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UTIs in the News, and It’s Not Good

15/08/2019 jleff 0

Recently the New York Times reported on how antibiotics are becoming less effective at treating urinary tract infections (UTIs), which it calls “the single biggest risk to healthy people from drug-resistant germs.” It’s disconcerting to know that the frontline defense against UTIs is crumbling. When they don’t respond to treatment, UTIs can turn into serious conditions, like kidney infections. 

The piece made me think it’s a good time to revisit the topic of avoiding UTIs altogether. Because of the way we’re built, with a short urethra in a warm, moist location close to our other orifices, our bodies lend themselves to bacterial growth. We are 50 times more likely to get UTIs than men until menopause and twice as likely after (due to changes that happen in men as they age).

In addition, the loss of hormones that happens during menopause makes our genitourinary tissue more delicate and, thus, susceptible to infections. Because it helps bacteria migrate from one spot to another, even having sex can cause a UTI.

To reduce the chances of developing a UTI:

  • Drink plenty of fluids—enough so that your urine is the color of straw.

  • Urinate after sex. This will help flush bacteria out of your urethra. 

  • Talk to your health care professional about a vaginal estrogen cream.

  • Practice good hygiene by wiping front to back and keeping your private parts extra clean.

When it comes to UTIs (and just about everything else), an ounce of prevention is worth a pound of cure!

Barb DePree, MD, has been a gynecologist for 30 years, specializing in menopause care for the past 10. Dr. DePree was named the Certified Menopause Practitioner of the Year in 2013 by the North American Menopause Society. The award particularly recognized the outreach, communication and education she does through MiddlesexMD, a website she founded and where this blog first appeared. She also is director of the Women’s Midlife Services at Holland Hospital, Holland, Michigan.

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What’s Your Heart Disease Risk? Important Numbers to Know

15/08/2019 jleff 0

Heart disease goes up as we age and especially after menopause. One in three female adults has some form of cardiovascular disease, according to the American Heart Association.

What’s up with that?

For one thing, aging causes changes in your heart and blood vessels. For another, menopause brings other changes—like the loss of estrogen. Estrogen is thought to be heart-protective .

But it’s important to note: Menopause itself does not cause heart disease.

But I always thought menopause and the ensuing loss of estrogen were the main culprits in developing heart disease. You mean that’s not true?

Many experts say estrogen loss during menopause “may” play a role. But aside from the estrogen connection, menopause causes changes in your body that can make you more susceptible more to heart disease.

Like what kinds of changes?

All things that naturally make your risk of heart disease rise, like:

  • LDL cholesterol. The “bad” kind (low-density lipoprotein) rises, while the “good” cholesterol (high-density lipoprotein) declines or stays the same.

  • Blood pressure goes up.

  • Triglycerides—a type of fat in your blood—rises.

  • Belly fat/weight increases.

Scary. I want to protect my heart, of course. What numbers do I need to know to assess my risk of heart disease?

  • Blood Pressure. Shoot for 120/80 mm Hg. High blood pressure is referred to as the “silent killer,” because there are no symptoms. Uncontrolled, it’s a major risk for heart disease and increases your risk of developing heart disease by 25 percent.

  • Body Mass Index. This number, also known as BMI, is calculated from your height and weight and should be around 25/kg/m2. BMI is a screening tool that helps determine body fat and can tell if you’re overweight or obese (which increases your risk for heart disease). If your BMI is between 18.5 and 24.9, you’re classified at a “normal” weight. Anything above that is considered overweight or obese. Keep in mind, though, that BMI measurements may have some limitations and may underestimate or overestimate your body fat. Learn more about estrogen and weight gain.

  • Waist Circumference. Women should shoot for a waist circumference of less than 35 inches. This may be a better tool than BMI for measuring body fat, say some experts. Carrying weight around your middle is known as visceral fat (also known as “active” fat), and it lies deep within the abdominal cavity near your organs. The fat you carry in your hips and thighs, known as subcutaneous fat, is less problematic and poses a lower risk to your heart.

    Here’s some info to help you know how to measure properly.

  • Blood Glucose Level. Aim for a number of less than 100. This is an important number, because having diabetes puts you at a fivefold greater risk for heart disease. That’s partly because it can damage the blood vessels and nerves that control your heart. A fasting blood glucose test is the most common way it’s measured.

  • Total Cholesterol. An ideal score, which includes a total of your LDL, HDL and 20 percent of your triglyceride score, is 200 or less. Since LDL is responsible for clogging your arteries, that’s the number most health care professionals will focus on lowering if it’s too high (a reading of 130 to 159 mg/dL is borderline high).

  • Resting Heart Rate. This is how many times your heart beats per minute when you’re at rest. A lower rate is associated with a lower risk of death because it’s usually a sign of your cardiovascular fitness. For most people, a rate between 60 and 100 beats per minute is considered in the normal range.

And speaking of a healthy heart, a little self-care goes a long way:

  • If you smoke, quit!

  • Get regular exercise. More about how much you actually need.

  • Limit alcohol.

  • Manage stress.

  • Get adequate sleep. Most adults need between seven and nine hours.

  • your weight at a healthy level.

  • Focus on healthy foods. Limit saturated fats and foods high in sodium and sugar. The DASH diet is the poster child for a heart-healthy way of eating.

And lastly, make sure you get regular annual preventive screenings, and make your health care professional aware of any family history or recent health changes.

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How to Know if You Have Urinary Incontinence

14/08/2019 jleff 0

I’m hearing (and saying) it all the time: I can’t drink anything after lunch or I’m up all night peeing. I can’t cough or laugh without leaking. I never know when I’m going to have to go—and sometimes it’s too late. I’m sure you have your own st…

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Estrogen and Weight Gain: What’s the Connection?

13/08/2019 jleff 0

You may be asking, “What’s estrogen’s role in weight gain?” And you’d be right to ask that.

You can’t win, can you? When estrogen is high, it causes problems.

When it’s high, it’s partially to blame for things you’re likely familiar with—like irregular periods, heavy bleeding, PMS, endometriosis, fibroids, fatigue, mood changes and sometimes breast or ovarian cancer.

And when it’s low, it affects us, too.

Much of the same—missed or irregular periods, infertility, mood changes.

Ahem, anything else? There’s more, I’m sure.

Related to menopause, yes, there’s more. Weak bones, for one. Hot flashes for another. And then there’s an increase in urinary tract infections and—the elephant in the room—

Lemme; guess weight gain.

Sorry, yes, but you already knew that. Low estrogen levels can, and do, contribute to weight gain in many menopausal women.

So, what really happens?

It’s not uncommon for women to notice that they’re gaining weight or it’s more difficult to lose weight. The form of estrogen known as estradiol decreases during menopause. Estradiol helps regulate your metabolism and your body weight. Hence, the weight issues.

And why does that weight like to gather around the mid-section, rather than the hips and thighs? I’m suddenly an “apple” and no longer a “pear.”

Although more research needs to be done, some has shown that “perimenopause, independent of age, is associated with increased fat in the abdomen as well as decreased lean body mass,” according to the website menopause.org. That’s apparently where this type of fat likes to migrate.

OK, break it to me. Why is it particularly dangerous to be an apple rather than a pear?

It’s because there’s more than just meets the eye: Belly fat is not just that extra layer of padding you see below your skin (known as subcutaneous fat). It’s also visceral fat, which is the fat hiding where you can’t see it—deep inside your belly, surrounding your internal organs.

Visceral fat is linked to many health problems that are potentially dangerous, like heart disease, type 2 diabetes, high blood pressure and high cholesterol and even an increased risk of premature death (regardless of your overall weight).

What do the experts have to say?

While some blame low estrogen for weight gain, others point to other midlife factors that take place around the same time as menopause, like the fact that women become less active and more sedentary (many midlife women—including this one—beg to differ) and a natural slowing of metabolism.

Sounds like low estrogen and weight gain is a done deal.

Certainly not. There’s strong evidence that physical activity and a good, healthful diet with sensible portions can offset much of the weight gain that appears during this time of life. Read Dr. Barb DePree’s tips to help menopausal women manage their weight.

You may also have to kick it up a notch and exercise more often than you’re used to, but it’ll pay off. Make sure to include strength training in that exercise regimen, because it helps boost metabolism and increase muscle mass that we also lose with age. Learn about fighting back with exercise.

And since studies show that sitting is linked to higher levels of abdominal fat, you’ll do yourself a favor if you stay vertical when you’re able. Stand more, sit less and move around more often. (A standing desk is great for people who sit while they work; so is pacing while you’re talking on the phone.)

Oh, there’s one other thing: Aim for a good, solid night’s sleep. Sleep deprivation activates the hormones leptin and ghrelin, which are responsible for regulating your hunger and appetite.

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Elevating Women’s Voices Will Advance Chronic Pain Treatment and Management

08/08/2019 jleff 0


From L to R: Monica Mallampalli, PhD, Beth Battaglino, RN-C, Marsha Henderson (former Associate Commissioner for Women’s Health at the FDA), Anita Gupta, DO, PharmD, MPP

I am so pleased to be writing about the success of HealthyWomen’s first Science, Innovation and Technology Summit: Chronic Pain in Women: Focus on Treatment, Management and Barriers, July 17-18.

Coordinated by Monica Mallampalli, PhD, HealthyWomen’s Advisor for Scientific and Strategic Initiatives, our two-day event aimed to advance and amplify current dialogue on the impact of chronic pain on women’s health. We certainly accomplished our goals. The summit convened leading experts in chronic pain science and treatment, policy experts from federal agencies and national pain advocacy organizations. Pain activists with personal knowledge of the devastation caused by chronic pain conditions also provided their unique insights. HealthyWomen is thankful to these trail blazers for illuminating the elusive aspects of chronic pain with the bright spotlight it demands.

I learned so much from our participants and from their commitment to ending the suffering connected with chronic pain. For example, artificial intelligence is now being applied to chronic pain study with tremendous potential. And, successful models for pain management programs exist, such as the one established for women veterans at the VA Connecticut Healthcare Center, can be emulated to benefit women and other populations in need.

My hope is that a reckoning for chronic pain in women is not far off. Improved awareness, louder patient voices and targeted research will elevate chronic pain’s status from “invisible” to “visible,” leading to faster diagnoses, innovative treatment and management strategies and, ultimately, will end long-term suffering.

This will be a triumph for women’s health because women bear a far greater burden of pain. Indeed, the prevalence of most common pain conditions (arthritis, back pain, headache, among others), is higher in women compared to men. In addition:

  • Seventy percent of chronic pain patients are women.

  • Women’s life expectancy is reduced by one year for every 10 years spent with chronic pain.

  • Women with chronic pain are more likely to be treated with prescription pain relievers, like opioids, and at higher doses and for longer periods, than are men, putting women at greater risk for developing opioid use disorder.

  • While some research has addressed sex differences in pain management, perception and pain threshold, this progress has not translated to improved pain treatment for women.

  • Sleep loss increases pain sensitivity and is a major risk factor for developing chronic pain, especially in women.

Our keynote speaker Anita Gupta, DO, PharmD, MPP, Professor, Rowan University School of Medicine and Senior Vice President, Heron Therapeutics, issued a call to action I am compelled to repeat. No stranger to the pain journey, Dr. Gupta shared her personal experience with treatment for a rare disease that has altered her approach to patient care. Like the World Cup-winning women’s soccer stars’ call for pay equity in their sport, it is time for “chronic pain equity” in women’s health, according to Dr. Gupta. No longer should women suffering from chronic pain caused by migraine, fibromyalgia, arthritis, debilitating complex regional pain syndrome, or pelvic pain conditions, such as endometriosis, be underserved.

There is no doubt that we still confront many challenges in the science and management of chronic pain. However, the following 10 highlights (and, it was hard to pick only 10) from our summit indicate to me that we are on the right path:

  1. More informed research about sex differences in pain likely will lead to pain medication and devices tailored specifically for men and women.

  2. Researchers and study proposal reviewers are now trained to ask questions and evaluate data with respect to biological differences important to understanding sex differences in pain and pain treatment.

  3. Because few drug trials are designed specifically to study women with pain, an opportunity exists to raise awareness about the importance of recruiting women for clinical trials about pain research.

  4. Innovative clinical approaches, such as motivational interviewing and functional pain inventories, can improve the patient-clinician dialogue and improve patient outcomes by setting goals for managing and living with chronic pain.

  5. Re-thinking treatment for opioid use disorder (OUD) to consider women’s unique health needs and family responsibilities will improve OUD treatment for women and replace current OUD treatment models based on treatment for men.

  6. More data on women of color and women of color experiencing chronic pain will inform policy, begin to eliminate health care disparities and will lead to changes in health care delivery for all women.

  7. Working to eliminate the stigma associated with chronic pain—including self-stigmatization and inherent race and gender biases–will help to break down major barriers to accessing care and successful treatment.

  8. A key to understanding pain is understanding the robust individual differences in pain experiences. Pain management innovation cannot be “one-size fits all.”

  9. Pain research is getting better at measuring pain and increasingly more able to activate, isolate and study specific cell types.

  10. The patient voice must be a partner in drug development, science and patient care.

HealthyWomen is proud to lead this call to action with our first summit on chronic pain in women. We support the “super heroes” so aptly described by Lindsay Weitzel, PhD, a migraine strategist and author, in the battle to raise awareness of chronic pain-related issues. We will continue to connect women, their families, and their health care providers with resources designed to help them overcome barriers to treatment and pain-free lifestyles. And, we will continue to help women tell their stories about their journeys, providing hope for those for whom the journey awaits.

We know that “pushing back against pain,” urged by Kate Nicholson, JD, in her closing plenary presentation, “Pain, Resilience and How We Heal,” will help society recognize the existence and impact of chronic pain. If you have a minute, check out Kate’s TED Talk on the implications of undertreating chronic pain.

A video recording of HeatlhyWomen’s Science, Innovation and Technology Summit: Chronic Pain in Women: Focus on Treatment, Management and Barriers, will be available soon here.

Please don’t hesitate to contact me with comments or questions about our summit or about HealthyWomen.

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What Is the Best Way to Pee?

08/08/2019 jleff 0

By Kelley Smith
For Women’s Health Foundation

The following is an actual conversation I have had with my husband (H) more than once. At the risk of being labeled “odd,” or “really odd,” or “odd beyond belief,” I’m going to share it with you. Don’t judge.

Me: Why don’t men sit on toilets to pee?

H: Because they don’t.

Me: But don’t urinals make you uncomfortable?

H: No.

Me: Really? Because a lot of men seem to be very uncomfortable with even giving another guy a hug, so it’s really interesting to me that these same men are fine urinating next to each other. I mean, the whole men’s restroom is bizarre. It’s like a homoerotic Roman bath, where you just casually expose your penis to strangers … every day … several times a day, in fact.

H: I don’t even know where to begin with this.

Why don’t men sit to pee?

The above conversation obviously never answered this question. Apparently, healthy men can empty their bladders very effectively sitting or standing. However, sitting is still the best practice for men with urinary issues (urinary urgency, frequency, weak stream, etc.).

When a healthy man chooses to stand among his peers to pee (versus sitting in a private stall), I can only conclude that he is trying to relive his glorious, madcap fraternity days—a conclusion that has been met with many an eye roll by my husband.

How should women pee?

There are certainly times when standing to void would be ideal. Sitting on a filthy public toilet (in a stall without seat covers and not enough toilet paper for wiping and covering the seat) is unappealing at best.

Squatting or hovering over the public toilet seat is an option, but not always realistic. Some people, like me, don’t have the strongest thigh muscles. Perhaps I should exercise someday.

But if you can squat, should you? Well, let’s say you shouldn’t make it a regular practice. For women, sitting is the best way to empty the bladder. The goal each time you urinate is to void as much as possible. Excess urine in the bladder can lead to a urinary tract infection.

Sitting allows the pelvic floor muscles to relax, which reduces pressure on the urethra (the urine tube that carries pee to the outside world) and allows smooth voiding. The pelvic floor muscles act as a sling that wrap around the urethra, vagina and anus. When the pelvic floor muscles are contracted or stretched tightly (as they are when squatting over a toilet), they compress the urethral opening. This reduces urine flow. When you sit on the toilet, your pelvic floor muscles stay relaxed and the urethral sphincter is left wide open for easy, complete urination. Got it?

WHF Founder and Executive Director Missy Lavender demonstrates. Don’t worry, these two minutes are completely G-rated:

Speaking of public bathrooms…

Wouldn’t it be nice to stand to pee when faced with an impossibly dirty public toilet? Don’t fool yourself with toilet seat covers. Only the plastic, rotating ones offer real protection.

You actually can stand, which is surprisingly effective for women. It will take you a bit longer than sitting, but you will be able to eliminate the same amount of pee as you would sitting down. Remember: We already know that the same cannot be said for squatting. Squatting leads to reduced urine flow.

The million dollar question: How do I stand to pee without getting urine all over my legs, the seat, the floor?

Enter pee devices. Yes. There are funnels available that will let women pee while standing without making a mess. The GoGirl funnel is reusable, while the Stand Up funnel is disposable and biodegradable.

In hiking circles, these funnels are called female urination devices, or FUDs, and they can come in quite handy on the trail. There are many brands and variations available, and Backpacker.com rates the top choices for various hiking adventures.

If you can’t bring yourself to use a funnel, it is OK to sit on a public toilet. It may not be your happiest moment, but it is highly unlikely you will catch any germs from sitting on a toilet seat.

Stand up to pee or sit down to pee—your choice. But, please don’t start peeing in front of strangers. We’ll let men keep that curious behavior to themselves.

Kelley Smith is a former high school biology teacher and earned her medical degree in 2003. This blog was originally published in August 2014 and has been updated with the latest information.

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Symptoms of Depression In Women You Should Never Ignore

07/08/2019 jleff 0

Depression can affect anyone regardless of age, race, class or gender. According to Mental Health America, depression afflicts more than 19 million American adults each year, approximately 12 million of whom are women.While it’s normal to feel sad from…

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Taking Prilosec or Other Potent Acid Blocker? Who Should Reconsider and How to Stop

06/08/2019 jleff 0

Potent acid blockers (called proton pump inhibitors or PPIs) are the second most commonly prescribed medications in the world. No surprise. They work incredibly well to block stomach acid and are best used to treat short episodes of heartburn or reflux. But for anyone taking them longer than the recommended two to eight weeks, read on.

What are the commonly used PPIs? Brand and generic names such as Prevacid (lansoprazole), Prilosec (omeprazole), Protonix (pantoprazole) and Nexium (esomeprazole) may be familiar to you. You see many of them filling the shelves of drugstores in the antacid section. Yes, they are available with a prescription and over-the-counter. 

But don’t be fooled. Just because potent acid blockers are available over-the-counter doesn’t mean they are safe to take for months or years.

Up to one-third of older adults are taking them. Many of them probably do not need them and shouldn’t be taking them. The long-term risks of taking PPIs may be greater than many people think. No matter your age, if you really don’t need to take them, don’t.

Learn more: Are Your Medications Doing What They Are Supposed to Do?

Many older adults don’t know or remember why or when the PPI medication was started. Maybe it was for an ulcer that has long ago healed or because they were in the hospital or maybe for a bad bout of heartburn months or years ago. Maybe it was started to prevent stomach irritation while they were taking an NSAID (ibuprofen or naproxen) to treat arthritis or low back pain, even though the NSAID has long been stopped.

A good friend called me about her mother recently. Her 95-year-old mother gets confused at times and has an aide to help her 24/7. My friend has heard my stories about older adults and the risks of taking many medications. She was worried and asked me to look at her mother’s medications—11 in all.

Like many older adults, she is taking a PPI—omeprazole (Prilosec). I asked why her mother was taking it. She thought perhaps her mother started taking it while she was in the hospital last year for heart failure.

This is a common story. I saw it used again and again for patients in the nursing homes I supervised. Almost every person was discharged with a PPI prescription following their hospitalization. The doctors treating them in the nursing home usually didn’t know why the PPI was started, but they almost always refused to stop it when I suggested they consider it.

Patients are commonly given additional medications, often high-risk ones, following their discharge from the hospital.

PPIs are on the famous STOPP list of high risk medications that health care professionals should consider stopping in older adults. The criteria state that health care professionals should consider stopping PPIs for patients after eight weeks maximum of treatment.

The STOPP recommendations were referring to older adults, not to people with certain serious conditions that may need a PPI for much longer.

There are people with special conditions  who should not stop their PPI unless advised to do so by their clinician. If any of these conditions apply to you, stopping or lowering the dose of your PPI may not be a good idea:

  • You take medication daily such as ibuprofen or steroids that can irritate your stomach. PPIs can lower the risk of an ulcer or bleeding from stomach irritation.

  • You had a major stomach or esophagus bleed from an ulcer or had severe inflammation of the esophagus. PPIs can lower the chances of another bleed or ulcer.

  • You had severe heartburn or indigestion and were referred to a gastroenterologist for an endoscopy and a biopsy. The biopsy showed you had a condition called Barrett’s esophagus or severe erosive esophagitis grade C or D. (Ask your doctor if you had grade C or D inflammation on your biopsy and ask for a copy of the biopsy results to keep in your personal health record file.)

If you have one of the above conditions you may not be able to stop your PPI, but you can ask about taking the lowest dose possible. In the circumstances listed above, the benefit of taking a PPI long-term is usually greater than any risk.

PPIs stop the production of stomach acid and work best if you take them before a meal. They are only recommended for short term use unless you have one of the conditions listed above.

With short-term use, they are very safe. But they can cause side effects and drug interactions if you are on multiple medications. So, even though they are available over-the-counter, check with your health care professional to be sure they are safe for you.

Side effects of PPIs are infrequent and can occur at any time. They include headache, flatulence, diarrhea, nausea, abdominal pain and vomiting.

Although I am in favor of patients having access to less costly and safe over-the-counter medications, I worry that PPIs can be overused by people who are not aware of the potential risks of taking them long-term. I also worry that someone who is taking an over-the-counter PPI beyond the recommended two weeks could have a more serious condition that is being masked by the acid-blocking of the PPI.

The U.S. Food and Drug Administration advises that PPIs purchased over the counter are only intended to be taken for two weeks.

Can blocking stomach acid have bad effects? Stomach acid is important for our health and digestion. It helps vitamins and nutrients get absorbed and serves as the first line of defense against bacteria and other organisms. Stomach acids also help with the absorption of many medications (iron, digoxin, ampicillin and some drugs for viral or fungal infections, for example).

Although long-term risks of taking these drugs are relatively uncommon, they do occur. And since millions of people worldwide take these medications daily, even a small percentage of people developing a serious problem is a big number. This is especially true in the elderly, who are more susceptible to their bad effects.

Taking a PPI for a long time, especially in older adults, has been linked to:

  • Hip fractures

  • Pneumonia

  • Vitamin B12, magnesium or calcium deficiency

  • Colon infection with the bacteria Clostridium difficile, which can cause
    severe diarrhea and can be fatal

  • Higher risk of kidney problems and reports of cognitive impairment

Although we don’t understand exactly how each of these conditions are related to the long-term use of PPIs, more research is being done to help us find out.

TIP: For anyone who needs to take PPIs long term, the FDA recommends getting a blood magnesium level before starting treatment.

PPIs also interact with a number of other commonly used medications. For example, omeprazole (Prilosec) can make the blood-thinning medication, clopidogrel (Plavix), less effective. Anyone taking a number of medications needs to have a clinician or pharmacist do a periodic medication checkup to be sure there are no problems.

If you have been taking PPIs for a long time and don’t have any of the serious conditions mentioned above, talk to your health care professional about the best way to get off the medication.

That means either stopping altogether and taking only as needed (called “on demand”) or reducing the dose.

It can be challenging to get off a PPI if you have taken if for a long time. Although there is no serious danger in stopping it cold, most clinicians prefer gradually lowering the dose before stopping.

What makes getting off PPIs difficult?

If you have been taking PPIs for a while, your stomach is probably used to their acid blocking effect. When you stop suddenly, you can have a sort of rebound of stomach acid returning in full force, causing worsening of heartburn or other uncomfortable symptoms for a couple of weeks.

Remember, this is temporary and your symptoms can be managed. To minimize your chance of getting symptoms, lowly lower the dose of your PPI over four weeks or more before stopping.

When you have stopped taking the medication, you can treat the occasional return of symptoms such as heartburn with milder over-the-counter acid blockers such as Zantac (ranitidine), Pepcid (famotidine) or antacids such as Tums or Rolaids. Taking an over-the-counter or prescription PPI only as needed—called the “on-demand” approach—is another good idea.

Sometimes it can be hard to tell if the sudden return of your symptoms is due to this rebound of acid or the return of the condition you were originally treating.

Even healthy volunteers without any heartburn symptoms who take PPIs in research studies have acid-related symptoms when they try to wean off PPIs. So, it is expected that you too may have heartburn symptoms when you lower the dose or stop the PPI.

I have occasional heartburn when I eat or drink (alcohol) late at night. Although I try to avoid late-night eating, I have learned that when I do, taking a Pepcid Complete works for me. Pepcid Complete contains both the acid blocker famotidine and the antacid calcium carbonate. It works great for me to prevent the annoying middle-of-the-night attack.

There is a lot of great information and research findings on how to taper off and stop your PPI at the Canadian deprescribing website. This approach is based on research and consensus among expert physicians and is a great resource. Many experts in the U.S. are referring to their work and guidelines as well.

Canadian deprescribing network recommends three approaches that are equally effective in preventing symptoms from coming back when you stop your PPI:

  1. Ask for a new prescription for only half the dose and take this for four weeks, then stop. (Most pills and capsules can’t be cut.)

  2. Skip a pill every second day for four weeks, then stop.

  3. Use your PPI or alternatives such as ranitidine (Zantac) or antacids including Tums, Rolaids or Maalox to keep control of your symptoms, only when needed.

Both “on-demand” therapy with a PPI and changing to a milder acid blocker such as ranitidine (Zantac) increase the risk of symptoms coming back more than just lowering the dose of the PPI.

When you select the best option for you, make sure you discuss this with your health care professional or pharmacist.

On-demand PPI use, according to expert Canadian guidelines, means the PPI medication, once stopped, is started again only if symptoms come back. If symptoms do come back, it is usually best to continue the medication for up to two weeks to be sure the episode is treated.

Hopefully, you have changed your lifestyle enough to avoid heartburn from returning if that is why you were put on it. But you may want to ask your physician for a prescription or advice about over-the-counter PPIs for “on-demand” use just in case.

Many seniors are taking these medications without any serious reason for them. They can usually lower the dose and then stop the PPI after discussing it with their health care professional. 

For older patients like my friend’s mother, stopping the PPI means one less drug to cause problems. Her mother stopped the PPI without lowering the dose and did just fine. In fact, older adults tend to have fewer difficulties stopping their PPI abruptly than younger adults.

A great rule to follow is that whenever a symptom arises in an older adult on multiple medications, always consider medication as the culprit.

The bottom line message is this:

When you need a PPI, you should take the lowest dose for the shortest amount of time possible.

Have you checked your parent or loved one’s medications recently? Are they taking a PPI? Do you know why? Do you know someone who has tried to stop taking PPIs? What happened?

Marie Savard, MD, is a trusted voice on women’s health, wellness and patient empowerment. She currently writes a blog called Ask Dr. Marie, where this column first appeared. Her blog focuses on the challenges of medication overload in older adults and what caregivers can do to help. Dr. Savard is a former ABC News Medical Contributor and author of four books including her most recent, Ask Dr Marie: What Women Must Know about Hormones, Libido, and the Medical Problems No One Talks About. She lives in Philadelphia with her physician husband and has three grown sons.

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Potent acid blockers (called proton pump inhibitors) work well to block stomach acid, but generally they’re intended to treat short episodes of heartburn or reflux. There are risks to long-term use.
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4 Personal Items You Probably Should Replace Today

05/08/2019 jleff 0

(HealthDay News) — Is your toothbrush more than four months old? And how about your contact lens case? These and other everyday essentials need regular replacing, no matter how comfortable you are with them.At the top of the list is your toothbrush. T…

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CBD for Women: What Are Women Using CBD For?

01/08/2019 jleff 0

These days, CBD—cannabidiol, a chemical derived from cannabis—has been getting a lot of buzz. It’s the supplement du jour that everyone is talking about.But don’t expect CBD to give you an actual buzz. Because CBD is non-psychoactive and contains no te…

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Could Exercise in Pregnancy Boost Baby’s Health?

01/08/2019 jleff 0

(HealthDay News)—Women who keep moving during pregnancy may have infants with more advanced motor skills, a small study suggests.

Researchers discovered the difference among 1-month-olds: Those whose moms got regular aerobic exercise during pregnancy tended to have stronger movement skills, versus babies whose mothers did not.

The movement tests included things like head turning, said researcher Linda May, an associate professor at East Carolina University, in Greenville, N.C.

What’s the significance of those first motor skills? According to May, past research has suggested that infants who are quicker in developing motor skills are more likely to be “movers” as kids. So, it’s possible that exercise during pregnancy might make for more active children.

May and her colleagues reported their findings in the August issue of the journal Medicine & Science in Sports & Exercise.

Long gone are the days when pregnant women were advised to stay off their feet. Experts now recommend that, unless there are medical reasons not to, women should get regular moderate-intensity exercise throughout pregnancy.

That, May said, means activity that’s vigorous enough to get the heart rate up and blood flowing—but not so intense that you’re breathless and can’t have a conversation.

A brisk walk, swimming, a ride on a stationary bike or a low-impact aerobics class would all fit the bill.

Learn More: 5 Best Exercises During Pregnancy

Studies have found many benefits of exercise during pregnancy, such as healthier weight gain for mothers-to-be and lower risks of preterm delivery and macrosomia, where a newborn is abnormally large and may need to be delivered by C-section.

For the new study, May’s team looked at whether the benefits extended to infants’ movement abilities.

The researchers started by randomly assigning 71 healthy pregnant women to either have supervised aerobic exercise sessions or to be in a “control” group. Women in the exercise group worked out three days a week for about an hour; they could choose to use a treadmill, stationary bike or elliptical, or do aerobics.

Women in the control group were limited to light-intensity exercise and could attend supervised sessions on stretching and breathing exercises.

When their babies were 1 month old, a physical therapist assessed their motor skills. It turned out that infants of exercising moms did a bit better—though all babies scored within the range of typical development.

As for why moms’ exercise habits might matter, the researchers pointed to some possibilities: Exercise might feed fetal brain development by boosting the flow of blood and oxygen to the womb. And it might aid overall growth and development through the release of proteins called growth factors.

In this study, though, much of the benefit of exercise appeared to be among female infants: Baby boys had somewhat higher scores than baby girls, on average, and there were few differences between boys whose moms exercised and those whose mothers did not.

The study cannot answer the question of why. But, May said, it hints that prenatal exercise might benefit girls more when it comes to motor skills.

A researcher not involved in the work offered some caveats.

First, it’s unclear what these differences at 1 month of age will mean later in life, said James Pivarnik, director of the Center for Physical Activity and Health at Michigan State University.

It’s also uncertain whether exercise is the sole reason for the group differences. There are other factors, like nutrition, that weren’t accounted for, Pivarnik said. Women in the exercise group gained more weight, he noted—an average of 13 pounds more. That’s a bit of a surprise that’s unexplained, Pivarnik said.

Learn More: The Ideal Weight Makes for a Healthier Pregnancy

In addition, he said, there were no details on birth weight, an important factor in infant development.

Still, Pivarnik said it’s important to have studies like this that delve into the effects of prenatal exercise on babies’ development. And its results support what’s already recommended, he noted.

“I think the message for pregnant women is, if you’re exercising, keep it up,” Pivarnik said. “And if you’re not exercising, you should start.”

Guidelines suggest women strive for 150 minutes of moderate exercise a week, May said. That can be spread across three to seven days.

SOURCES: Linda May, Ph.D., M.S., associate professor, foundational sciences and research, and kinesiology, and obstetrics and gynecology, East Carolina University, Greenville, N.C.; James Pivarnik, Ph.D., professor, epidemiology and kinesiology, and director, Center for Physical Activity and Health, Michigan State University, East Lansing, Mich.; August 2019, Medicine & Science in Sports & Exercise

Copyright © 2019 HealthDay. All rights reserved.

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Regular aerobic exercise during pregnancy may improve baby’s motor skills and may even lead to more active kids later on, a new study suggests.
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Finding Wellness Trends at the Fancy Food Show

29/07/2019 jleff 0

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Warning: This blog post may make you hungry!My stomach was empty as I entered the Jacob Javits Center in June for my walkabout—or should I say drink-and-eat-about—at the 20…

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Why You Need Omega-3 Fatty Acids

29/07/2019 jleff 0

(HealthDay News) — After vitamins and minerals, fish oil with its omega-3 fatty acids is the most widely used supplement, taken by an estimated 10% of Americans.

So, when research reviews show that it doesn’t provide the health benefits for people w…

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How Chronic Pain Impacts Women’s Lives

25/07/2019 jleff 0

Imagine missing out on work, family events, or even sleep because you’re in pain. This is the reality for many women and according to a recent HealthyWomen survey, 95 percent of women say their pain affects their ability to live a full and active lifestyle with more than half saying their pain interferes with their sleep. But that’s not all we uncovered. Below are the final results from our survey.

But we don’t just want to report on survey findings. We want to make a difference. In an effort to educate women and health care professionals about chronic pain, HealthyWomen held a two-day Chronic Pain Summit. During this summit, we addressed current knowledge gaps and existing challenges in treating and managing chronic pain in women. We also explored cutting edge and crucial research on chronic pain, heard firsthand from women living with chronic pain, and learned about industry perspectives.

Please click here for more information on our summit.

For more information on chronic pain, visit healthywomen.org/chronicpain.

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The majority of women living with chronic pain say it affects their ability to live a full and active life. Learn more about what women shared during our HealthyWomen survey.
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What Causes Bad Breath? 11 Reasons for Your Smelly Breath

24/07/2019 jleff 0

You’re not alone if you’re constantly popping breath mints. According to the American Dental Association, at least 50 percent of adults have had halitosis, commonly known as bad breath, in their lifetime. But what causes bad breath? Read on to …