour," says Robert Gotlin, DO, director of orthopaedic and sports rehabilitation at Beth Israel Medical Center in New York. Since it takes 3,500 calories to lose a pound, you could expect to lose a pound for every seven hours you walk, if you did nothing else.

Don't go from the sofa to walking an hour day, though. Richard Cotton, a spokesman for the American Council on Exercise, says beginners should start by walking five to -10 minutes at a time, gradually moving up to at least 30 minutes per session.
"Don't add more than five minutes at a time," he says. Another tip: It's better to lengthen your walks before boosting your speed or incline.

2. Interval training.

Whether you're a beginner or an exercise veteran, a walker or an aerobic dancer, adding interval training to your cardiovascular workout will boost your fitness level and help you lose weight.

"Varying your pace throughout the exercise session stimulates the aerobic system to adapt," says Cotton. "The more power the aerobic system has, the more capacity you have to burn calories."

The way to do it is to push the intensity or pace for a minute or two, then back off for anywhere from two to -10 minutes (depending on how long your total workout will be, and how much time you need to recover). Continue doing this throughout the workout. ^

3. Squats.

Strength training is essential, the experts say. "The more muscular fitness you have," says Cotton, "the greater the capacity you have to burn calories."
And our experts tended to favor strength-training exercises that target multiple muscle groups. Squats, which work the quadriceps, hamstrings, and gluteals, are an excellent example.
"They give you the best bang for the buck because they use the most muscle groups at once," says Oldsmar, Fla., trainer David Petersen.
Form is key, though, warns Petersen.
"What makes an exercise functional is how you perform the exercise," he says. "If you have bad technique, it's no longer functional."
For perfect form, keep feet shoulder-width apart and back straight. Bend knees and lower your rear, says Cotton: "The knee should remain over the ankle as much as possible."
"Think of how you sit down in a chair, only the chair's not there," suggests Gotlin.
Physical therapist Adam Rufa, of Cicero, N.Y., says practicing with a real chair can help.
"Start by working on getting in and out of a real chair properly," he says. Once you've mastered that, try just tapping the chair with your bottom, then coming back up. Then do the same motion without the chair.
Gotlin sees lots of patients with knee pain, and says quadriceps weakness is the cause much of the time. If you feel pain going down stairs, he says, strengthening your quads with squats may very well help.

4. Lunges.

Like squats, lunges work all the major muscles of the lower body: gluteals, quadriceps, and hamstrings.

"A lunge is a great exercise because it mimics life, it mimics walking," only exaggerated, says Petersen.

Lunges are a bit more advanced than squats, says Cotton, helping to improve your balance as well.

Here's how to do them right: Take a big step forward, keeping your spine in a neutral position. Bend your front knee to approximately 90 degrees, focusing on keeping weight on the back toes and dropping the knee of your back leg toward the floor.
Petersen suggests that you imagine sitting on your back foot. "The trailing leg is the one you need to sit down on," he says.
To make a lunge even more functional, says Rufa, try stepping not just forward, but back and out to each side.

"Life is not linear, it's multiplanar," says Rufa. And the better they prepare you for the various positions you'll move in during the course of a day, the more useful exercises are.

5. Push-ups.

If done correctly, the push-up can strengthen the chest, shoulders, triceps, and even the core trunk muscles, all at one time.
"I'm very much into planking exercises, almost yoga-type moves," says Petersen. "Anytime you have the pelvis and the core [abdominals and back] in a suspended position, you have to rely on your own adherent strength to stabilize you."

Push-ups can be done at any level of fitness, says Cotton: "For someone who is at a more beginning level, start by pushing from the kitchen-counter height. Then work your way to a desk, a chair, the floor with bent knees, and, finally, the floor on your toes."

Here's how to do a perfect push-up: From a face-down position, place your hands slightly wider than shoulder-width apart. Place your toes or knees on the floor, and try to create a perfect diagonal with your body, from the shoulders to the knees or feet. Keep the glutes [rear-end muscles] and abdominals engaged. Then lower and lift your body by bending and straightening your elbows, keeping your torso stable throughout.

There are always ways to make it harder, says Rufa. Once your form is perfect, try what he calls the "T-stabilization" push-up: Get into push-up position, then do your push-ups with one arm raised out to the side, balancing on the remaining three limbs without rotating your hips.

6. Abdominal Crunches.

Who doesn't want firm, flat abs? Experts say that when done correctly, the familiar crunch (along with its variations) is a good choice to target them.

For a standard crunch, says Cotton, begin lying on your back with feet flat on the floor and fingertips supporting your head. Press your low back down and begin the exercise by contracting abdominals and peeling first your head (tucking your chin slightly), then your neck, shoulders, and upper back off the floor.

Be careful not to pull your neck forward of the rest of your spine by sticking the chin out; don't hold your breath, and keep elbows out of your line of vision to keep chest and shoulders open.

For his part, Petersen teaches his clients to do crunches with their feet off the floor and knees bent. He says that with feet kept on the floor, many people tend to arch the back and engage the hip flexors.

"Crunches can be excellent, but if they're not done correctly, with the back arching, they can actually weaken the abdominals," Petersen says.

To work the obliques (the muscles on the sides of your waist), says Cotton, take the standard crunch and rotate the spine toward one side as you curl off the floor.

"Twist before you come up," he says. "It's really important that the twist comes first because then it's the obliques that are actually getting you up."

But keep in mind that you won't get a flat stomach with crunches alone, says Cotton. Burning belly fat requires the well-known formula: using up more calories than you take in.

"Crunches work the ab muscles; [they're] not to be mistaken as exercise that burns the fat over the abdominals," he says. "That's the biggest myth in exercise going."

7. Bent-over Row.

Talk about bang for the buck: This exercise works all the major muscles of the upper back, as well as the biceps.
Here's how to do it with good form. Stand with feet shoulder-width apart, then bend knees and flex forward at the hips. (If you have trouble doing this exercise standing up, support your weight by sitting on an incline bench, facing backward.) Tilt your pelvis slightly forward, engage the abdominals, and extend your upper spine to add support. Hold dumbbells or barbell beneath the shoulders with hands about shoulder-width apart. Flex your elbows, and lift both hands toward the sides of your body. Pause, then slowly lower hands to the starting position. (Beginners should perform the move without weights.)

Technique

These seven exercises are excellent, efficient choices, the experts say. But with just about any strength or resistance exercise, says Petersen, the question is not so much whether the exercise works as how well you execute.

"Done with good technique, all exercises do what they're supposed to do," says Petersen.

The trouble is that poor form can change the whole exercise, putting emphasis or even strain on different areas than intended. This can hurt, rather than help you.

So especially if you're a beginner, it's a good idea to seek the advice of a fitness trainer - whether it's a personal trainer or a trainer at your gym -- to be sure your form is safe and correct.

Plan Your Day to Lose Weight

Making lifestyle changes doesn't come naturally. To change your eating and exercise habits, you've got to plan - to make it happen.

By Jeanie L. Davis
WebMD Feature

Reviewed by Louise Chang, MD, MD

You're running late, flying out the door. You might skip breakfast: the cereal box is empty, and the milk's gone sour. Forget taking lunch: there's peanut butter in the jar, but you are out of bread. Exercise before work? You've got to be kidding. It's a typical hectic morning, at the beginning of a typical jam-packed day. What happened to those resolutions to exercise more, eat healthier, lose weight? It's easy for them to get lost in the daily shuffle.

In a perfect world, we could accomplish all this by the time our busy day starts:

• Jump out of bed by 6:30 (or earlier).
  
• Get a good chunk of exercise, 20 minutes or more.
  
• Eat a satisfying but healthy breakfast: fresh fruit, high-fiber cereal, low-fat milk.
  
• Brown-bag a wholesome lunch: more fresh fruit, low-fat yogurt, whole-wheat bread, homemade vegetable soup (maybe that you prepared last night).

It's true -- with a little planning, this could be your reality. Your morning rush would go more smoothly, and your weight loss efforts would stay on track. You bounce out of bed, knowing what your next move is - all day, all week, all year.

"If you leave exercise and healthy eating to chance, it's not going to happen," says Milton Stokes, RD, MPH, chief dietitian for St. Barnabas Hospital in New York City. "You're responsible for you. Use your personal digital assistant to set your day - gym time, dinner. Make these things pre-meditated - so it's not like a surprise, you've got an extra hour, should you go to the gym or watch TV. If you don't plan it, you won't do it."

Planning for Weight Loss

Planning helps you build new habits, says Barbara J. Rolls, PhD, the Guthrie Chair in Nutrition at Pennsylvania State University in Pittsburgh and author of The Volumetrics Weight Control Plan. "Without planning, you're always going to be struggling - trying to figure out how to eat what you should. You'll end up making yourself eat things you don't want to eat. Eating will always feel like work."

Indeed, planning involves discipline - and that is a key trait that is evident among the "successful losers" who belong to The National Weight Control Registry. They have maintained a 30-pound weight loss for at least a year - and many have lost much more, and kept it off for much longer.

"It is very difficult to lose weight and keep it off - and people who succeed must have discipline," says James O. Hill, PhD, the Registry's co-founder and director of the Center for Human Nutrition at the University of Colorado Health Sciences Center. "People who are most successful plan their day to ensure that they stick to their eating plan and get regular physical activity. It takes effort to be successful in long-term weight management."

Goal No. 1: Plan Your Daily Food

First, take note of every bite of food you have during the day. Don't forget that run through the supermarket - all those tasty samples you couldn't pass up. "A food journal is the single best thing you can do," says Gary Foster, PhD, clinical director of the weight and eating disorders program at the University of Pennsylvania School of Medicine. "You become more conscious of what you're doing. It helps you monitor yourself, and make corrections in mid-course."

Dietitians call it a food journal. But really, it's research for your plan of action, he explains. You'll see where you need improvement. "Plans work better than platitudes," Foster tells WebMD. "Instead of 'I'll exercise more,' make it 'I'll walk tomorrow morning at 7 a.m.'"

Keep it simple. Journals don't have to be labor-intensive, he says. Focus on your high-risk time slots when you're most likely to get off course. Example: You know you eat junk at night, or that you snack after 3 p.m., or between lunch and dinner. Just keep notes during that time period. You'll quickly see problem habits: banana split vs. banana, the whole container of nuts vs. a handful.

Set specific goals. You can't just tell yourself to eat less junk food after 8 p.m. Be specific - 'I'm going to substitute popcorn for potato chips.' That way you know exactly what to do. There's no question.

Use weekends wisely. "When things are a little quieter on weekends, you can think about the upcoming week," says Stokes. "Decide what you're going to eat. Go to the market, so you're a little ahead of the game. You can even prepare food on the weekend and freeze it, then pull it out during the week."

Consider your options. Keep lists of healthy foods and meals you love, and plan accordingly, adds Elisabetta Politi, RD, MPH, nutrition manager at the Duke Diet & Fitness Center at Duke University Medical School. "I advise people to think of five different breakfast, lunch, and dinner options. Then you'll have some freedom - you can choose from your favorites. But your eating will be more structured. That's what's important."

Shop wisely. A well-stocked fridge and pantry can make it easier to grab a healthy snack or prepare delicious meals that are also good for you. Keep basics like these on hand: low-fat milk and yogurt, eggs, peanut butter, a variety of fresh fruits (include berries and grapes) and vegetables (include carrots and celery), soybeans, garlic, whole grain pasta/bread, fish, and high-fiber cereal.

Plan healthy treats. Low-fat cheese or yogurt, hummus with veggies, and fresh fruit are great choices. Keep them at home; take them to the office. That will help you eat the right foods when you're starving - especially in the late afternoon, during drive time -- and when you finally get home at night.

Do it yourself. These are great prepare-ahead healthy meals that will keep you feeling full and help you control your weight:

• Make a dried-fruit-and-nut mix for emergency snacking. (Be wary of granola, since it typically has lots of sugar, says Stokes.) Pack small amounts in a little plastic bag - great for the car or office.
  
• Cook a big pot of homemade vegetable soup, which can be frozen for several lunches or dinners.
  
• Try smoothies - blend low-fat yogurt and fruit - for a grab-and-go meal.
  
• Mix up big salads or a pasta primavera with lots of veggies and whole-wheat pasta. Prepare large quantities so you can have a moderate-sized helping for dinner and then have leftovers for lunch the next day.

Buy healthy frozen entrées. "These have really improved," says Rolls. "They have more whole grains in them now, and they seem to be getting tastier. If I'm traveling and can't get to the grocery store, I make sure I have frozen entrees on hand."

Don't limit yourself. It's OK to eat breakfast food for snacks, lunch, or dinner. "You can eat a hard-boiled egg or cereal any time, not just breakfast," Stokes advises.

Goal No. 2: Plan Your Exercise

First, talk to your doctor - especially if you are overweight or are at high risk for heart disease, advises Thompson. Your doctor may suggest that you ask a fitness trainer to develop a workout plan that best suits your needs.

Analyze your morning schedule. "You'll find there's a lot of free time there," says Gerald Endress, ACSM, fitness director at Duke Diet & Fitness Center at Duke University Medical Center. "People tell me it takes them two hours to get ready for work. It's not that they're prettying themselves up - they're basically just wasting time. But when they start exercising in the morning, they find they use their time better. One guy told me he got to work 20 minutes earlier on days he exercised. If you've got a structured period of activity, you know to keep things moving."

Set your program. Decide what works best for you, such as 8 a.m. on Monday, Wednesday, and Friday. "You don't let anything interfere with that," advises Thompson. "That's not to say once a month something comes up you can't exercise. That's OK. It's when you're making excuses three, four, five days in a row -- that's a problem. It's got to be the highest priority because it's your health."

Know your options. What kind of exercise - or physical activity - will get you out of bed in the morning? A yoga video, walking, a workout session at the YMCA? Figure out what will motivate you.

Tackle roadblocks. Is inertia a problem for you in the morning? "When the alarm clock sounds, it's easy to hit the snooze button," says Bryant. A workout buddy can provide motivation. "If you know someone is waiting for you, counting on you, you'll go. Once you go, you're happy you went. Once you get past that inertia, you're glad you did the workout."

Don't think of it as "early". It's a mindset issue, says Foster. Setting the alarm 30 minutes early should not be a negative in your day. Give it a positive spin. "Quit thinking of it as getting up early. Your day starts when the alarm goes off. That's how you should think of it."

Remind yourself. Put yellow sticky notes on the fridge or the computer - like "get off the bus four stops early - Mon., Wed., Fri."

Reward yourself. "Establish a goal for your workouts - daily, weekly, monthly goals," Bryant advises. "When you've done those workouts, accomplished those goals, pat yourself on the back." He suggests going out and buying a favorite DVD or CD, or even getting yourself that iPod you wanted! "Rewards help keep you motivated," says Foster.

"Planning helps you overcome the unpredictability of daily life," says Foster. "Having any plan, even if it's a bad or ineffective plan, increases your confidence in accomplishing the task at hand. Just the fact that you've thought it through means it will have some effect."

The Top 10 Medication Mistakes Parents Make

WebMD Feature from "Good Housekeeping" Magazine

By Francesca L. Kritz

Consult Your Doctor

One night a few summers ago, when my 18-month-old daughter's mosquito bites were making her itchy, cranky, and sleepless, I went to a 24-hour pharmacy to buy antihistamine. It wasn't until I got home that I read the package instructions: for children under 6, consult physician. By then it was after 10:00 p.m., and I didn't want to bother her doctor. So I guessed and gave Dina a teaspoonful. As it turns out, the amount was right, but that didn't keep me from getting a warning from my pediatrician when I called the next day: Just one extra dose of an antihistamine could make a child of Dina's weight (20 pounds) sluggish. Four times that dose could heavily sedate her.

Doctors say many well-intentioned parents slip when giving medication. The mistakes listed here can prolong a child's illness, cause bothersome side effects, and even sabotage treatment.

Measurements

"A few months ago, I started to give a patient medicine using a standard measurement cup," recalls Cheston Berlin, M.D., F.A.A.P., chairman of the American Academy of Pediatrics' committee on drugs and a pediatrician at Hershey Medical Center in Hershey, Pennsylvania. "Her mother asked me to use a kitchen teaspoon instead, since that was how she gave her daughter medicine at home." Kitchen spoons or cooking measuring utensils should never be used, says Dr. Berlin, because they don't provide accurate measurements — a child may get too little or too much of the drug. Whenever you give your child liquid medication, be sure to use marked spoons, cups, or syringes.

Gauge by Weight

Dosages for most nonprescription children's drugs are based on a child's weight, not his age, says Joseph Greensher, M.D., F.A.A.P., professor of pediatrics at Winthrop University Hospital in Mineola, New York. Two teaspoons of the pain reliever acetaminophen should bring down a 55-pound eight-year-old's fever within an hour, but it will take three teaspoons to budge the thermometer if he weighs 75 pounds. Always note your child's new weight at each doctor visit, advises Dr. Greensher. And because not all over-the-counter children's medications list dosage information by weight, check with your pharmacist or doctor.

Check Your Doses

Matthew, my one-year-old, gets a different antibiotic every few weeks to treat his chronic ear infections, and the dose is usually a teaspoonful. So it wasn't until I'd given him a few doses of his most recent antibiotic that I happened to check the label and realized I'd been giving him a quarter of a teaspoon too much. In this case the extra amount caused more intense side effects — gas and diarrhea. But with pain relievers a few extra doses over several weeks could lead to possible liver or kidney damage. Check all labels carefully

Keep tabs on expiration dates, too, especially with drugs that your child takes only once in a while. "A mother called me recently to tell me that the drug her child takes occasionally for painful heartburn wasn't working," recalls Marilyn Bull, M.D., F.A.A.P., director of developmental pediatrics at Riley Hospital for Children in Indianapolis. "The problem was that the drug has a shelf life of only thirty days, and the mother hadn't remembered to refill the prescription."

What to Look For

Anyone who has tried to give medication to a fidgety child knows that sometimes both adult and child can end up wearing a lot of it. But enough may have entered the youngster's system, and giving another full dose could be dangerous. The same applies to children who vomit within an hour of downing medicine. In both cases, it's best to call your pediatrician, who can advise you on whether — depending on the drug — it's okay to give another dose.

Follow Through

Your child is feeling better, but you've still got a half bottle of antibiotic left. Your instinct may be to shelve it. After all, you wonder, why spend money on more if you need it a few months later? But, says Laura Prager, M.D., F.A.A.P., a pediatrician with Kaiser Permanente in Redwood City, California, most prescriptions, especially antibiotics, are meant to be used in full. If you don't give your child the entire dose, the illness could recur.

If your doctor switches your child from one type of refrigerated liquid antibiotic to another halfway through, don't store the first kind for future use; refrigerated antibiotics tend to lose their potency after two weeks. You can save unused tablets or capsules, but don't give them to your child unless you have your doctor's approval, says Dr. Prager.

Don't Use Old Medication

"I recently examined a child whose parents had started him on his sister's leftover antibiotics because they thought he might have had a recurrence of strep throat," says Jerome Paulson, M.D., F.A.A.P., an associate professor of health-care sciences and pediatrics at George Washington University Medical School in Washington, D.C. "By the time I saw him three days later, there was no way to accurately diagnose him because the drug had either cleared up the infection or wasn't necessary in the first place."

Giving a child an unnecessary antibiotic also increases the chance that the bacteria will develop a resistance to it. If that happens, the drug may not work when the child does need it.

Quality, Not Quantity

Parents sometimes assume that if a drug does not work right away they need to give a little more. With many drugs, including antibiotics, it can often take three to four days before your child will start to feel better, points out Dr. Prager. An extra teaspoonful won't speed up recovery and could cause serious side effects.

Questions to Ask Your Doctor

Ask the doctor if it's okay to skip nighttime doses. Sometimes it is more important to wake a child than to let him sleep. And make sure baby-sitters, relatives, and other people who look after your child know how and when to administer the medication.

Mistakes

A frantic parent once called Dr. Greensher in the middle of the night because she had grabbed adult cough syrup in the darkness and given it to her seven-year-old instead of his antibiotic. "This can happen during the day too," says Dr. Greensher, "especially if a busy parent is in a rush." To be on the safe side, call the doctor should such a mistake occur.

Never Assume

"Parents shouldn't just assume that a drug is working," says Dr. Greensher. "Ask the doctor when your child should show signs of improvement and about potential side effects." If you're in any doubt, don't hesitate to call. Your pediatrician may need to give your child a different medication.

How to Give Medication

It's tempting to slip medicine into food or drink to make it more palatable. "But this can prevent drugs from being absorbed," says Howard Mofenson, M.D., F.A.A.P., a pediatric pharmacologist at Winthrop University Hospital in Mineola, New York. Some key precautions:

• Most antibiotics should be taken an hour before or an hour after meals. Those that can be taken with meals include sulfa drugs, commonly prescribed for ear infections, and new types of erythromycin and amoxicillin.
  
• It's best to give drugs with water. Carbonated beverages can inhibit absorption, as can milk when downed with tetracycline, fluoride drugs, and drugs for pediatric heart conditions. Doctors say it's fine, however, to pour some chocolate syrup into a dose of liquid medicine.
  
• DON'T TAKE WITH FOOD includes juice, although a half ounce or less usually won't degrade the drug.
  
• If a drug can be mixed with food, use just enough to mask the taste — a teaspoon of applesauce, yogurt, or ice cream should do the trick. If a portion is too large, a child may not finish it and won't get the full dose.

Broccoli Good for the Heart
Nutrients in Broccoli May Help Protect the Heart, Say Scientists Studying Rats
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD

Jan. 18, 2008 -- Here's another reason to eat broccoli: It may help your heart.
University of Connecticut researchers report that news after studying broccoli and heart health in rats.

The scientists brewed a broccoli extract and fed it to rats for a month in addition to regular rat chow. For comparison, they fed other rats water instead of the broccoli extract in addition to their regular diet.

After feeding the rats broccoli extract or extra water for 30 days, the scientists tested the rats' hearts. Some of those tests deprived the heart of oxygen, similar to a heart attack.

The rats that had eaten the broccoli extract had three heart advantages over the other rats:

• Better blood-pumping ability
  
• Less heart damage during oxygen deprivation
  
• Higher levels of heart-health chemicals during oxygen deprivation
  

Broccoli's key nutrients include selenium and sulforaphane, which may also curb cancer, note graduate student Subhendu Mukherjee and Dipak Das, PhD.

Their findings appear in the Journal of Agricultural and Food Chemistry.

Green Tea May Ward Off Weight Gain
But You'd Have to Drink a Lot of Tea to Match Preliminary Lab Tests in Mice
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD

Jan. 23, 2008 -- The benefits of green tea might include blocking fat and keeping extra pounds at bay, according to preliminary lab tests in mice.

Don't skip over that word "preliminary." There's no proof yet that sipping green tea will do the same for people. Staying in shape continues to be a balancing act between calories and activity.
Here's what those preliminary lab tests in mice show:

• Less weight and fat gain. Among mice with an obesity gene, those that ate chow laced with green tea extract gained less weight and less fat.
• Less fat in the liver. There was less sign of "fatty liver" disease in the mice with the obesity gene that ate chow laced with green tea extract.
• Lower cholesterol and triglyceride levels in mice with the obesity gene that ate the chow laced with green tea extract, compared to other mice with the same obesity gene.

A healthy liver isn't fatty. But obesity -- in mice or in people -- can lead to fatty buildup in the liver and cause nonalcoholic fatty liver disease.

As for that green tea extract, the study used it in doses equal to what a person would get from drinking at least seven cups of green tea a day.

The University of Connecticut's Richard Bruno, PhD, RD, and colleagues report their findings in February's edition of The Journal of Nutrition.

Middle Age a Global Bummer
Across The Globe, People Are Happier Before, After Middle Age, Study Shows
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD

Jan. 29, 2008 -- If life is a journey, happiness hits a speed bump in middle age for people worldwide, a new study shows.

But on the bright side, emotional well-being perks up again with age, according to the report.
Those findings come from more than 204,000 people in 72 countries. They rated their happiness or life satisfaction.

Around the world, from Austria to Zimbabwe, happiness ratings were higher before and after middle age. Picture a U-shaped curve, with middle age down in the valley of the U.
Getting Back to Happiness

U.S. men were almost 53 years old when they emerged from their midlife blues; U.S. women shifted back toward happiness earlier, when they were about 39 years old.

Those ages varied somewhat around the world, with the 40s as the turning point for men and women in Europe and developing countries.

The findings are based on adults of all ages. But participants weren't followed over time; the study was a snapshot of worldwide well-being.

Marriage, income, and education didn't explain the results. The impact of health on happiness wasn't part of the study.

The report comes from two economics professors: David Blanchflower, PhD, of Dartmouth College and Andrew Oswald, DPhil, of England's University of Warwick.

Why the Midlife Downturn?

The study doesn't show why happiness dips in midlife and picks back up again later. But the researchers have three theories:

* People adapt to their strengths and weakness, ditching unrealistic expectations during middle age.
* Cheerful people may live longer, making for more happiness later in life.
* In middle age, a person may look around at others who have had a hard time and start to appreciate their own lives more.

Of course, the data paint a very broad picture. The findings don't mean that middle age is miserable for everyone.

The study is due to appear in an upcoming edition of Social Science & Medicine, according to a University of Warwick news release.

Detox Diets: Purging the Myths

Detox Diets: Purging the Myths
'Cleansing' diets may be worthless or even dangerous, experts warn.
By Richard Sine WebMD Feature
Reviewed by Louise Chang, MD

Molly Davis lives a healthy lifestyle, but she decided recently that she wanted to help her body "perform optimally." What she needed, she thought, was a flush of her system. So the Atlanta-based advertising director chose what might be the most popular "detox" regimen, the Master Cleanse.

For 10 days, she ate no solid food. Instead, she drank at least eight glasses a day of a concoction combining lemon juice, water, maple syrup, and cayenne pepper. In the mornings, she drank two full quarts of salt water. In the evenings, she drank a laxative tea.

The results were as dramatic as would be expected: "I felt like hell," Davis tells WebMD. She suffered from headaches,

acne, and irritability. A strange whitish film covered her tongue.

She also lost 10 pounds. "My mom said I looked like skin and bones," says Davis, 25. "She was really mad at me."

Davis quickly regained the weight, but nonetheless decided to try the diet again a few months later. This time she felt none of the adverse effects and a boost of energy -- though she didn't lose as much weight and didn't follow the diet as strictly. She remains a detox fan. "I think it's important we let our body heal itself once in awhile," Davis says.

Dozens of books and hundreds of web sites promote "detox" regimens. Spas invite dieters to spend thousands of dollars to starve themselves in exotic locations. But many dietitians and medical experts say these diets are pointless at best and dangerous at worst.

Like other fad diets, detox regimens promise quick weight losses that are ultimately unsustainable, critics say. They're based on "junk science" rather than a true understanding of how the body works. Worst of all, extreme diets like the Master Cleanse can cause serious side effects in vulnerable groups.

"These diets can give people a false sense of security, a feeling that they've been protective of their health," Dawn Jackson-Blatner, a dietitian at the Northwestern Memorial Hospital Wellness Institute and American Dietetic Association spokeswoman, tells WebMD. "Then, when the diet's over, they go back to their normal way of eating."

Toxins, Toxins Everywhere?

Detox proponents say the body is under constant assault from toxins such as smog, pesticides, artificial sweeteners, sugar, and alcohol. Without a periodic cleansing, these poisons accumulate in the body and cause headaches, fatigue, and a variety of chronic diseases.

But the science behind the detox theory is deeply flawed, says Peter Pressman, MD, an internal medicine specialist at Cedars-Sinai Medical Center in Los Angeles. The body already has multiple systems in place -- including the liver, kidneys, and gastrointestinal tract -- that do a perfectly good job of eliminating toxins from the body within hours of consumption.

"There's no evidence at all that any of these approaches augment the body's own mechanisms," Pressman tells WebMD.

Most detox regimens urge dieters to strip down their diets to the basics of water and raw fruits or vegetables. Some diets also recommend laxatives, enemas, or colonic irrigation to speed up the detox process.

There's a grain of wisdom in detox diets, Jackson-Blatner tells WebMD. It's true that the average person doesn't drink enough water or consume enough fruits and vegetables. The problem is most detox diets are so restrictive that they're ineffective for long-term use. And any

weight loss that occurs during the diet is likely to be temporary.

"When people think about losing weight, they think about losing fat," she says. "But this is water lost and water gained."

Detox dieters may report a variety of benefits, Pressman notes, but none can be traced to the idea of detoxification. Fewer headaches can be traced to other lifestyle changes such as reduction in alcohol and caffeine intake. Clearer skin can result from improved hydration, and less bloating could be a result of eating less food.

Some detox dieters report a boost in energy and even a sense of euphoria. Pressman says the feeling -- also commonly reported by people who are fasting -- is actually a reaction to starvation. It likely evolved as a way to help a person evade threats and locate food, he says.

"There's something to be gained from avoiding large quantities of alcohol, smoke, junk food, or anything to excess," Pressman says. "Moderation is best, but these regimens are anything but moderate."

When Detox Turns Dangerous

The Master Cleanse -- also known as the Lemonade Diet -- dates back to the 1970s. But it got a publicity boost recently when pop star Beyoncé Knowles lost 20 pounds in 10 days on the diet to slim down for a role in the upcoming film Dreamgirls. The news caused a sales upswing of the pricey maple syrup that's used in the lemonade.

But Knowles soon regained the weight after she finished shooting the film. In interviews, she warned ordinary dieters away from the regimen.

A healthy, young woman like Knowles may be able to endure even the strictest diet for a short while, Pressman tells WebMD. The problem is that some groups may suffer severe adverse effects from highly restrictive diets. They include children and teenagers, pregnant or

breastfeeding women, seniors, and people with heart disease, diabetes, or other chronic conditions. These groups are especially vulnerable to intestinal and even cardiac problems stemming from malnutrition, Pressman says.

The use of laxatives in detox diets also raises red flags among dietitians, as laxative abuse is commonly associated with eating disorders. The belief that laxatives are useful for weight control is a myth, the National Eating Disorders Association notes. In fact, laxative abuse can cause severe

dehydration and heart or colon damage, the association says. Colonic irrigation, another fixture of some detox diets, carries the risk of bowel perforation or infection, both of which can cause death.

Detox diets promise a quick fix, but in fact are just another round on the diet treadmill, Jackson-Blatner says. You can change your life in 10 days, Jackson-Blatner says -- but not through the Master Cleanse. Instead, use those 10 days to make the transition to a balanced diet with lots of fruits and vegetables -- and then stick to that diet for good.

Steroids in Sports: Questions Answered (Man's health)

Steroids in Sports: Questions Answered
Get Answers to 16 Questions About Performance-Enhancing Drugs in Baseball and Other Sports

By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD

Dec. 13, 2007 -- The Mitchell Report, released today, details the alleged use of performance-enhancing drugs including steroids and growth hormone in Major League Baseball.
The long-awaited report by former U.S. Sen. George Mitchell names names, but it doesn't show what the long-term effects of such drug use may be.

For answers to that and other questions about the use of steroids and other performance-enhancing drugs in sports, WebMD talked to John Morley, MD, professor of medicine and the acting director of the endocrinology division at St. Louis University and the St. Louis VA Medical Center.

(Will the Mitchell Report affect how you feel about

your baseball heroes? Discuss it on the Health Cafe message board.)

What are performance-enhancing drugs?

Performance-enhancing drugs come in many forms. Most people think of them as the anabolic hormones, which divide into the steroids (the testosterone-like products) and the growth-hormone-like products. In addition to that, we would include amphetamines as a performance-enhancing drugs, though I believe the Mitchell Report excluded amphetamines.

(Medical Editor's note: Anabolic steroids are different from corticosteroids, which are used to treat

rheumatoid arthritis, asthma, and other diseases.)

What do these drugs do for athletes?

It depends on which drug. Anabolic steroids build bulk very much; they put on extra muscles, so they make you bigger. So that's one piece.

But the other part of them, which is perhaps more important for a person who's perhaps a home-run hitter, is they improve visual-spatial function. Visual-spatial function means that the way you hit home runs is that you can wait long enough that you can commit a millionth of a second longer into your swing. If you do that, basically, you don't strike out all the time to change-ups.

Most home-run hitters are not necessarily bulky. It's nice if you are, but you don't have to be. You've got to basically have a great ability to wait that millionth of a second longer, and that's what anabolic steroids do for the hitters, as opposed to the pitchers or if you're looking at football players or athletes where you're trying to get an increase in strength, per se.

And what do they do for pitchers?

If you're using an anabolic steroid, you build strength. But many of the pitchers take with it growth hormone. The reason they use the growth hormone is growth hormone builds your muscle bulk out of proportion to your strength.

Now, if I'm going to be a pitcher and I'm going to throw, what I would like to be able to do is make the batter think that fundamentally, my ball is going to come slightly faster. In other words, the batter looks at your size, looks at the speed that you seem to be moving your arm, and makes a

calculation about how fast the ball will get there. This is all done sort of without thinking about it but that's what they do. And if I take growth hormone, my arm looks bigger, so the batter thinks the ball's going to get there faster and so therefore he commits a little earlier, so you're more likely to strike out.

edge?

You're not going to take somebody like me and make me, when I was younger, into a professional baseball player. This is somebody who's already there and you give them the 1% enhancement.

The best way to look at that is if you look at the world records for the 1 mile from 1880 through to the modern day. They improved by about 1% every four years. So if I can improve your

performance by 1%, I put you four years ahead of everybody else. So if you're not quite that good, I put you as good as everybody else. If you're really good, I put you four years ahead of where the rest of the people are going to be with modern training methods and so on.

Amphetamines do the same thing for focus.

What are some of the side effects for adult players?

This is the question. We don't really know. Obviously, people don't admit and we haven't been able to follow people taking steroids over a long period of time. The potential of liver damage is clearly one of those [risks], because steroids have a first pass through the liver. In addition ... there's a question of whether it would increase neoplastic disease [

cancer], either in the prostate or in other parts of the body.

If the use is relatively short-term, a couple of years, the effects may be minimal. Lots of sports players who've done this are turning up with diseases and problems.

We need some major, good studies looking at long-term effects within sport.

Amphetamines certainly create high-strung behaviors, bizarre behaviors, much more than any of the other drugs

In women, [steroids have] huge effects on hirsutism (excess hair) and effects on potential reproductive ability. Female athletes do it; they just seem to be less likely to be caught at the moment.

How widespread are these drugs among younger players?

We don't know. If I'm a young boy, or young girl for that matter, and I'm looking to be successful -- and when you're young, you really care about winning -- and when you see your heroes doing this, they become a role model. That's a very bad role model.

I think we've got a problem because as you go to younger kids, clearly this is not something you want to be doing and certainly, around puberty this could be a total disaster.

What are some of the side effects for younger players?

Younger players you can get alterations in growth, in particular. The other big potential effect is the effect on behaviors, the so-called "

roid rage."

How young are some players starting?

I think we've got people -- 12-, 13-, 14-year-olds -- who certainly see this as something that's worthwhile.

What would you want parents to keep an eye out for if they have a young athlete?

If they've got a young athlete and his muscles suddenly go up dramatically, that's probably the single best way to look for most of these drugs. Behavior changes in puberty -- all behavior changes don't mean they are taking drugs.

The big thing is if a person is suddenly bulking up. It doesn't come without working, as well. It's a combination of the person who starts to work out a lot but taking a steroid. Somebody whose performance goes up dramatically -- they were the sort of the middle of the pack and they're suddenly at the top. Now, this may be a normal growth spurt, but those sort of things, as a parent you've got to be suspicious that maybe your kid is doing something.

And if they do have those suspicions, what do they do?

You can go to the physician and have them tested for these drugs, just the same way as the sports authorities test for the drugs. Basically, the physician can send off tests for these drugs. I'm not saying that's what they should do, but I think that's what I would do if I felt it was important.

Do they drug-test young players in high school?

They usually don't. I think we're going to see more and more of this happening. The other group who don't [get tested] are the masters athletes, the people over 60. It's clearly something that stretches through all ages, into old age.

Are all performance-enhancing drugs illegal?

No. A number are very legitimate. We should not throw out the baby with the bath water.

How do you test for these drugs? Can you test for all of them?
The tests for growth hormone, at the moment, are very poor. The Olympic Committee is hoping that this year they will have an adequate test for growth hormone.

The tests for the others begin usually with a urine test looking for alterations in the urine testosterone ratio. All of them will affect that ratio. If that looks abnormal, the modern testing is now do to NMR scanning [nuclear magnetic resonance spectroscopy] and you can actually pick up the peaks, the abnormal peaks, of the different compounds. Most of those are known.

Where you can get away with it is if you have a compound that nobody actually knew existed.
We've got to recognize that there are a whole new set of ... pills that are being developed to help people in rehabilitation following surgery. And all of these are, quite honestly, much more powerful. They can be taken orally. They have less side effects, and my assumption is that now that most of the steroids are gone, that people are going to find a way to get growth hormone and the next thing you'll see is this large new class of drugs, these selective androgen receptor molecules [SARMs] -- will be used by the athletes. Many are in phase I and phase II trials

As for the tests for the things we can test for now, how accurate are those tests?

They are very, very accurate.

How do SARMs work?

Basically, they combine with either the testosterone or the dihydrotestosterone receptor and they activate it, but they do it by a nonsteroidal mechanism.

The other [class of drugs being developed] are the anti-myostatins.

Myostatin inhibits the growth of muscle and if you can block that, you will put on an extra 10% of muscle so you will bulk out pretty quickly, and there are drugs that are being developed by a number of companies now that are in phase I and phase II trials, and so that becomes yet another way to bulk people out.

There's a little boy in Germany who basically has a spontaneous myostatin deletion [a gene glitch] and he's extraordinarily strong at 5 years of age.

So all of these things are happening, and there's a very legitimate need to use these drugs if you get away from sport. For older people with disease, there's clearly a legitimate need to develop drugs that can strengthen you and allow you to function.

What else would you want to add about the topic?

We as a society have to decide what do we want out of our sports people. Do you want them to be superheroes? Is that what we really want, or do we just want to see people just playing to the best of their ability?

I think the public has spoken with their checkbooks. Over my lifetime, sports has gone from something that was not a huge moneymaker to an incredibly huge moneymaker. We're not paying to go watch the backyard players play anymore. We're paying to watch superstars and who are so much better than any of us. And there is a price to pay and it's going to come in performance-enhancing drugs.

I don't think that there's any belief that this hasn't been going on in every one of our professional sports over the last 20 years.

I would argue that this is not a new phenomenon. It's a new phenomenon for steroids

.

Mother's Diet After Birth

Mother's Diet After Birth

Eating right after delivery isn't that complex. Just continue eating a good-quality diet just as you did during pregnancy. If you are not breast-feeding, your nutrient and calorie needs are the same as they were before you became pregnant. If you are breast-feeding, or if you are anemic or recovering from a cesarean delivery, you require special nutritional management.

Keep It Simple

Take a creative approach to nutrition, choosing foods that require little or no preparation. Quick, nutritious foods include fresh fruit, raw vegetables, melted cheese on toast, cottage cheese, and yogurt with raisins, sunflower seeds, nugget-type cereal, or low-fat granola. Broiled meats and fish are faster to prepare than casseroles.

Fresh fruits and vegetables are quick, easy, and nutritious meal that you can sneak in between your many responsibilities as a new mom.

Let friends and family help you by providing nutritious meals during the early months after childbirth. Meals you can freeze are especially helpful because you can pull them out of the freezer for use on those occasional difficult days.

Nurture yourself by taking time to sit to eat your meals. Eating on the run or standing to eat makes you feel you have not had a meal; this habit contributes to fatigue and may even contribute to overeating. It's also not very good for your digestion. Place your baby in a swing or in an infant seat so your hands are free. If your baby needs to be close to you, an infant backpack or sling is helpful. Or you may wait to eat until your baby's quiet time or when she is asleep.

Constipation

Constipation is a common and unpleasant post-partum complaint. The following advice can help relieve it:

· Get some form of daily exercise, such as walking.
· Make sure you have adequate dietary fiber. Bran muffins, high-fiber cereals, and lots of fruits and vegetables are good fiber choices. (Be sure to increase your fluid intake as you increase your fiber intake.)
· Drink to fulfill your fluid needs. Two to three quarts of fluids a day is generally recommended-drink even more if you breast-feed.
· Drink four ounces of prune juice on an empty stomach followed by several cups of hot water, decaffeinated tea, or other hot beverage.
· Avoid the regular use of laxatives. If you use a laxative more often than every third or fourth day, you may have problems moving your bowels without the use of the laxative.
· Try fiber-containing stool softeners such as Meta-mucil, Fiberall, and Fibercon. They can help relieve constipation without the problems associated with laxative use.

Dealing With Fatigue

No foods actually relieve fatigue. A good-quality diet helps you to feel well but is not a substitute for rest and sleep.

Most new mothers find themselves feeling tired from time to time. Getting adequate rest is important for your recovery from birth, for making milk, and for enjoying your baby.

How do you get rest? Take time to rest every time your baby rests or sleeps instead of using the time to clean house or wash clothes. During your rest times, take the phone off the hook so you are not disturbed. Let your family and friends help you by doing laundry and other household chores. Avoid caffeine to improve your rest and sleep.

Restoring Your Iron Reserves

Some women learn they are anemic after childbirth. This means they have fewer red blood cells than is ideal to adequately supply their body with oxygen. Postpartum anemia may result from having been anemic during pregnancy, from blood loss during childbirth, or from giving birth to more than one baby.

Your doctor evaluates your blood during the post-partum period. If laboratory tests confirm you are anemic, treatment begins immediately. If blood loss was heavy during childbirth, you may have received a blood transfusion. Otherwise, treatment aims at restoring iron levels through diet and supplements.

If your doctor prescribes an iron supplement, you need to help your body absorb it. To do this, eat a meal that includes a food rich in vitamin C when you take your iron supplement. Excellent sources of vitamin C include citrus fruits, tomatoes, baked potatoes, and steamed broccoli. It also helps to include a food that contains iron.

Food sources of iron include lean red meats, organ meats, spinach, egg yolks (limit to three to four a week), and cream of wheat. Avoid taking your iron supplement with any significant source of calcium because calcium interferes with iron absorption. Calcium sources include milk, yogurt, cheese, and antacids. Since low-fat dairy products are of significant nutritional importance, don't cut these out altogether; include them in meals other than the ones that accompany your iron supplements.

Recovering From a Cesarean Delivery

Undergoing a cesarean section temporarily upsets the passage of food through the digestive tract, resulting in gas production and constipation. Both of these early discomforts can be treated by walking, which increases bowel activity and aids you in passing gas.

Be sure to eat, too. There is a temptation not to eat when you feel so bloated, but consumption of food helps restore normal bowel action, thereby relieving constipation and gas.If you are anemic after delivery, treating the anemia with the recommendations for restoring your iron reserves helps speed your recovery from surgery.

Nutritional management after surgery includes increasing the vitamin C and protein in your diet. Vitamin C contributes to wound healing, and protein helps your body repair itself.

While nutrition should be the most important concern, many new mothers are worried about losing the weight they gained during their pregnancy. We'll look at realistic expectations for this goal in our next section

What Are the Treatments for Pregnancy Discomforts?

Understanding Pregnancy Discomforts - Treatment
What Are the Treatments for Pregnancy Discomforts?

Here are some tips on what you can do for some of the common health problems you may face during your pregnancy, along with alternative therapies that may help. Remember, though: Never hesitate to call your doctor about any discomfort or illness you experience while you're pregnant.

Abdominal Pain

To relieve sharp pains or cramps from stretched abdominal muscles and ligaments, particularly when sitting or lying down, use a warm heating pad. Regular exercise will strengthen and tone your abdominal muscles. Take care to avoid exercises while supine (lying on your back) after the first trimester, since this may decrease blood flow to your developing baby.

Backache

Keep your weight gain under control with proper diet and exercise. Avoid taking analgesics; instead, use a heating pad to relieve pain. Special exercises to strengthen abdominal muscles can also help reduce backache. Try a pregnancy girdle or elastic sling to support your abdomen. Wear shoes or shoe inserts designed for pregnant women, and avoid high heels.

Don't stand for long periods and don't stretch to reach high places. Sit straight without slouching, and whenever possible, sit with your legs elevated. Sleep on a firm mattress. Lying on your side with a pillow between your legs may provide some relief.

Be careful when lifting heavy loads -- especially children. Bend at the knees, keep your back as straight as possible, hold the object or child close to your body, and raise yourself slowly.
See a licensed chiropractor for treatment of possible spinal misalignment brought about by the stress of the pregnancy. Or try a chair massage: Sit on a straight chair, facing the back. Lean forward, over the back of the chair, with your head resting on your crossed arms. Have the massager use long strokes, working upward and outward from the lower back, avoiding pressure on the spine.

Breast Discomfort

Wear a bra that gives your enlarged breasts proper support. If your breasts leak small amounts of fluid, use nursing pads in your bra.

Breathlessness

Some breathlessness is common and normal. Keep your weight gain within the recommended limits and maintain good posture, especially when you are sitting. Sleep on your side -- preferably your left side -- not on your back.

Constipation

To keep stools soft and bowel movements regular, get plenty of dietary fiber from fresh fruit, vegetables, whole-grain cereals and breads, and dried fruit. Avoid using over-the-counter laxatives. Fiber or stool softener agents may be helpful. Try psyllium (Plantago psyllium), an herbal bulk-forming agent. Drink lots of fluids and exercise regularly.

Contractions

Mild, painless uterine contractions usually start sometime after the 20th week of pregnancy. If they cause discomfort, try changing positions. If contractions start coming at regular intervals, call your doctor.

Cystitis (Bladder Infection)

If you develop a bladder infection or any type of urinary tract infection, ask your doctor about appropriate treatment. Many bladder infections are triggered by sexual intercourse. Remember to empty your bladder immediately after sex and watch for symptoms. Several glasses of cranberry juice a day are said to be helpful in preventing urinary tract infections.

Dizziness and Faintness

Slow down when you stand up or get out of bed. Dizziness when you stand up too quickly from sitting or lying down is called postural hypotension. If you're in a crowd and start feeling dizzy, step away and get some fresh air; if possible, lie down with your feet elevated or sit with your head between your knees.

Fatigue

Get a full night's sleep, and rest with your feet up for at least 15 minutes several times a day.

Headaches

Make sure you get enough rest, eat regularly, and drink 6 or more glasses of water daily. Avoid aspirin or other over-the-counter painkillers except for acetaminophen. Instead, try stress-reduction techniques like yoga or meditation. Or try taking a hot bath with a cold pack on your forehead.

Heartburn

Avoid heavy meals and spicy, greasy, sugary, and acidic foods. Stick to a bland, high-fiber diet, drink lots of fluids, and exercise daily. Small, frequent meals may relieve some of the symptoms. Don't lie down right after a meal. Raise the head of your bed 2 to 4 inches with a stable support such as wooden blocks. Antacids can be helpful.

Hemorrhoids

Hemorrhoids may develop due to the increased blood in your body during pregnancy, along with the increased pressure to the blood vessels in your pelvis. Hemorrhoids usually disappear after delivery. Eat a high-fiber diet to keep your stool soft, drink lots of fluids, and don't strain during bowel movements. To relieve itching or pain, try a warm sitz bath, or apply an ice pack or a cloth soaked in witch hazel. Kegel exercises, designed to strengthen the pelvic muscles, can improve circulation in the area. Getting off your feet may also help.

Leg Pains and Cramps

Wear support hose during the day, and elevate your feet when resting, if possible. Use a heating pad or gentle massage on the back of your thigh to ease sciatica.
When a leg cramp hits, straighten your leg and slowly flex your ankle and toes while massaging your calf; or soak your leg in hot water. You may be able to prevent night cramps by wearing socks to bed or by pressing your foot against the bed board. If painful cramps persist, ask your doctor about calcium or magnesium supplements.

Morning Sickness

You may feel nauseated at any time of the day, typically in the first trimester. Try eating frequent, small meals rather than three full meals. Keep your diet high in protein and complex carbohydrates, and low in sweets and fatty foods. Drink plenty of fluids, and eat fresh fruits and vegetables, which are high in water content.
Talk to your doctor about trying 25 mg of vitamin B-6 taken 3 times a day. Antacids sometimes help, especially if heartburn is part of the problem. In general, try to minimize stress in your everyday activities.

Mouth and Gum Discomfort

Pregnancy can be demanding on your teeth, so see your dentist early in your pregnancy for a checkup and cleaning. Brush your teeth and tongue at least twice a day, and floss regularly. Sugarless gum can be substituted for an after-meal cleaning if it isn't feasible to brush your teeth.
Make sure you're getting plenty of calcium in your diet -- 1,200 mg daily. You might try a folic acid rinse, but don't swallow it -- and check with your doctor first.

Nasal Congestion or Nosebleeds

Use a vaporizer to humidify your bedroom at night. Lubricate each nostril with a dab of petroleum jelly during the day to prevent nosebleeds. Avoid decongestant nasal sprays, which can constrict blood vessels.

Numbness

Avoid lying on your hands while sleeping. If your hands feel numb when you wake up, shake them over the side of the bed. Soaking the hand in warm water or using a heating pad twice daily may help ease numbness; or try wearing a wrist splint. If numbness persists, try vitamin B6 supplements

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Skin Changes and Stretch Marks

Rashes from hormone changes during pregnancy generally go away after the baby is born. To prevent freckles or darkened skin on your face, called a "pregnancy mask" or chloasma, wear a wide-brimmed hat and use sunblock on sunny days.
Lubricate dry skin around your abdomen with a moisturizing cream; stretch marks usually fade and decrease after the birth. For heat rash, try to stay as cool as possible and use cornstarch powder under your breasts, on your thighs, or wherever your skin tends to chafe.

Sleep Problems and Insomnia

Women who are pregnant often experience sleepless nights and daytime fatigue in their first and third trimesters. During the first trimester, frequent trips to the bathroom and morning sickness may disrupt sleep. Later in pregnancy, vivid dreams and physical discomfort may prevent deep sleep. After delivery, the new baby's care or a mother's postpartum depression may interrupt sleep.
Fatigue during the first trimester of a pregnancy is likely due to changing levels of hormones, such as progesterone. Toward the end of pregnancy, some women find it difficult to sleep because they're uncomfortable due to the size of a growing abdomen. Some women are too excited, anxious, or worried about becoming mothers to sleep well. Sleep apnea, especially if it's severe and causes your blood oxygen level to drop during sleep, is a risk to the fetus.
Pregnant women who experience insomnia during pregnancy may find relief by taking afternoon naps, drinking warm milk, or taking a warm (not hot) bath before bedtime. Exercise during the day may help, too. Expectant mothers may find it more comfortable to sleep on one side, with pillows supporting the head, abdomen, and topside knee. Don't take sleeping pills or herbal sleeping remedies without talking with your doctor first.

Leg Swelling

Monitor your weight gain throughout your pregnancy. To control swelling in your legs and ankles, wear support hose and avoid standing for long periods. Wear shoes that fit well and give good support, or buy shoe inserts designed especially for pregnant women. Getting off your feet helps the most. Lying down is often more comfortable than sitting.

Taste Changes

You may find some foods unappealing and develop a craving for others, especially sweets. Iron supplements may leave a bad taste in your mouth; talk to your practitioner if this is a problem. Use mouthwash often. Chewing gum, mints, or hard candies can also chase away unpleasant tastes.
Urination Problems
Kegel exercises can help you control stress incontinence -- losing a small amount of urine when you sneeze, cough, or laugh. You can also use a sanitary pad. Leaning forward while urinating helps to empty your bladder completely.

Vaginal Discharge or Itching

A thin, mild-smelling discharge is normal in pregnancy. Use sanitary pads, but don't douche without your doctor's approval. Any red or brown discharge is a signal to call your doctor immediately.
Vaginal itching and soreness may indicate an infection, which requires treatment by your doctor. Vaginal yeast infections can be common in pregnancy and may disappear without treatment after the baby is born.

Varicose Veins

Pregnancy puts extra strain on the blood vessels in your legs. Support stockings or pantyhose can help relieve the discomfort. Exercise regularly, but don't stand for long periods. Raise your legs above hip level when sitting, if possible. Lie on your side in bed, or put a pillow under your feet. Ask your doctor or a nutritionist about taking vitamin C supplements to strengthen blood vessels.

Vision Change

If your eyes swell from fluid retention and hard contact lenses become uncomfortable, switch to soft lenses or glasses

Special Warnings: Caring For Two

* The most dangerous time to take any medication is during the first trimester,
when the fetus is developing rapidly and is more vulnerable to injury. Always
check with your doctor before taking any over-the-counter or prescription drugs,
including drugs that were prescribed before you became pregnant.

* Several diseases pose special hazards to pregnant women and an unborn child,
such as rubella, chickenpox, "fifth disease" (erythema infectiosum), mumps,
cytomegalovirus, chlamydia, gonorrhea, genital herpes, genital warts, syphilis,
and AIDS/HIV. Call your doctor immediately if you think you have been exposed
to any of these. If possible, get vaccinated against rubella, chickenpox, and
mumps before pregnancy, unless you've had those diseases or their vaccines
already. Ask your doctor about performing a blood test for chickenpox and rubella
if you can't remember if you've had these conditions as a child, and try to get the
vaccines at least 4 weeks before pregnancy (or afterward) if you need them.

* Don’t smoke. Smoking during pregnancy increases the risks of vaginal bleeding,
miscarriage, stillbirth, premature birth, low birth weight, and many other potential
problems that you and your baby don't need. Second-hand smoke, smoke-filled
rooms, car exhaust, and industrial fumes can also be hazardous to pregnant
women. Avoid prolonged exposure to environmental pollutants as best you can.

* Avoid breathing in or touching chemical household cleaners, paints, and insecticides.

* Be careful walking and getting out of the shower or tub since a growing baby can
throw you off balance.

* Check with your doctor before you start exercising. Some otherwise normal activities
should not be undertaken during pregnancy, and others need to be modified.

* Most couples are able to have sexual intercourse until near the time of birth.
Check with your doctor about the advisability of intercourse if you have a history
of miscarriage or preterm birth, any infection or bleeding, if the placenta is in an
abnormal position (known as placenta previa), or during the last trimester if you're
carrying multiple fetuses. Avoid sex after the amniotic sac has broken or fluids leak.
If you develop pain or abdominal cramps that continue or worsen for more than an hour
after having intercourse, call your doctor, since your cervix could be dilating.

* Avoid having unnecessary X-rays. If you must get an X-ray, be sure to tell the doctor
or the technician that you are pregnant.

* Don't get overheated, avoid exercising in hot and humid weather, and stay out of hot tubs,
saunas, and whirlpool baths. If you have a fever, cool down with a shower or cool bath and
take acetaminophen